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jon-tyson-yrwV3tYeE0Q-unsplash.jpgPsychological First Aid (PFA) is an early intervention widely recommended for recent trauma survivors (Vernberg et al., 2008). It emerged in the early 2000s as an alternative to debriefing, a popular technique which was found to increase the incidence of Posttraumatic Stress Disorder (PTSD) (Rose et al., 2002). Over a decade since the popularisation of PFA, its safety and efficacy have been questioned due to a lack of empirical evidence (Hermosilla et al., 2023; Shultz & Forbes, 2014). To address this knowledge gap, we conducted a study to assess the effectiveness of PFA in preventing early PTSD diagnosis, providing immediate emotional relief, and reducing PTSD and depression symptoms up to six months post-intervention (Figueroa et al., 2022).
Our study was a clinical trial carried out in five emergency medicine departments in Santiago, Chile, where 221 adults experiencing recent trauma (≤ 72 hours post-trauma) were randomly assigned to be offered either PFA (n = 109) (according to the original “PFA-ABCDE” protocol, comprised of active listening, breathing retraining, categorisation of needs, assisted referral to social networks, and psychoeducation [PE]), or PE alone (n = 112). We did not use waitlist control due to the ethical considerations of leaving recent trauma survivors without any kind of formal support. PE was regarded as an "attention placebo control" (Popp & Schneider, 2015), given its lack of effectiveness in reducing PTSD or depressive symptoms as a stand-alone intervention (Brooks et al., 2021). An English version of the intervention manual can be downloaded at https://medicina.uc.cl/publicacion/manual-abcde-la-aplicacion-primeros-auxilios-psicologicos/.
Immediately post-intervention, self-reported emotional relief was measured. One-month post-intervention, PTSD diagnosis was assessed using a structured diagnostic interview. Furthermore, self-reported PTSD and depression symptoms were measured at one and six months post-intervention.
One-month post-intervention, we did not find that participants assigned to PFA had a decreased PTSD prevalence compared to PE. However, immediately following the intervention, participants assigned to PFA reported greater immediate emotional relief compared to PE. Additionally, at one-month post-intervention, these participants reported fewer PTSD symptoms. We did not find significant differences in PTSD or depression symptoms at six months post-intervention.
Although our findings did not show that PFA is effective in preventing PTSD, they do suggest PFA could be a safe and effective intervention for delivering immediate emotional relief and reducing early PTSD symptoms in recent trauma survivors. Nevertheless, our findings must be interpreted cautiously because our high attrition rate could have reduced our statistical power and added systematic bias to our results. Moreover, as we did not exclude trauma survivors with a low risk of developing PTSD, high rates of natural recovery could have made any effect of PFA negligible. Further, as we only assessed PFA’s effect on follow-up scores and no changes in scores over time, baseline imbalance between the conditions could have inflated our inference error. Despite these limitations, our study was acknowledged as “the most robust trial” in the last systematic review of PFA of which we are aware (Wang et al., 2024), and our paper was recognised with the Best Paper Award 2022 by the European Journal of Psychotraumatology (Olff, 2023).
Our results are aligned with other studies that have shown a positive effect of PFA on reducing anxiety and facilitating adaptive functioning (Wang et al., 2024). They are also aligned with the recommendations of the World Health Organisation, Red Cross, and United Nations, which indicate the use of PFA with recent trauma survivors. However, there is still a paucity of evidence on PFA’s effectiveness, safety, and mechanisms of action (Hermosilla et al., 2023; Wang et al., 2024). Future research should focus on high-risk populations less inclined to natural recovery to increase statistical power. Additionally, designing studies to dismantle PFA component efficacy will be essential to understanding PFA’s working mechanisms. Studying PFA with different protocols and in multiple populations and settings will be indispensable for understanding the breadth and ecological validity of research findings.
 About the authors
Dr. Rodrigo Figueroa https://orcid.org/0000-0002-4040-8946, Twitter account username @RodrigoAFiguero. Dr. Figueroa is an adult psychiatrist. He is the Head of the Neuroscience Division and an Associate Clinical Professor at the Pontificia Universidad Católica de Chile School of Medicine. He is also a PhD candidate at Amsterdam University Medical Centers/University of Amsterdam. With a significant background in aviation, military and emergency medicine, his research has been focused on early interventions for trauma survivors, disasters, and, lastly, the use of artificial intelligence and psychedelics in mental health.
Dr. Humberto Marín https://orcid.org/0000-0001-5839-1575, Twitter account username @hmarinu. Dr. Marin is an Adjunct Professor and the Academic Deputy Director of Continuing Education, International Affairs, and Outreach at the Pontificia Universidad Católica de Chile School of Medicine. With a long experience as a volunteer firefighter in the Santiago Fire Corps, his research has been focused on disasters, risk management, and human behaviour in emergencies. He has provided consulting services on human factors to several companies in the mining and aviation fields.
Drs. Rodrigo Figueroa and Humberto Marín are paid for teaching in the “Psychological First Aid ABCDE certification workshop” at the Pontificia Universidad Católica de Chile School of Medicine. Correspondence concerning this article should be addressed to Rodrigo A. Figueroa, Diagonal Paraguay 362, Santiago, Chile. Phone/Fax: +56 2 2354 3028. Email: rfiguerc@uc.cl
To review the published article, please see below:

Figueroa, R. A., Cortés, P. F., Marín, H., Vergés, A., Gillibrand, R., & Repetto, P. (2022). The ABCDE psychological first aid intervention decreases early PTSD symptoms but does not prevent it: results of a randomized-controlled trial. European Journal of Psychotraumatology, 13(1), 2031829. https://doi.org/10.1080/20008198.2022.2031829


Brooks, S. K., Weston, D., Wessely, S., & Greenberg, N. (2021). Effectiveness and acceptability of brief psychoeducational interventions after potentially traumatic events: A systematic review. European Journal of Psychotraumatology, 12(1), 1923110. https://doi.org/10.1080/20008198.2021.1923110
Hermosilla, S., Forthal, S., Sadowska, K., Magill, E. B., Watson, P., & Pike, K. M. (2023). We need to build the evidence: A systematic review of psychological first aid on mental health and well-being. Journal of Traumatic Stress, 36(1), 5–16. https://doi.org/10.1002/jts.22888
Olff, M. (2023). Crises in the anthropocene. European Journal of Psychotraumatology, 14(1). https://doi.org/10.1080/20008066.2023.2170818
Rose, S., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, 2, CD000560. https://doi.org/10.1002/14651858.CD000560
Shultz, J. M., & Forbes, D. (2014). Psychological First Aid: Rapid proliferation and the search for evidence. Disaster Health, 2(1), 3–12. https://doi.org/10.4161/dish.26006‎
Vernberg, E. M., Steinberg, A. M., Jacobs, A. K., Brymer, M. J., Watson, P. J., Osofsky, J. D., Layne, C. M., Pynoos, R. S., & Ruzek, J. I. (2008). Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice, 39(4), 381–388. https://doi.org/10.1037/a0012663

Wang, L., Norman, I., Edleston, V., Oyo, C., & Leamy, M. (2024). The effectiveness and implementation of psychological first aid as a therapeutic intervention after trauma: an integrative review. Trauma, Violence & Abuse, 15248380231221492. https://doi.org/10.1177/15248380231221492 ‎