Crisis Intervention and Psychological First Aid

  • George S. EverlyJr.
  • Jeffrey M. Lating


Throughout this text, we have discussed the body and mind’s continuing struggle to maintain homeostasis. As the body struggles to maintain a physical homeostasis (Cannon, 1932), or “steady state,” so the mind struggles to maintain a similar balance. As a medical crisis is a state wherein physiological homeostasis has been disrupted with resultant physical distress and dysfunction, we then see the possibility of a psychological analogue. A psychological crisis is a response to a critical incident or distressing event wherein the individual’s psychological balance has been disrupted. There is, in effect, a psychological disequilibrium. This disequilibrium results because the individual’s usual coping mechanisms have failed. The predictable result is the emergence of evidence of acute psychological or behavioral distress coupled with some degree of functional impairment. More practically speaking, a crisis may be defined as a state of acute distress wherein one’s usual coping mechanisms have failed in the face of a perceived challenge or threat and there results some degree of functional impairment (see Caplan, 1961, 1964). This description argues more for an acute stress management-based intervention platform rather than traditional psychotherapeutic engagements. In 1952, F. C. Thorne wrote the following, “In our opinion, … preoccupation with depth psychology [psychotherapy] has had a very detrimental effect in causing us to overlook presenting complaints which may be very distressing to the client and about which he urgently wishes us to do something … Prophylactically, it is probable that many disorders could be nipped in the bud if prompt attention could be given to germinating seeds which may later grow into tall oaks … Diagnostically, one of our problems is to identify these emergency situations so that we can discriminate what needs to be done immediately…Therapeutically, much will be gained if the client can be made more comfortable even though no deep cure can be effected by first aid methods” (Thorne, 1952, p. 210). In this chapter, we shall examine crisis intervention and psychological first aid (PFA) as interventions that target acute distress seeking stabilization and acute mitigation rather than resolution and therapeutic growth.


Mental Health Clinician Crisis Intervention Acute Distress Disaster Mental Health Formal Mental Health 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. American Psychiatric Association. (1954). Psychological first aid in community disasters. Washington, DC: AuthorGoogle Scholar
  2. Artiss, K. (1963). Human behavior under stress: From combat to social psychiatry. Military Medicine, 128, 1011–1015.PubMedGoogle Scholar
  3. Blain, D., Hoch, P., & Ryan, V. G. (1944). A Course in Psychological First Aid and Prevention: A Preliminary Report. Paper read at the Centenary Meeting of The American Psychiatric Association, Philadelphia, Pa., May 15–18Google Scholar
  4. Bordow, S., & Porritt, D. (1979). An experimental evaluation of crisis intervention. Social Science and Medicine, 13, 251–256.Google Scholar
  5. Boscarino, J. A., Adams, R. E., & Figley, C. R. (2005). A prospective cohort study of the effectiveness of employer-sponsored crisis interventions after a major disaster. International Journal of Emergency Mental Health, 7, 9–22.PubMedGoogle Scholar
  6. Boscarino, J., Adams, R., & Figley, C. (2011). Mental health service use after the World Trade Center disaster: Utilization trends and comparative effectiveness. The Journal of Nervous and Mental Disease, 199, 91–99.PubMedCrossRefGoogle Scholar
  7. Boscarino, J. A., Adams, R. E., Foa, E. B., & Landrigan, P. J. (2006). A propensity score analysis of brief worksite crisis interventions after the World Trade Center disaster: Implications for intervention and research. Medical Care, 44(5), 454–462.PubMedCrossRefGoogle Scholar
  8. British Psychological Society. (1990). Psychological aspects of disaster. Leicester, UK: Author.Google Scholar
  9. Cannon, W. (1932). The wisdom of the body. New York, NY: Horton.Google Scholar
  10. Caplan, C. (1961). An approach to community mental health. New York, NY: Grune & Stratton.Google Scholar
  11. Caplan, G. (1964). Principles of preventive psychiatry. New York, NY: Basic Books.Google Scholar
  12. Everly, G. S., Jr., Barnett, D., & Links, J. (in press). The Johns Hopkins Model of Psychological First Aid (RAPID – PFA): Curriculum development and content validation. International Journal of Emergency Mental Health Google Scholar
  13. Everly, G. S., Jr., & Flynn, B. W. (2005). Principles and practice of acute psychological first aid after disasters. In G. S. Everly Jr. & C. L. Parker (Eds.), Mental health aspects of disasters: Public health preparedness and response, revised (pp. 79–89). Baltimore, MD: Johns Hopkins Center for Public Health Preparedness.Google Scholar
  14. Everly, G. S., Jr., & Langlieb, A. (2003). Evolving nature of disaster mental health. International Journal of Emergency Mental Health, 5, 113–119.PubMedGoogle Scholar
  15. Everly, G. S., Jr., & Mitchell, J. T. (1999). Critical Incident Stress Management: A new era and standard of care in crisis intervention (2nd ed.). Ellicott City, MD: Chevron.Google Scholar
  16. Hawker, D. M., Durkin, J., & Hawker, D. S. J. (2010). To debrief or not to debrief our heroes: That is the question. Clinical Psychology and Psychotherapy, Published online in Wiley Online Library ( Scholar
  17. Institute of Medicine. (2003). Preparing for the psychological consequences of terrorism: A public health strategy. Washington, DC: The National Academy of Sciences.Google Scholar
  18. Jacobson, J. M., Paul, J., & Blum, D. (2005). The EAP work-place critical incident continuum. Journal of Employee Assistance, 32, 28–30.Google Scholar
  19. Mitchell, J. T. (1983). When disaster strikes… the Critical Incident Stress Debriefing process. Journal of Emergency Medical Services, 8, 36–39.PubMedGoogle Scholar
  20. Mitchell, J. T, & Everly, G. S. (2000). The CISD and CISM: Evolution, effects and outcomes. In B. Raphael & J. Wilson (Eds.), Psychological debriefing (pp. 71–90). Cambridge: Cambridge University Press.PubMedGoogle Scholar
  21. National Institute of Mental Health. (2002). Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence: A Workshop to Reach Consensus on Best Practices. NIMH (NIH Publication No 02–5138). Washington, DCGoogle Scholar
  22. Neil, T. C., Oney, J. E., DiFonso, L., Thacker, B., & Reichart, W. (1974). Emotional First Aid. Louisville, KY: Kemper-Behavioral Science Associates.Google Scholar
  23. Raphael, B. (1986). When disaster strikes. NY: Basic Books.Google Scholar
  24. Regel, S. (2007). Post-trauma support in the workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organizations in the UK. Occupational Medicine, 57, 411–416.PubMedCrossRefGoogle Scholar
  25. Regel, S. (2010). Does Psychological Debriefing work? Healthcare Counselling and Psychotherapy Journal, 10(2), 14–18.Google Scholar
  26. Salmon, T. (1919). War neuroses and their lesson. New York Medical Journal, 108, 993–994.Google Scholar
  27. Solomon, Z., & Benbenishty, R. (1986). The role of proximity, immediacy, and expectancy in frontline treatment of combat stress reaction among Israelis in the Lebanon War. American Journal of Psychiatry, 143, 613–617.PubMedGoogle Scholar
  28. Solomon, Z., Shklar, R., & Mikulincer, M. (2005). Frontline treatment of combat stress reaction: A 20-year longitudinal evaluation study. American Journal of Psychiatry, 162, 2309–2314.PubMedCrossRefGoogle Scholar
  29. Sphere Project. (2004). Sphere Project Handbook, Revised. Geneva: AuthorGoogle Scholar
  30. Stapleton, A. B., Lating, J., Kirkhart, M., & Everly, G. S., Jr. (2006). Effects of medical crisis intervention on anxiety, depression, and posttraumatic stress symptoms: A Meta-Analysis. Psychiatric Quarterly, 77(3), 231–238.PubMedCrossRefGoogle Scholar
  31. Thorne, F. C. (1952). Psychological first aid. Journal of Clinical Psychology, 8(2), 210–211.PubMedCrossRefGoogle Scholar
  32. Tuckey, M. (2007). Issues in the debriefing debate for the emergency services: Moving research outcomes forward. Clinical Psychology, 14, 106–116.Google Scholar
  33. World Health Organization. (2003). Mental health in emergencies. Geneva: Author.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • George S. EverlyJr.
    • 1
  • Jeffrey M. Lating
    • 2
  1. 1.School of MedicineThe Johns Hopkins UniversitySeverna ParkUSA
  2. 2.Loyola University MaylandBaltimoreUSA

Personalised recommendations