Trauma Resilience Model Therapies
Psychological First Aid (PFA) is the primary trauma resilience model therapy, designed as an early intervention following traumatic exposure that emphasizes safety, calm, efficacy, and connectedness through active listening, relaxation/stabilization, problem-solving/practical assistance, and social connection. 1
Core Components of PFA as a Resilience Model
PFA interventions align with four of Hobfoll's five essential elements of trauma resilience (reflected in 7 of 11 evaluated PFA protocols): 1
- Safety: Establishing physical and emotional security in the immediate aftermath of trauma 1
- Calm: Utilizing relaxation and stabilization techniques to reduce acute distress 1
- Efficacy: Building problem-solving skills and providing practical assistance to restore sense of control 1
- Connectedness: Facilitating social connection and appropriate referrals to support networks 1
The "hope" element remains less developed across PFA protocols, likely due to challenges in operationalizing it effectively in acute trauma settings. 1
Specific Techniques Used in PFA
The commonalities across different PFA approaches include: 1
- Active listening: Providing empathetic, non-judgmental presence without forcing disclosure 1
- Relaxation/stabilization: Teaching grounding techniques and stress reduction methods 1
- Problem-solving/practical assistance: Addressing immediate concrete needs (shelter, food, safety planning) 1
- Social connection/referral: Linking individuals to family, community resources, and mental health services when indicated 1
More intensive PFA protocols have evolved to incorporate cognitive reconstruction techniques adapted from cognitive-behavioral therapy, though this intensifies delivery beyond traditional early intervention models. 1
Delivery Format and Timing
PFA is delivered face-to-face, either individually or in groups, with timing varying from immediately following trauma exposure to up to 2 years later. 1 Single-session PFA is typically delivered by non-specialist providers, while mental health specialists deliver more intensive multi-session formats lasting from 2 weeks to 10 months. 1
Evidence for Effectiveness
PFA demonstrates positive effects for: 1
- Anxiety reduction: Significant effects across all study designs, particularly for individuals exposed to physical injury, crime, and displacement 1
- Adaptive functioning: Improvements in quality of life and coping measures in randomized trials 1
- Resilience and self-efficacy: Positive effects in pre-post studies conducted in mass trauma settings 1
The evidence for preventing PTSD or reducing depressive symptoms is less compelling, with small but significant short-term effects that do not necessarily translate to sustained intermediate or long-term prevention of PTSD. 1
Important Distinction from Trauma-Focused Treatment
PFA is fundamentally different from trauma-focused cognitive-behavioral therapy (TF-CBT), which is the evidence-based treatment for established PTSD rather than a resilience model. 2, 3 TF-CBT involves direct trauma processing through exposure techniques and cognitive restructuring, achieving 40-87% remission rates for PTSD after 9-15 sessions. 4, 5 This is a therapeutic intervention for diagnosed trauma disorders, not a resilience-building early intervention like PFA.
Critical Pitfall to Avoid
Psychological debriefing administered within 24-72 hours after trauma is not supported by evidence and may be harmful—this is distinct from PFA and should not be confused with resilience-based approaches. 1, 5 PFA focuses on practical support and stabilization without forcing trauma narrative processing in the acute phase.