Where Acute Traumatic Stress Management™ Meets AI-Integrated Emotional Wellness™

Fostering Emotional Wellness in Real Time During a Crisis

By Mark D. Lerner, Ph.D.

Chairman, The National Center for Emotional Wellness

Principal Consultant and Creator, AI-Integrated Emotional Wellness

In medicine, there’s a concept known as “the golden hour.” It represents a crucial period during which prompt medical intervention can significantly improve the chances of survival. For example, when faced with profuse bleeding, emergency responders don’t wait—they act immediately.

There’s a comparable window of opportunity in crisis response—one in which all caregivers can say and do the right thing early on to address the “emotional hemorrhage.”

Despite advancements in trauma-informed care, psychological/crisis intervention remains largely reactive—often provided weeks or even months after exposure to a traumatic event.

Over twenty-five years ago, I created Acute Traumatic Stress Management™ (ATSM) as a “traumatic stress response protocol” for emergency responders. My objective was to reach people early, during, and in the immediate aftermath of a crisis to prevent acute stress reactions from becoming chronic and debilitating stress disorders.

This article introduces the contemporary integration of ATSM with AI-Integrated Emotional Wellness™ (AIEW)—the ethical and responsible interface between the cognitive abilities of artificial intelligence (AI) and the depth, uniqueness, and complexity of human emotion. AIEW incorporates the accessibility of AI’s evidence-based strategies, techniques, and support while recognizing the irreplaceable role of authentic human presence.

Together, ATSM and AIEW offer a practical, human-centered approach that can address emergent psychological needs in real time, during a crisis, to ease emotional pain, keep people functioning, and mitigate ongoing suffering.

An Opportunity for Emotional Wellness

A crisis is the psychological response to a traumatic event that overwhelms an individual's coping and problem-solving abilities. During such an event, the priority must always be the stabilization of injury and the preservation of life. However, in the vast majority of cases, there’s also an opportunity for first responders to raise their level of care by addressing the whole person—including acute emotional needs.

From a psychological perspective, during peak emotional experiences, people are highly suggestible and vulnerable. Saying and doing the right thing (e.g., “I’m here for you”) and avoiding the wrong thing (e.g., “This could’ve been much worse”) can have a profound impact on how people respond in the aftermath of a crisis.

Historically, psychological intervention arrives after people have experienced acute stress reactions and developed chronic stress disorders. This timely article proposes a fundamental shift in approach: intervention can, and should, occur during the earliest phase of traumatic exposure.

Acute Traumatic Stress Management™ (ATSM)

ATSM was developed to address the emergent psychological needs of individuals in the midst of crisis. It’s not psychotherapy, nor is it critical incident stress debriefing. Rather, it’s a goal-directed, real-time intervention framework designed to keep people functioning and mitigate ongoing suffering during and in the aftermath of a traumatic event.

After the release of Acute Traumatic Stress Management (ATSM), I was called upon by the FBI to address acute emotional needs after the attack on the World Trade Center on September 11, 2001. I was then appointed as an expert consultant by the United Nations Department of Safety and Security in New York and Paris, France, and served as a guest instructor at the Federal Law Enforcement Training Center (FLETC) for the U.S. Department of Homeland Security. I then presented ATSM in hospital systems; pharmaceutical companies; airlines; small businesses and large corporations; universities and schools; and EMS, police, and fire departments—both domestically and internationally.

This was an exciting and fulfilling chapter in my career, but it pales in comparison to the potential of integrating ATSM with AI-Integrated Emotional Wellness today.

First, let me provide an overview of the 10 Stages of Acute Traumatic Stress Management that can be implemented during a critical incident. The first four stages are of primary importance to EMS personnel, situation management, and emergency medical care. All caregivers can implement the latter six stages.

It’s important to recognize that the nature of the event, time constraints, the developmental level of victims, and the intensity of individuals’ reactions will vary during traumatic exposure. Consequently, appropriate intervention may not fall neatly into a linear progression of stages. Given the presenting circumstances, you’ll need to be flexible.

1. Assess for Danger/Safety for Self and Others

Upon arriving at the scene, assess the situation to determine whether there are factors that can compromise your safety or the safety of others. You’ll be of little help to someone else if you’re injured—or worse. For example, don’t enter an environment that may be compromised by dangerous gases without the appropriate gear. If possible, remove people from the location, the "inner perimeter," to prevent further traumatic exposure.

2. Consider the Mechanism of Injury

Form an initial impression of those impacted by the event. To understand the nature of exposure, it’s important to assess how the event may have physically impacted the individual—how environmental factors transferred to the person. For example, if people are unconscious, it’s important to know what factor or factors led to their loss of consciousness.

It’s also important to consider the perceptual experiences of victims. For example, directly observing people mutilated after a suicide bomber attacked a crowded bus will have a powerful impact on those who observe the incident. Similarly, the sounds of people screaming in the wake of such an attack will etch a lasting impression in the minds of all who arrive at the scene to help. I refer to this as "the imprint of horror."

Ask yourself whether it’s necessary for you to expose yourself to the inner perimeter. Direct exposure to a gruesome scene can compromise your ability to address emergent psychological needs.

3. Evaluate the Level of Responsiveness

Determining if an individual is alert and responsive to verbal stimuli is important. Are they aware of what has occurred or what’s presently occurring? Do they feel pain? Are they being influenced by a substance?

During a traumatic event, the individual may be experiencing “emotional” shock. Therefore, symptomatology may mimic acute medical conditions (i.e., rapid changes in respiration, pulse, blood pressure, etc.). Recognize that a psychological state of shock may be adaptive in preventing the individual from experiencing the full impact of the event too quickly. For example, in the case of a terrorist attack in a subway, many people will emerge on the street from the stairways and stare blankly while first responders attempt to engage them in conversation. This lack of responsiveness may not be the effect of a physical agent but rather the effect of acute traumatic stress. This reaction is not unusual.

During traumatic events, people experience a wide range of emotional reactivity.

4. Address Medical Needs

Emergency responders are trained to assess the ABCs (i.e., airway, breathing, and circulation). They understand that if an individual is not breathing, little else can be done to help them. Emergency responders also understand the importance of addressing significant symptomatology (e.g., severe chest pains) and knowing about existing medical conditions (e.g., diabetes). They’ve also been trained to recognize injuries that may threaten life (e.g., internal bleeding).

Medical intervention must be provided only by trained emergency medical personnel. Consider the potential danger of moving a young woman found outside a derailed train. Despite the best intentions of good samaritans, the woman may have suffered a back injury, and movement could cause permanent injury to her spinal cord.

Life-threatening illness and injury must be addressed before psychological needs.

5. Observe and Identify

Observe and identify those who've been exposed to the event. Very often, these individuals will not be the direct victims. They may be secondary, vicarious, or hidden victims. Witnessing or even being exposed to another individual who's faced traumatic exposure can cause traumatic stress.

As you observe and identify who's been exposed to the event (i.e., directly and/or indirectly), begin to observe and identify who's evidencing signs of traumatic stress. An awareness of the emotional, cognitive, behavioral, physiological, and spiritual reactions suggestive of traumatic stress is important. Carefully look around you. Anyone, including yourself, may be a direct or hidden victim.

This observation and identification stage of ATSM may be viewed as the first traumatic stress-specific stage.

6. Connect with the Individual

During a crisis, introduce yourself and let people know your role (e.g., “My name is Ron; I’m a paramedic and firefighter with the Melton Fire Department.”). If the individual isn't physically injured and has been cleared by emergency medical personnel, move them away to prevent further traumatic exposure. Begin to develop rapport by trying to understand and appreciate their experience. A simple question such as, “How are you doing?” may be used to engage the individual. Use appropriate non-verbal communication (e.g., eye contact, body turned toward them, a gentle touch, etc.).

Recognize that during a traumatic event, individual reactions may range from a detached, withdrawn reaction to the most intense displays of emotion (e.g., uncontrollable crying, screaming, panic, anger, fear, etc.).

During a crisis, you may find yourself working to connect with small groups of people.

7. Ground the Individual

When you have established a connection with someone (or people) exposed to a traumatic event (e.g., eye contact, body turned toward you, dialogue directed at you, etc.), you can initiate this grounding stage. Begin by acknowledging the traumatic event at a factual level. 

Attempt to orient the person by discussing the facts surrounding the event. Address the circumstances of the event at a cognitive or thinking level. While we do not discourage the expression of emotion, we attempt to focus on the facts in the here and now and help the individual to know the reality of the situation. Their “reality” may be seriously clouded due to the nature of the event.

Remember, traumatic events overwhelm an individual’s coping and problem-solving abilities. Assure the individual that they're now safe, if they are. They may still be “playing the recording” of the event repeatedly in their mind. By reviewing facts, you may disrupt “negative cognitive rehearsal” (i.e., repetitive, potentially destructive thinking), ground the individual, and help them to deal with the circumstances at hand.

It’s important to “place the individual in the situation.” Encourage them to “tell their story” and describe where they were, what they saw, what it sounded like, what it smelled like, what they did, and how their body responded.

Encourage people to discuss their behavioral and physiological response to the event rather than “how it felt.”

8. Provide Support

Factual discussion and the realization of a traumatic event, particularly when the event is unfolding, will likely stimulate thoughts and feelings. This is often the time when individuals who are exposed to trauma need the most support. However, it’s also when many people look the other way. Many individuals feel unprepared to handle others’ painful thoughts and feelings. Oftentimes, they fear that they’ll “open a can of worms” or “say the wrong thing.” Generally, a reasonable attempt to help others is preferable to avoidance.

It’s important to establish and maintain a facilitative or helping attitudinal climate. Here, you attempt to understand and respect the uniqueness of the individual—the thoughts and feelings they’re experiencing. You strive to “give back” a sense of control that's been “taken from them" by their exposure to the event. Support them and allow them to think and feel.

Remember this: it’s generally not what you say that helps people the most—it’s often what you don’t say.

Many people will experience an overwhelming sense of aloneness and withdraw into their world in the face of a traumatic event. You should make a respectful effort to “enter that world” and help the individual know that they're not alone and that their unique perception of their experience is important.

Don’t attempt to talk a person out of a feeling (e.g., “Don’t be scared; everything will be fine"). Communicate an appreciation of the other person’s experience. Attempt to understand the feelings behind their words (or perhaps actions) and convey that understanding to them.

Developing empathic listening skills is an area that should be addressed before a crisis.

9. Normalize the Response

While you’re attempting to support an individual by allowing them to express their thoughts and feelings, begin to normalize their reactions. This is an important component when intervening with people who’ve been exposed to trauma and who may be feeling very alone.

Experiencing a cascade of emotions, or perhaps a lack of emotional reactivity, may cause them to feel as if they're “losing it” and, perhaps, “going crazy.” Normalizing and validating an individual’s experience will let them know that they’re a normal person trying to deal with an abnormal event.

Don't become sympathetic and overidentify with the situation with statements such as "I know what it feels like... When I was…" Rather, you should proffer statements like, “I see this is overwhelming right now... Seeing a friend badly injured would be very hard for anyone to handle. I’m here for you.”

An important component of the normalization process is to begin educating the individual by helping them understand how people typically respond to traumatic events. As time allows, discuss the emotional, cognitive, behavioral, physiological, and spiritual reactions people frequently experience.

Remember, these reactions don’t necessarily represent an unhealthy or maladaptive response. Rather, they may be viewed as normal responses to an abnormal event.

10. Prepare for the Future

The final phase of the ATSM process aims to prepare the individual for what lies ahead. It’s helpful to: (1) review the nature of the traumatic event, (2) bring the person to the present, and (3) describe likely events in the future. The educational process initiated during the previous Normalization Stage should continue during this final stage of ATSM.

Be careful not to tell someone, as you near the end of your intervention, that “everything is going to be okay” or that “everything is going to work out.” These “band-aid” statements may minimize an individual’s feelings and cause them to feel misunderstood. Instead, focus on the facilitative attitudinal climate that you’ve established—“I’m glad I had the opportunity to be here with you.”

ATSM is not counseling or psychotherapy, and it’s not a "crisis response plan." Rather, it provides a roadmap that can guide individuals through times of crisis, keep people functioning, and mitigate long-term emotional suffering.

AI-Integrated Emotional Wellness™ (AIEW): Extending Real-Time Support

While Acute Traumatic Stress Management™ (ATSM) provides a structured, person-centered framework for intervention, AI-Integrated Emotional Wellness™ (AIEW) extends its reach through the ethical and responsible integration of artificial intelligence.

AIEW allows for the delivery of accessible practical strategies and techniques when individuals are most vulnerable and when trained caregivers may not be immediately available. During this critical time, AI systems can offer timely guidance that helps individuals ground themselves, better understand and normalize their emotional reactions, and engage in adaptive, evidence-based coping strategies. Rather than waiting hours, days, weeks, or months for support, AIEW makes it possible to begin the stabilization process in real time—when it matters most.

However, at its core, AIEW is guided by a fundamental and unwavering truth: while technology can inform, guide, and support, it can’t replicate the depth, nuance, and healing power of authentic human presence.

Face-to-face human interaction remains essential for emotional healing and, ultimately, emotional wellness.

Conclusion

Traumatic stress—our feelings, thoughts, actions, and physical and spiritual reactions when faced with a traumatic event—can begin at the moment of exposure, and so too can our response. By integrating Acute Traumatic Stress Management™ with AI-Integrated Emotional Wellness™, we create a framework for addressing emergent psychological needs during the earliest phase of traumatic exposure.

By reaching people early, during a crisis, we can potentially prevent acute difficulties from becoming chronic and debilitating stress disorders. We can foster emotional wellness.

This model represents an evolution in emergent psychological care during times of crisis. It affirms that while technology can provide accessible evidence-based strategies, guidance, and support, it will never replace the authentic presence of people—humanity.

AI-Integrated Emotional Wellness Consulting