Psychological First Aid in Barcelona

'Psychological First Aid (PFA) is a technique that is applied in order to reduce the frequency of Post Traumatic Stress Disorder (PTSD) and traumas. Its application is pivotal in situations surrounding a critical event: an incident that is unexpected, highly arousing and often causes long lasting negative consequences.' On reading this rough description, I was immediately gripped by what was a novel concept for me, and knew that I wanted to get involved. I decided I would undertake a PFA course at the wonderful 'Universitat Autònoma de Barcelona' (UAB). 

The course consisted of three weeks of morning teaching, in English, on the University site just a 30-minute journey from Barcelona's city centre. Enrolling through the Summer School section of the UAB website was straightforward, and just three weeks from my initial application my place had been confirmed. 

The last few months of my second year at University flew by, and the time came for me to jump on a plane headed for Spain. I arrived in Barcelona and set off for my accommodation and then by metro to the UAB Campus. My teacher was to be Professor Ingeborg Porcar Becker, director of the crisis centre at UAB, who has been working as a PFA provider and trauma therapist for over 30 years in many different countries. Through emails, she had told me the course would be split into four subdivisions for marking: roleplays and participation, specific critical event management challenges, mini tests regarding the previous day's content to be undertaken every morning, and a final presentation. 

First day and week 

The dependable sunshine made the early starts much easier than those I battled with in England, and on my first day I made my way to the Faculty of Arts building, where I knew I was to be welcomed to the University with an opening ceremony. This led us to our professors and to the classrooms that would accommodate us. The content on the first day was multiple ice breakers, leading me to get to know the other students in my class. Much to my surprise and delight, I found that of my fellow 25 classmates only one other was from England. There were students from countries all over the world, including Canada, Brazil, Germany, Hungary, Afghanistan, Korea, China and India. We had the most fascinating conversations about everyone's cultures and experiences over a cortado in the sun; a tradition which fostered many beautiful friendships and dialogues. 

The first week of learning covered the definition of critical events and their many guises, such as their location (within daily or extraordinary circumstances) their origin (natural vs manmade) and their target (you, someone you know or someone you witness). We ran through examples of critical events in our lifetimes, (covering those such as the Manchester arena bombing, the Las Ramblas attack and the Germanwings crash), and their effects on the different communities involved. We moved on to cover Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD) and the neurological origins of these conditions that so often arise from various critical events. 

It is during these times of crisis that the body's Fight or Flight response plays a key role in producing the adrenaline overload that disables regular bodily functions, such as accurate memory processing and storage of the event. Due to this improper memory integration, when we encounter similar stimuli to those present at the time of the critical event, it can lead to a similar high sense of fear and threat as that felt during the incident; this experience is called a flashback. Due to this high sense of fear and discomfort, it is common to avoid these stimuli and flashbacks, but avoidance only inhibits the moderative function of the hypothalamus that mediates threat responses and attempts to allow the memory to be accurately stored. 

The neuropsychology behind ASD and PTSD was fascinating to me, and proved to be an important basis for reasoning PFA's three main goals: 

1) Promoting safety, 

2) Keeping activation levels low, and 

3) Facilitating confrontation with reality 

Grieving, role play and speaking the language 

The second and third weeks contained details of PFA that were applicable to the families of those who have been in critical events, such as how to communicate bad news and the tasks of grieving within bereavement. We looked at four specific 'tasks' of grieving: 

1) Accepting reality 

2) Tolerating and processing grief 

3) Adapting to your new reality 

4) Emotionally relocating your loved one. 

In these weeks we also covered how to deliver PFA to both children and adolescents, using real-life examples that my professor had encountered across her career, acknowledging the specific difficulties that each situation held. We progressed through the course with more and more roleplays and example challenges to practice how we would apply our learnt PFA knowledge to real-life situations. 

The role plays were a slightly challenging aspect for me, especially when faced with the pressure of the whole class watching - but they were an invaluable part of the learning process and critical when extracting the content of the course to those precarious situations where PFA is necessary. This teaching style meant that as we continued the course our confidence within these challenging situations flourished, along with our respect and admiration for PFA providers themselves. 

Another key reason I had chosen to study PFA at Barcelona was to enhance my Spanish, which I'd fallen in love with as an optional module at Sheffield University alongside my degree. While both Castellano and Catalan are recognised as national languages of Catalonia, Barcelona was an ideal place to practice my (limited) Spanish. The locals were incredibly supportive, forgiving and encouraging of my communication attempts. 

Key points 

Now, on the other side, it feels almost ludicrous to admit that I hadn't heard of Psychological First Aid. I now realise how vital, relentless and selfless the work of these healthcare providers is. Here are just a few of the key points I learned: 

• There is no direct 'process' to grieving: it should be referred to as 'tasks' rather than a 'process' of passively allowing time to just carry out its course, as it requires active involvement from the affected person 
• There is no help in 'sugarcoating' bad news when delivering it. Assertiveness and directness is crucial as a PFA provider. Although it feels natural and in good societal practice to deliver news in this softened form, it can often promote denial and delay to both the acceptance and grievance journeys. 
• As a PFA provider you should try not to lie to a child when they ask you for information regarding the event. There are ways in which it can be phrased to reduce the impact of the news, but especially in this world of social media if you do not deliver the correct information then the child will grow to distrust you as a valid source. 
• Men and women often have different ways of dealing with bereavement. Women likely need to speak more about it and men can often find that very unhelpful and deal with the news in a different way. This means that experiencing critical events can have very damaging effects on relationships if you can't attempt to understand that these differences in coping mechanisms may be prominent within some partnerships. 

My experience this summer in Barcelona has been eye-opening for me. I have newfound knowledge and appreciation surrounding PFA and its providers. I completed the course with a 97 per cent overall score, six internationally applicable university credits and cherished memories for life. Huge thanks to my Professor, the University, and a special acknowledgement to my classmates. I thoroughly recommend both a PFA course and the UAB Summer School experience.