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Psychological First Aid for Returning Military

and Their Families

Focus on Military and their Families

By: James J. Messina, Ph.D.

What are some reasons why returning Military need Psychological First Aid?
These returning military may have experienced:

  • Experience stress and anxiety due to unexpected episodes in their lives while deployed
  • Have fears about the trauma they fear or may have experienced which can unsettle them for the rest of their lives
  • Become so overwhelmed by the need to survive their fears and experiences they lose pre-existing ability to cope with life
  • Need assistance to learn to cope with the “new normal” resulting from experiences in their lives while deployed which make it difficult to go on the way they have lived their lives up to this point prior to deployment

What are the challenges to family members of returning military members?
These family members often experience:

  • Being part of a collective crisis with their returning military service members
  • Repeated exposure to “surreal” experiences resulting from the realities they are facing due to the stressors, behaviors and emotions of their returned military family members 
  • Having to maintain “one’s cool” in emotionally difficult and exhausting circumstances
  • Lacking sleep and feeling fatigued
  • Feeling like “no matter how much I dig out from this mess it will never be enough”
  • Facing personal, family, and work dilemmas resulting from the circumstances they find themselves in as a result of the stress coming from post deployment issues
  • Falling into despair, anger and lack of trust in God, helpers and system to help them pull out of their dire circumstances
  • Feeling frustrated by policies and decisions of helping organizations, leadership of the organizations and their workers

What are some signs of “loss of faith” coming from these challenged returned military and/or their family members?
These people often experience:

  • Wounded ideals and/or cynicism
  • Feeling unappreciated or betrayed by organizations
  • Mistrusting fellow peers undergoing similar challenges and the helpers reaching out to assist them
  • Loss of enthusiasm and/or inefficiency
  • Grandiose beliefs about self-importance
  • Heroic but reckless and/or antisocial behavior
  • Neglecting personal safety and physical needs
  • Excessive tiredness and/or sleep difficulties
  • Inability to concentrate
  • Symptoms of illness or disease
  • Excessive use of alcohol, tobacco or drugs

What is Psychological First Aid?

Psychological First Aid is the practice of recognizing and responding to people who are experiencing emotionally challenging events in their lives who are feeling stress, problems with coping, and struggling to get their feet on the ground.

Through the use of Psychological First Aid:

  • You create an environment of compassion
  • You show respect for the person you are reaching out to
  • You help the person to build up capacity to cope with the daily stressors faced
  • You encourage the person to be resilient in the face of challenges which life has presented them at the current time

Skills and attitudes needed to provide challenged people with Psychological First Aid are:

  • Demonstrating good listening skills
  • Being patient with the challenged people
  • Providing a caring attitude
  • Being trustworthy
  • Being approachable
  • Providing culturally competent responses
  • Responding in an empathetic manner
  • Being non-judgmental
  • Being kind
  • Maintaining a committed effort to provide support
  • Being flexible in providing what is needed to support these challenged people
  • Being able to tolerate uncertainty, chaos, and ambiguity

What are some strategies of Psychological First Aid?

  • To create a compassionate environment for these challenged people as a “rebuilding of faith” strategy
  • To assess what challenged people might need at a particular time
  • To provide immediate support to challenged people in stressful situations
  • To create a helping environment which helps challenged people cope in the face of stressful events
  • Providing sound guidance and support
  • Creating an open and sharing coping culture
  • Conducting regular and frequent meetings with people who are facing similar challenges
  • Demonstrating and encouraging respect for confidentiality of these challenged people
  • Creation of peer support systems for fun, rest, and recreation as well as for emotional, physical and spiritual healing
  • Encourage these challenged people to keep a daily journal of feelings about what they experience
  • Use painting or drawing art projects for these people to get out stress and anxiety faced daily in their efforts to cope and “bounce back”
  • Use playing or listening to music to get out daily stress and anxiety
  • Conduct a weekly or daily “debriefing” session with these people to “tell their stories” about stressors they are experiencing in trying to cope with their “new normal”
When should you refer a person you are assisting with Psychological First Aid (PFA) for outside professional Assistance?
You need to refer this person if he or she:
  • Begins to show signs of physical and mental fatigue where compassionate presence is not enough!
  • Threatens to harm or kill self or others
  • Cannot be calmed after PFA attempts to respond to needs
  • Behaves erratically and exhibits questionable judgment possibly due to alcohol or drugs or shows signs of excessively self-medicating
  • Acts confused and disoriented, saying or doing things that do not make sense in the context of the situation and may result in harm to self or others
  • Has witnessed or experienced the death of a loved one, friend, or military unit member and is not able to move on from the horror of it
  • Has witnessed or experienced serious injury to self, relative, friend, or military unit member and is not able to move on from the horror of it

Psychological First Aid is process which can be applied to a variety of populations. What follows below is a PowerPoint of a presentation presented on Feb 12, 2010 in Tampa Florida. The presentation was part of a larger program called: Pathways to Resilience: A Conference dedicated to family and professional 

caregivers. The program was sponsored by the James A Haley Veterans' Hospital in Tampa and the 

Tampa Bay Chapter of the American Red Cross.

References on Psychological First Aid

C.S.T.S. (2005). Psychological First Aid: Helping Victims in the Immediate Aftermath of Disaster. Fact Sheet of The Center for the Study of Traumatic Stress. Bethesda, MD: Uniformed Services University, Our Nation’s Federal Medical School at http://www.      

C.S.T.S. (2005). Psychological First Aid: How you can Support Well Being in Victims of  Disasters. Fact Sheet of The Center for the Study of Traumatic Stress. Bethesda, MD: Uniformed Services University, Our Nation’s Federal Medical School at

Everly, G. S., Phillips, S. B., Kane, D. & Feldman, D. (2006). Introduction to and Overview of Group Psychological First Aid. Brief Treatment and Crisis Intervention, 6(2), pp: 130-136.

International Federation of Red Cross and Red Crescent Societies. (2003). Community-based psychological support Training manual.

Miller, J. (2006). Wave Amidst War: Intercultural Challenges While Training Volunteers to Respond to Psychosocial Needs of Sri Lankan Tsunami Survivors. Brief Treatment and Crisis Intervention. 6(4), pp 349-365.

National Child Traumatic Stress Network and National Center for PTSD. (2005).
Psychological First Aid: Field Operations Guide.

National Child Traumatic Stress Network and National Center for PTSD, Psychological First Aid: Field Operations Guide, 2nd Edition. July, 2006. 

SAMSHA. (2005). Psychological First Aid for First Responders: Tips for Emergency Workers and Disaster Response Workers. Fact Sheet from SAMSHA

Zagurski, R., Bulling, D., Chang, R. (2004). Nebraska Psychological First Aid Curriculum. Lincoln, NE: University of Nebraska Public Policy Center.

PFA Relate Links on Internet

Center for the Study of Traumatic Stress Material for members of Military Framilies


National Center for PTSD (2007). Psychological First Aid: Field Operations Guide For Disaster Mental Health Responders. Available at:


Parker, C. (2007) Psychological First Aid Competencies for Public Health Workers. Baltimore, Maryland: Johns Hopkins Center for Public Health Preparedness. Available at:


SAMSHA. Deployed Military Personnel and Their Families: Annotated Bibliography - A rich resource of downloadable readings on providing intervention to returned militatry and their families. at:

University of Nebraska Public Policy Center. (2005). Nebraska Psychological First Aid Curriculum

Lincoln, Nebraska: University of Nebraska Public Policy Center. Note you must register access this training program: Available at: 

Wilderness Manuals. (2003) First Aid: Chapter 8. First Aid for Psychological Reactions: Importance of Psychological First Aid. Wilderness Survival. Available at: