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According global epidemiology surveys, 70% of individuals will experience a traumatic event at some point during their lifetime. Unfortunately, exposure to a traumatic event such as a physical assault or a natural disaster either directly or as a witness can lead to mental health disturbances; specifically, acute stress disorder (ASD), posttraumatic stress disorder (PTSD), depression, anxiety and increased rates of suicide are frequently reported by trauma survivors. Over time, posttraumatic symptoms can lead to a wide range of other repercussions such as somatic complaints, increased risk of cardiovascular disorders, type 2 diabetes, lowered work performance, marital problems and other types of impaired social functioning.

The experiences of survivors in the first few days after the event can have a profound influence on the development and maintenance of posttraumatic stress reactions. Indeed, the seriousness of posttraumatic symptoms highlights the need for early intervention after exposure to a traumatic event. For this reason, it is important to train emergency first responders so they can apply these five principles as effectively as possible. Early intervention refers to any intervention taking place immediately after exposure to a traumatic event and up to a month after.

Unfortunately, to date, the quantity and quality of research on early interventions have paled in comparison to other trauma interventions. One major difficulty has been identifying a coherent set of outcomes to guide intervention design and research. In 2007, Hobfoll and colleagues assembled a worldwide panel of experts to comment on the needs of patients recently exposed to natural disasters and mass violence. The goal was to build consensus and foster evidence-informed practices for early intervention in the aftermath of disasters and mass violence. In the end, they identified five core principles that should guide and inform all future interventions, they are:

  1. Promoting Safety. Promoting a sense of safety as soon as possible can lower physiological reactions such as a racing heartbeat and hormonal secretions that normally characterize fear responses. Examples of safety promotion could be bringing the victim to a safe place, repeating to the victim that the event is now over, and respecting the victim’s desire to discuss aspect of the trauma if desired.
  2. Promoting Calm. Encouraging a return to a sense of calm by addressing symptoms of dissociation, agitation or paralysis is an essential component of helping survivors move on. Keeping the victim in a distressed state for too long could interfere with their recovery by affecting, among other things, their ability to achieve restful sleep or daily functioning. This could mean addressing the victim’s immediate concerns, offering the victim information to help them process events more effectively, and teaching them new techniques to help manage their anxiety and cope better (i.e., grounding, deep breathing, normalizing stress reactions).
  3. Promoting A Sense of Self-Efficacy. Self-efficacy, either at the individual or collective level, gives survivors a sense of control, agency and belonging. Self-efficacy is also associated with the belief that actions are more likely to lead to positive outcomes despite the presence of adversity. Examples could be involving the survivor or the community in the decision-making process and helping them set and achieve future objectives.
  4. Promoting Connectedness. Perceived social support plays a crucial role in the improvement of posttraumatic symptoms. Promoting the establishment of social ties and access to support networks or professional resources can help victims recover more quickly. This could translate into helping victims identify and contact loved ones, warning them against negative social influences and identifying those at greatest risk of loneliness.
  5. Instilling Hope. Hope can be instilled by challenging irrational fears and self-destructive behaviors. Victims who remain optimistic are more likely to recover in the aftermath of a traumatic event. This could mean helping victims get their lives back in order, highlighting the progress made so far, encouraging positive coping behaviors and identifying victims’ strengths.

According to Hobfoll, these five principles should be at the core of any future psychosocial intervention designed for individuals or their community. Likewise, these five principles should be operationalized and adapted to every situation (e.g., location, event type, victim type, local culture) to ensure optimal functioning in the aftermath of a traumatic event. Thanks to Hobfoll’s contributions, most clinical trials testing the efficacy of early trauma interventions are based on these five principles.

About the Authors:

Mrs. Marine Tessier, PhD.c., MPs, is pursuing her doctorate in clinical psychology at the Université de Montréal. She holds a master’s degree in clinical psychology from France and has benefited from multiple clinical experiences with various populations including victims of crime and those detained in the criminal system. Her doctoral research project is on posttraumatic stress injuries among paramedics and emergency dispatchers.

Josianne Lamothe, MSW, is a doctoral student in criminology at the Université de Montréal. Her research focuses on the youth protection workers’ experiences with client violence.