Correspondence

Digital psychological
first aid for Ukraine
The ongoing war in Ukraine has
already taken an enormous toll on the
lives of many. Ukrainians and others
affected by the war need to sustain
their mental health in this context.
Hobfoll and colleagues1 identified
five essential elements of immediate
and midterm psychosocial support
following trauma exposure: ensuring
safety; fostering calming; maintaining
a sense of self and community efficacy;
sustaining connectedness; and fos­
tering hope. 2 These elements are
children. This chatbot was developed
in Ukrainian but is also available in
English. 4 weeks after being made
available it has already reached more
than 40 000 users both within and
beyond Ukraine.
During war, it is even more crucial
to deliver valid guidance to mental
health professionals on evidence-
based treatments that can be safely
used. The Traumatic Stress Network
initiative of the European College
Neuropsychopharmacology is suppor­
ting this approach to deliver safe and
valid treatments with the First Aid to
Terror tool that was made available for
2 Hobfoll SE, Watson P, Bell CC, et al.
Five essential elements of immediate and
mid-term mass trauma intervention: empirical
Published Online
evidence. Psychiatry 2007; 70: 283–315.
3 Vermetten E, Frankova I, Carmi L. May 5, 2022
Risk management of terrorism induced stress: https://doi.org/10.1016/
guidelines for the golden hours (who, what S2215-0366(22)00147-X
and when). Amsterdam: IOS Press, 2020.
4 Wasil AR, Palermo EH, Lorenzo-Luaces L,
DeRubeis RJ. Is there an app for that? A review
of popular apps for depression, anxiety, and
well-being. cognitive and behavioral practice.
PsyArXiv 2021; published online Oct 12.
https://doi.org/10.31234/osf.io/su4ar
(preprint).
5 WHO. Assessment and management of
conditions specifically related to stress:
mhGAP intervention guide mode. 2013.
https://apps.who.int/iris/handle/10665/85623
(accessed April 29, 2022).
For more on First Aid to Terror
see http://firstaidtoterror.com/

widely accepted as general guidelines
for the development of primary and
secondary prevention strategies and
are core in recommendations during
the “golden hours” of the early care
needed.3
The current crisis requires psy­
chological support to be delivered
swiftly and to be maintained for as
long as needed, highlighting the value
of digital formats. A meta-analysis
also suggests that digital tools can
expand access to mental health care
and can be effective for depression and
anxiety.4
On the second day of the war, a
Telegram-based self-help chatbot
called Friend. First Aid was activated
for Ukraine. A chatbot is a convenient
service that simulates a text con­
versation with a virtual specialist on a
mobile phone. Telegram is a freeware,
cloud-based instant messaging
service that is commonly used in
Ukraine. Friend. First Aid contains
various exercises, tasks, and useful
recommendations on how to cope
with ongoing stress. The chatbot is
based on psychological first aid,5 with
the recommendations adjusted for the
ongoing stress of the war. Friend. First
Aid makes use of different scripts for
specific environments, for example,
considering whether the user is in a
life-threatening or safe environment.
The chatbot also includes recom­
mendations on relaxation exercises
and stress management for adults and
free on the iOS and Google play app
stores.
As a group of international mental
health professionals, we are calling for
assistance to deliver these digital tools
to the Ukrainian people and those
caring for them. We would be glad to
receive expertise, comments, and help
to deliver the assistance and support
that is sorely needed and will need to
be sustained in the future.
EAH is on the Editorial Advisory Board of
The Lancet Psychiatry. All other authors declare no
competing interests.
*Iryna Frankova, Eric Vermetten,
Arieh Y Shalev, Marit Sijbrandij,
Emily A Holmes, Robert Ursano, For article detailing chatbot
Ulrike Schmidt, Joseph Zohar launch see https://rubryka.com/
iryna.frankova@gmail.com en/2022/02/25/bot-
psyhologiya/
Medical psychology, psychosomatic medicine, and
For Friend. First Aid see
psychotherapy, Bogomolets National Medical
https://t.me/friend_first_aid_bot
University, Kyiv, Ukraine (IF); Department of
Psychiatry, Leiden University Medical Center, Leiden,
Netherlands (EV); Hadassa Medical Center,
The Hebrew University of Jerusalem, Jerusalem,
Israel (AYS); Department of Clinical Psychology, Vrije
University Amsterdam, Amsterdam, Netherlands,
(MS); Department of Psychology, Uppsala
University, Uppsala, Sweden (EH); Department of
Clinical Neuroscience, Karolinska Institutet,
Stockholm, Sweden (EH); Department of Psychiatry,
Uniformed Services University of the Health
Sciences, Bethesda MD, USA (RU); Clinic of
Psychiatry and Psychotherapy, University Hospital
Bonn, Bonn, Germany (US); Clinic of Psychiatry and
Psychotherapy, University Medical Center
Göttingen, Göttingen, Germany (US); Post-Trauma
Center, Sheba Medical Center, Tel Hashomer, Israel
(JZ); Sackler Faculty of Medicine, Tel Aviv University,
Tel Aviv, Israel (JZ)
1 Hobfoll SE. Conservation of resources: a new
attempt at conceptualizing stress. Am Psychol
1989; 44: 513–24.

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