Indiscriminate trauma preventions may discriminate: A randomised controlled trial of group psychological first aid

Psychological First Aid (PFA) has been widely promoted as a universal intervention following traumatic incidents. However, early interventions once considered preventative were later found harmful, underscoring the importance of testing before widespread use. This randomised controlled trial examined the efficacy of PFA compared to natural recovery in reducing psychological distress using a validated stress-video paradigm. Based on recent evidence, it was hypothesised that PFA would alleviate short-term anxiety but show no long-term benefits. Eighty-four participants were randomised to either PFA (n = 47) or control (n = 37) following video exposure. Psychological distress was assessed using self-report measures over two weeks, with 74 participants completing follow-up (PFA n = 39, Control n = 35). The video reliably induced immediate distress. However, post-intervention analyses showed greater stress reduction in the control group compared with PFA, with a medium effect size. At two-week follow-up, no differences emerged between groups on any distress measures. Notably, participants experiencing higher initial distress displayed significantly greater trauma symptoms two weeks later-but only if they had received PFA. These findings challenge the classification of PFA as best practice, instead suggesting its similarity to previously discredited trauma interventions such as debriefing. Rather than being universally beneficial, group PFA may interfere with natural recovery in highly distressed individuals. Caution is warranted in its continued implementation, and post-trauma care should prioritise stepped, individualised approaches for those who develop clinically significant difficulties.