Psychological first aid from a distance in wartime:�Israeli therapists for Ukrainian citizens

Dr. Yanina Shraga

first day

• On the first day of the “Russian-Ukrainian War,” social media in Israel published a post written by a woman social worker who had emigrated to Israel from the former USSR in the 1990s. She called for the establishment of a group of volunteers to provide psychological first aid to emotionally distressed Ukrainian citizens harmed by the war

• That very day, in response to her call, 15 Russian-speaking therapists from the field of mental health joined her effort. They advertised their personal names and mobile phone numbers via the Ukrainian social media, inviting all who need help to call them for mental health first aid. During the first 24 hours, a wave of calls came from Ukrainian citizens and, over the first months of the war, an average of 30-50 calls were received per day

• The therapists responded via their mobile phones by means of digital platforms, such as Whatsapp, Viber, and Telegram.�Approximately a month and a half after promoting this service, over 200 Russian-speaking volunteers, mostly women, joined to offer psychological support. All these volunteers had originally come to Israel from the USSR in the 1990s

This group was managed according to a number of basic principles:

• The service provides psychological first aid. The number of conversations held with each caller ranged from one to four;
• The service is intended to reduce emotional and mental distress, for moral support, and to guide the caller back to normal functioning;
• The volunteer therapists are psychologists, social workers, art therapists, and educational advisors;
• The service in entirely voluntary;
• In complex cases, when prolonged intervention is required, our therapists assist the callers in locating appropriate care services in Ukraine

• It is possible to explain why these Ukrainian citizens called our first-aid service in Israel for the following reasons. At the start of the war, all the Ukrainian first-aid phone lines became overloaded and crashed. The therapists in Israel were available to respond and assist within a day after receiving an appeal.
• An additional reason was the high esteem the Ukrainians held for the Israeli therapists.
• The third reason was the ability to easily converse in a shared language (Russian)

• The Israeli therapists, who had emigrated to Israel from the Soviet Union, were also familiar with the callers’ Soviet (post- Soviet) culture. It was possible to sense the preserved Soviet cultural norms of the callers, even though they had been living in an independent Ukraine for up to thirty years. An explanation for this phenomenon may be found in the research literature dealing with the slow change and preservation of cultural norms over a few generations (Slonim-Nevo, & Shraga, 2000; Slutzki, 1979).

• The expression of these Soviet norms may be seen, for example, during the first conversation. Immediately after the therapist had identified herself, the callers, even though they were in a state of crisis, often under fire, responded with great politeness. Such polite responses are not generally characteristic in people in crisis, but it is a powerful reflection of the Soviet and post- Soviet norm that one must value and show respect to professional authorities.

• In conversations with the Israeli therapists, callers were able to speak openly, revealing things early on that helped create a strong rapport. In our opinion, this almost anonymous intervention from a distance allowed for openness and frankness. One male caller noted that this therapeutic relationship was like a meeting with a stranger on a train and an open conversation that spontaneously developed between them.

• Unlike a regular therapy session, in which the therapist is an uninvolved figure, a psychological assistance service to Ukrainian citizens essentially represents ‘taking a stand of solidarity’, expressed by the affinity and cooperation between the therapist and the suffering of ‘the other’ (Kogan, 2023; Sagi, 2020). During each session, the caller was told the following: “I’m with you and I’ll stay with you as long as you need me. We support Ukraine.”).

• Over the first three months after the “Russian-Ukrainian War” broke out, I received 34 calls from Ukrainian citizens, of which 30 were women and four were men. All the callers were over 18 and the eldest was a 72-year-old woman. The majority of the callers were between the ages of 18-42. Most of the calls were due to anxiety , and panic attacks.

• For instance, some callers said that during sirens and explosions it was hard for them to get their bearings, they were out of control, suffered anxiety and had autonomic symptoms, such as shaking hands and a rapid heartbeat. Several callers talked about their inability to accept their reality as is, and they described a feeling that they were going mad

• There were those who described that, since the start of the war, they feel anger and rage, and they cannot control these emotions, and do not know how to cope with them. They had responded with anger or rage towards family members, causing suffering to all those at home. They had even frightened themselves with their angry reactions. Additional callers described feeling helpless, having trouble making decisions, and feeling lonely. For example, for some, it was hard to decide whether to stay where they reside or to leave, escape to other countries.

A model of psychological first aid

• Interventions were based on the therapists’ prior experiences with the population in Israel’s southern region during earlier periods of military-security crises. This assistance focused on the reduction of mental distress, building internal and external strength and order, and helping the callers to adopt more efficient strategies of coping.

• Sessions with the callers were designed and included the following elements (Ruzek, 2007,Lahad, 2017):
• 1. Creating an effective empathetic connection. After receiving the initial appeal, the connection started with correspondence, in which the therapists provided their names and roles. The callers were given several communication options: hours, days, and viable means for making contact—either by vocal conversation or written correspondence. After the caller decided how and when, the first conversation was held.

• 2. Concern for physical safety and a sense of security. For most of the callers, this was their first experience of war, an unfamiliar reality with air-raid sirens and bombing. It was very important to make certain that they knew the whereabouts of safe locations (i.e., places to take shelter) in their vicinity, and that they knew how to behave when the air-raid sirens sounded, followed by bombs dropping. In Israel, the public has had much experience of that kind and knows how to cope with such situations, so it was important and practical to share that knowledge and those emergency instructions with our callers.

• 3. Initial data collection. The callers were asked to tell us their age, location, and who was with them. They were requested to tell us the worst problems that were bothering them, and to describe their current conditions and behaviors. The responses to these questions were essential for identifying their immediate needs and worries, making our interventions as suitable as possible moving forward. Responding to our questions, enabled the callers to “connect fragmented sequences” and to make some cognitive

order for the purpose of our conversations.

• 4. Calming the callers and providing practical solutions to their problems. Most of the callers reported mental distress. The normalization technique proved to be highly effective. They were told that their reactions were normal, natural, and expected given the circumstances. It was explained to them that they will not go crazy, as they fear, rather those who started this war—they lost their minds. In addition to the normalization of the callers’ reactions, they were taught soothing breathing exercises and grounding. Such techniques reduced their distress and calmed them

• Another effective technique was offering solutions to their immediate problem or concern. Their primary problem was identified, and solutions were discussed together, as well as effective actions that might be taken.

• When the callers were dealing with anxiety, with autonomic symptoms (e.g., shaky hands, racing pulse) during siren soundings, we taught them to seek refuge in a safe place, wherever they are, and we inculcated the skill of gradual exposure to siren sounds (desensitization). After conversation and teaching various skills, each caller was sent a summary of all the means of action and solution options that had been discussed.

• 5. Connecting to strengths and enhancing capabilities. The callers were asked how they had managed past life crises, who had helped them, and what coping mechanisms they had found to be effective for them. The goal of this portion of the conversation was to investigate which previous resources and experiences had been successful. Talking about these past successes helped to enhance their sense of capability and to strengthen their ability to manage their lives.

• 6. Providing information about resources and new coping techniques. During this part of the conversation, the callers were presented with information regarding beneficial coping ways to better their reactions and behaviors. Most often, this information was only imparted once the callers had calmed down, when they understood their own reactions to be normal and were able to conduct the conversation calmly and attentively

• BASIC Ph (Lahad, 2017) was found to be effective in Israel and was also used to help the Ukrainian citizens. This model was translated into Russian and named “Чувства” [“Feelings”]. While presenting this model to the callers, its components were discussed, familiarizing them with its various resources and new coping strategies, so they might choose the most suitable ones and expand and enrich their coping toolkit. After talking about BASIC Ph, a written description of the model was sent to them.

• At the conclusion of each conversation, callers were imparted with a message of belief in their personal strength and bravery, as well as in the resilience of the Ukrainian nation. It was suggested that they could have a follow-up conversation, further providing support, monitoring their well-being, and assessing their utilization of resources and newly learned coping strategies. For particularly complex cases, efforts were made to arrange long-term care with professional therapists in Ukraine.

​

​