The Evolution of Psychological First Aid

Evidence-based practice guidance underscores the value of prompt and practical workplace response to critical incidents, but increasingly there is compelling evidence that traditional approaches must be reconsidered. Evidence-based practice has become increasingly important in all aspects of medical care, including behavioral health. Interventions designed to address psychological trauma, especially preventative interventions of the type typically used in workplaces, have received particular scrutiny as the mobilization of mental health resources in response to disasters and terrorist incidents has gained strong momentum. There is a clear consensus that the mental health impacts of such incidents can be significant and warrant systematic response efforts, but some widely practiced and promoted approaches—most specifically, debriefing and related techniques—have proven, in a growing range of controlled studies, to be ineffective in preventing post-traumatic stress disorder (PTSD) or depression, and a few well-controlled studies have reported adverse outcomes from using these approaches with some traumatized persons (see, for example, Rose et al. 2004 or van Emmerik et al. 2002, for detailed meta-analyses of relevant studies; see also McNally, Bryant, and Ehlers 2003 for a