Psychological First Aid Tools for Covid-19 and all content on this page & website are not medical advice. For medical advice contact your physician. This material is intended for a Canadian audience. These tools are to be used at the discretion of the user/provider. 

 
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COVID-19:
TOOLS TO REDUCE ACUTE STRESS, ANXIETY AND PANIC

These evidence-informed Psychological First Aid Tools were developed by Dr. Marcia Kostenuik

©Dr. Marcia Kostenuik 2020

Thank you to the physician peers & other professionals who reviewed and contributed to editing the tools.

 
Calm Sea

Psychological First Aid Tools for Training, Teaching & Research

If you are a researcher, clinician or other professional or organization interested in using the tools for research purposes, or if you would like to book an online group training session, contact Dr. Marcia Kostenuik at marcia@drkostenuik.com.


Additional content, references and related information (e.g. mitigating risks of vicarious trauma, addressing suicide risk factors etc.) is available upon request. Contact Dr. Kostenuik for details or to book a live interactive training session for your group. 

The tools may be printed for personal use.

Psychological First Aid Tools© may not be reprinted without explicit permission.

These tools are not medical advice and are to be used with the discretion of the user/provider. For medical advice contact your physician.

 

PSYCHOLOGICAL FIRST AID TOOLS FOR COVID-19

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May 13th 12-1pmET/9-10amPT

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PSYCHOLOGICAL FIRST AID FOR COVID-19

Are you or your patients experiencing stress and anxiety related to the pandemic?

These tools can help.

Psychological first aid is an evidence informed approach to responding to human suffering in the immediate aftermath of a mass emergency and is recommended by the World Health Organization for the COVID-19 pandemic.


Dr. Kostenuik has created tools that include key elements of psychological first aid along with trauma-informed psychotherapeutic techniques and a practical emergency medicine approach.


These new Psychological First Aid Tools help physicians and other responders address acute stress reactions, provide immediate psychosocial support, and identify those requiring specialized care.


The ABC123 tool is used to immediately reduce anxiety, panic, dissociation, or other emotional distress. The L.A.R.G.E. tool creates a framework to respond to individuals experiencing losses, grief, or stress related to the pandemic.The tools can be used independently or in combination.

 

WHY USE THE TOOLS?

PSYCHOLOGICAL FIRST AID TOOLS

Help physicians and others to

  • reduce their own anxiety & stress reactions

  • respond to acute psychological reactions in patients

  • empower other staff members to provide initial support

The ABC123 tool

  • reduces anxiety, panic and dissociation

  • can be used as a daily practice

  • can be used when needed even while at work

The L.A.R.G.E. tool helps physicians support

  • patients suffering from psychosocial distress

  • family members suffering from grief & loss

  • peers experiencing work or life stress

 
Doctors

WHEN & HOW DO I USE THE TOOLS?

HOW DO I USE THE TOOLS?

  1. The tools can be used independently or in combination.

  2. For acute anxiety and panic use the ABC123 tool first.

  3. To provide psychosocial support start with the L.A.R.G.E. tool.

  4. Obtain simple verbal consent before assisting an individual.

  5. If symptoms are severe or prolonged, or other serious risk factors are present, contact crisis services.


Use for Self-Care

Support Peers and Patients

 
Ducks Over the Lake

PRINTABLE POSTERS

PSYCHOLOGICAL FIRST AID TOOLS FOR  COVID-19

Feel free to print these tools for personal use.

 

ABC123 TOOL

Reduce Acute Emotional Distress including Anxiety, Panic and Dissociation

L.A.R.G.E. TOOL

Psychosocial Support During a Pandemic

PSYCHOLOGICAL FIRST AID TOOLS FOR COVID-19

Learn how and why the tools were developed

What is psychological first aid?

PSYCHOLOGICAL FIRST AID is a humane and practical approach to addressing acute psychological reactions after a mass emergency. This approach is commonly used in humanitarian and foreign aid contexts. Psychological first aid can be adapted for clinical use to help physicians during the COVID-19 pandemic.

Dr. Kostenuik has created clinical tools using elements of

  • psychological first aid

  • psychotherapy and emergency medicine

  • trauma-informed therapy

According to a systematic review of psychological first aid, interventions after a mass emergency should be practical, easy to learn and promote a sense of:

  • safety

  • self-efficacy

  • empowerment

  • connectedness

  • calm

  • hope​


Why new tools?

Physicians and patients are asking for practical tools to address acute psychological distress in themselves and others during the COVID-19 pandemic. Existing psychological and mental health first aid resources may be inappropriate or impractical for health care workers and for COVID-19 as they are designed for foreign aid workers in poor countries, are intended for specific mental illnesses, or require significant training.

Physicians need tools that are easy to learn, use and remember, and that are immediately effective for the types of acute reactions that they and their patients are experiencing. 


Most acute psychological reactions to the pandemic are normal responses to an abnormal situation. The majority of these acute reactions can and should be addressed with supportive measures and do not require psychiatric or specialized care.


During a pandemic physicians are faced with an increased demand from patients for emotional and psychological support. Physicians on the frontlines and those responding in other care settings need tools to respond to anxiety, panic and severe acute stress and grief reactions in patients, family members and peers. New skills and approaches are needed to help address both the VOLUME and TYPES of acute psychological reactions that occur in response to a global pandemic.

Why trauma informed tools?

After an extreme stressor, a significant minority of individuals are at risk of developing serious disorders including post-traumatic stress disorder (PTSD) and depressive, anxiety and substance use disorders.

The ABC123 and L.A.R.G.E. Psychological First Aid Tools address two key risk factors for the development of post-traumatic stress disorder:

  • peri-traumatic dissociation

  • lack of social support

The ABC123 tool provides physicians with immediate skills to respond effectively to acute anxiety, panic and peri-traumatic or post-traumatic dissociation. The L.A.R.G.E. tool promotes social support and connection.

Why mnemonic memory aids?

Semi-structured approaches and the use of mnemonic memory aids are common in emergency and acute care medicine and help ensure safer and more consistent delivery of care and skills. 

The ABC123 and L.A.R.G.E. mnemonics help physicians remember the skills even when they may be under extreme stress themselves. The tools help frame an effective clinical encounter making it easier to respond to patients in an organized and safe way. Having an effective easily remembered approach can increase physician confidence in handling acute psychological distress and may reduce the risk of errors, adverse events, difficult patient encounters and complaints. 

How can these tools help during COVID-19?

During a pandemic the increased volume of individuals needing psychosocial support risks overwhelming physicians and the health care system. The ABC123 and L.A.R.G.E. Psychological First Aid Tools can be used by physicians without specialized mental health training, as well as nurses, first responders, support staff, and non-specialized personnel. 


It is recommended by WHO and the Inter-Agency Standing Committee that all responders, community leaders, teachers, and the entire population affected by the COVID-19 pandemic be trained in basic psychological first aid. The ABC123 and L.A.R.G.E. psychological first aid tools are easy to learn, use and remember and can be rapidly disseminated for immediate use. These tools were designed specifically for the COVID-19 pandemic but may be useful in other contexts.


What if individuals need more than first aid?

After a mass emergency, a significant minority of individuals, especially those from vulnerable populations, may experience emerging, regressing or worsening mental illness and will require specialized mental health support. The tools include a triaging element to help recognize red flags indicating the need for referral to crisis services or other specialized care.

Go To ABC123 and LARGE Tools (PDFs)


Resources:

In case of crisis contact your local crisis services:

Crisis Services Canada: 1-833-456-4566 (24hrs), Text 45645 (4pm-midnight)

Mental Health Crisis Line: Barrie ON 705-728-5044, 1888-893-8333

Canadian Mental Health Association: cmha.ca


References:

WHO/PAHO Mental Health Protection and Psychosocial Support in Epidemic Settings 2016

Bisson 2020 Systematic review of Psychological First Aid

IASC Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak

WHO Mental health and psychosocial considerations during the COVID-19 outbreak

 
Image by Wilhelm Gunkel

THANK YOU

Special thanks to the following individuals

As the COVID-19 pandemic hit, anxiety mounted and countless discussions with colleagues, peers, patients, friends and family members informed the need to develop tools to help address immediate symptoms and suffering. I cannot name all the physicians, allied health providers, friends and patients here, however I sincerely thank them for everything they shared and for the feedback they provided. 


Special thank you to:

Dr. Barry Pakes MD PhD who helped from the earliest discussions about the need for the tools and provided support with the editing of supplemental materials. Thank you also for your friendship and kindness. 

Dr. Brian Kuzik for his help editing the tools.

Dr. Paul Kostenuik for his feedback, enthusiasm, and help editing the tools.

Dr. Savithiri Ratnapalan for her encouragement.

Thank you also to:

Dr. Elizabeth Alvarez

Dr. Brenda Pakes

Dr. Celeste Bouchard

Joan Hawkins Wong, Jungian Psychoanalyst

Sheri Van Djyk MSC

for your encouragement and feedback. 

 

Psychological First Aid Tools for Covid-19 and all content on this page & website are not medical advice. For medical advice contact your physician. This material is intended for a Canadian audience. These tools are to be used at the discretion of the user/provider.