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The emergency psychologist during COVID-19 pandemic
Sandra Rossi1,2, Roberta Carbone 1,2, Enrica Pedrelli 2, Anna Sozzi 2, Giovanna Artioli 1,
Leopoldo Sarli1
1 Department of Medicine and Surgery, University of Parma, Italy; 2 Italian Society of Emergency Psychology Social Support,
SIPEM SoS Emilia Romagna, Italy
Abstract. Background and aim of the work: the new coronavirus pandemic COVID-19 has had a strong psy-
chological impact on the world population. Volunteer psychologists, and psychologists that work in the emer-
gencies have also been exposed to the consequences of the impact of the pandemic. e purpose of this study
was to explore the experiences of the psychologist during the Covid-19 emergency intervention. Methods:
an exploratory study, following a qualitative design using Focus Group method was adopted. A total of 24
psychologists was recruited from volunteers of the “Pronto Psy - Covid-19” service, organized by the Ital-
ian Society of Emergency Psychology Social Support, Emilia Romagna. Focus Group Discussions (FGDs)
was held about: their experiences during the online psychological support; needs detected by users; training
needs that emerged during the intervention and professional skills applied. Results: five themes were identi-
fied: psychological distress of rescuers; online emergency setting; support of colleagues and gratitude as stress
management strategies; need of skill and tools in pandemic emergency intervention; integrated psychological
intervention. Discussion: the stress reaction of the emergency psychologists was due in particular to the type of
emergency and lack of standardized approach. e group meetings represented an important resource to face
traumatic stress. Conclusions: this study showed the role the need for specific tools for pandemic intervention
to protect the well-being of the professional from impact of stress. Further research is needed.
Key words: Qualitative research, emergency psychologist, Pandemic COVID-19, psychological stress, online
psychological support, Italian, qualitative research, focus group
Introduction
In December 2019, an outbreak of a new coro-
navirus pneumonia compare Wuhan (Hubei, China).
During the following weeks, other significant out-
breaks caused by the novel coronavirus were reported
around the world. e occurrence of epidemics has
always generated specific psychological reactions in
entire communities, changing people’s behaviors and
their habits (1). e COVID-19 pandemic had world-
wide devastating effects, affecting the physical and
mental health of the population, economic activity,
society and the environment (2-4). In response to the
highly contagious nature of the virus and rapid one-
to-one transmission, governments took unprecedented
containment measures, including severe restrictions on
free movement, self-isolation and social distancing (5,
6). All these measures had a strong impact on the daily
life of the population, negatively affecting physical
and psychological well-being (7, 8). e extent of this
pandemic, due to its characteristics, represented expo-
sure to symptoms of traumatic stress reactions such as
alertness, somatic anxiety, feelings of anger, hopeless-
ness to manage lifestyle changes , physical and mental
fatigue, insomnia, thoughts of death, a general sense of
fear, uncertainty, and anxiety ( 9, 10-12). In emergency
settings a first important intervention: the most im-
portant is to remove the person from the danger zone
Acta Biomed 2021; Vol. 92, Supplement 2: e2021508 DOI: 10.23750/abm.v92iS2.12326 © Mattioli 1885
Original article: Health professions and Covid Related Issues
Acta Biomed 2021; Vol. 92, Supplement 2: e2021508
2
and put him in safety (13). However, the COVID-19
pandemic did not allow an intervention of this type the
immediate life threatening (14). Guidelines for emer-
gency interventions to reduce the psychosocial out-
comes of the COVID-19 outbreak, issued by the Chi-
nese National Health Commission, consisted of the
implementation of psychological teams, usually made
up of psychiatrists, health professionals, and promot-
ing online psychological support (15). Subsequently,
WHO addressed the issue of emergency psychosocial
support by for the intervention of psychiatrists and
mental health professionals to help both patients and
the general population (16). Several countries have es-
tablished procedures for psychological crisis interven-
tions to deal with public health emergencies (17,18,
19,). us, all over the world, governments developed
to support people who experienced anxiety or psycho-
logical distress due to COVID-19; in Malaysia (20)
Tunisia (21) , in South Korea (22) but also in Europe
Germany (23) and France, (24) organized online sup-
port services. In Italy from 3 March 2020 an example
of the first online aid stared from the Italian Society
of Emergency Psychology ȘoŞ Social Support, Emilia
Romagna, involving a group of professional psycholo-
gists, volunteers, that opened the service:“Pronto Psy -
Covid-19” (25). However, psychologists, volunteered,
like the rest of the population, suffered from the conse-
quences of the pandemic too. Psychotherapists work-
ing remotely amid a global health showed a need for
personal and professional support crisis about their
professional practices and experiences during the pan-
demic (26). Healthcare professionals during pandemic
have been substantially exposed to the risk of direct
trauma (first level victims, i.e. when those who directly
suffer the critical event) and to the risk of vicarious
trauma. In fact, health workers have found themselves
in a position to provide help in complex situations,
having to balance their personal physical and mental
health needs with those of users and patients for an
indefinite period of time and in conditions of extreme
difficulty (11). It is important to increase understand-
ing of and account for significant distress experienced
by psychologists who provide treatment. Although
psychologists are trained to recognize and account for
personal issues that may interfere with their ability to
meet their patients’ needs, the global disruptions expe-
rienced by all humans (including psychologists), may
have created an unusual situation of lacking the neces-
sary self-care coping strategies (27).
Aims
e principal purpose of this study is to explore
the experience of volunteer psychologists about their
intervention during COVID-19 pandemic. Specifi-
cally, to investigate which intervention tools and tech-
niques they used in the provision of psychological (on-
line) support.
Materials and methods
A qualitative general approach was adopted with
Focus Group Discussion methods (FCD) holded from
June to December 2020. FGD research is a way of
collecting qualitative data, which essentially involves
engaging a small number of people in an informal
group discussion (or discussions), ‘focused’ around a
particular topic or set of issues (28). FGDs in their
structure create a non-judgmental climate that helps
participants discuss their perceptions, ideas, opinions
and thoughts (29).
Context and method of sampling.
e sample was recruited using a purpose sam-
pling method among the 30 volunteer psychologists
who intervened in psychological support “Pronto Psy
- Covid-19” service, during the lockdown period from
3 March to 30 May 2020 (25).
Ethics
Participants received an explanation of the pur-
pose and significance of the research undertaken and
after approval, which was intended to obtain the state-
ment of consent. Interviews were conducted approve
the video recording of the discussions, conducted re-
motely on the platform zoom, in order to obtain the
greatest number of information and fidelity of the ver-
batim transcripts with guarantee of non-disclosure of
the images.
Acta Biomed 2021; Vol. 92, Supplement 2: e2021508 3
Data collection
FGDs took place in videoconferencing led by an
experienced moderator psychologist, who recorded the
session after formal consent was given. e moderator
is responsible for facilitating discussion, getting mem-
bers to talk, requiring overly talkative members to get
others to talk, and encouraging all members to par-
ticipate (30). An observer, psychologist of the research
team took part in each focus group and, guided by an
observation grid, provided supportive data consisting
in a description of the participants’ verbal and non-
verbal communication and interactions.
In the FGDs, a semi-structured guide was used
to investigate: the psychologist experience; the profes-
sional skills used in triage; psychological support and
the psychologist’s training needs emerged during the
intervention (table 1).
Data Analysis
e participants were 24 volunteer psychologists
who worked at the service “Pronto-Psy Covid-19”.
Four FGDs were formed with an average of 6 partici-
pants each group. e research interdisciplinary team,
psychologist and researcher, codified qualitative data,
derived from the interaction of the group during the
discussions. A framework method was adopted to ana-
lyze the emerging themes (31, 32). e FGDs were
videotaped and verbatim transcribed (word for word)
manually. After this, the team moved on to the “open
coding” of the transcripts line by line, conducted inde-
pendently by 4 researchers 1 for each focus group. e
researchers defined and isolated extracts (Participant
Quotations), and cataloged by assigning codes. Each
Participant Quotations had a progressive number of
the identification (eg Focus Group-FG, Participant
n.5. Participant Quotations 01, 02...). Data resulted
in 4 code books (see table 3). In the last data analysis
step, the research team discussed the principals themes
emerging from the code books (33).
Results
Participants sociodemographic characteristics are
described in table n. 2. e psychologist volunteers’
experiences related to psychological support could be
summarized in five themes:
Theme 1: psychological distress of rescuers
e psychologist volunteers was victim too of the
restrictions introduced by the strict lockdown the first
Table 1: Focus Group Discussion guide
Areas Of Investigation Inputs / Objectives
e psychologist’s experience Input:
- What are the personal experiences that emerged during the psychological support intervention?
Objective:
- Identify the psychological impact on the psychologist volunteers as rescuers.
Kinds of needs detected by users Input:
- Did the requests specifically concern issues related to Coronavirus?
- Did the need identified correspond to the initial request reported by the user?
Objective:
- describe the characteristics of the psychological support needs. of users of the Pronto-Psy
Covid-19 service
e psychologist’s training needs
emerged during the support in-
tervention
Input:
- Did the requests specifically concern issues related to the Coronavirus?
- Did the need identified correspond to the initial request reported by the user?
Objective:
- identify the training needs of the front-line psychologist in a pandemic emergency.
Professional skills used in the
intervention of triage and psy-
chological support
Input:
- Which skills were found useful during the triage and psychological support intervention?
- Was more specific training needed?
Objective:
- Explore first the skills applied in emergency contexts
Acta Biomed 2021; Vol. 92, Supplement 2: e2021508
4
months of the pandemic, which required a reorganiza-
tion in the same environments of working and family
life:FG 4.3.22 “We found ourselves facing the emergency
in which we ourselves were inside the emergency”.
FG1, 6. 06 “The greatest effort was the resistance
over time, because the effort to find moments of decom-
pression was an extremely long emergency ... I felt tight,
because there was this correspondence between the place
of work, the place of private life, an entanglement that is
sometimes difficult to manage, but not so much a priori as
in the long term”.
FG2 2.03 “For me too it was very tiring for the same
reason, because I lost human contact”.e psychologists
in the role of rescuer and victim of the emergency must
manage the emotional resonance:
FG1 1.03 “… in particular, obviously also being
inside the emergency when someone might express some
thoughts on that day it came to mind rightly because I too,
that is we too, were victims of the emergency. e ...”.
FG2 1.06 “I had a certain intolerance in manag-
ing them, weakness on my part, because then, among other
things, it coincided with an important bereavement, in my
family circle…”. FG2 4.02 “This regret, the fact of not be-
ing able to do enough, not being able to manage the family
question, because we were all also victims of this emergency”.
Theme 2: online emergency setting
e psychologists found very difficult to use the
telephone or the computer to get in touch with patients
to conduct interviews. e video call or telephone call
can be distancing or, on the contrary, an intrusive tool.
In fact, the user may indirectly expresses the need (or
not) for proximity, due to the lack of human contact
but also for the technical problems encountered:
Table 2. Participants sociodemographic characteristics
Total Number (N) 24
Female (N) 23
Men (N) 2
Average age 45% years
Number of participant as member of the
SIPEM Association more than 10 years
7
Number of participant as member of the
SIPEM Association from year 2020
4
Average numbers of years as member of the
SIPEM Association
5,32%
Number of participants Psychotherapist 19
Table 3 Experiences of volunteers Psychologist
Theme Category Sub-Category
Psychological distress
of rescuers
1. e professional as a victim
and rescuer
2. Dissatisfaction
3. Sense of helplessness
Fatigue
4. Anxiety of contagion
The setting of psychological intervention generating the loss of boundaries
between private life and volunteer service.
Fear of contagion.
Be on the same level as the victim.
Overburdened in interviews with people who were grieving.
A need to want to do more and a feeling of not being able to do enough.
Fatigue in managing the many requests and the amount of work
Lack of physical connection between professionals and service users.
Online Emergency
setting
1. Difficulty in managing the
emergency intervention for a
prolonged time
Difficulty in the first period of not being able to send to the local structures of the
health system
Difficulty for the request to give continuity to the support
Support of colleagues
and gratitude as
strategies to stress
management
1. Sense of belonging
2. Needs support from colleagues
3. Need for comparison
Gratitude
The support of colleagues as a personal and professional coping strategy
Supervision with colleagues
Gratitude from the users of the service
Feedback from users of the service
Need of skill and
tools in pandemic
emergency
intervention
1. New type of emergency
intervention
Experienced frustration of the professionals rescuers due to lack of experience,
skills and tool in a pandemic covid-19
Frustration of the professionals due to lack of experience, skills and the tool used.
Integrated
psychological
intervention
1. Training in emergency
psychology
Training contents on Psychotraumatology approach
Neurophysiological knowledge of the circuits of fear, alarm, anxiety.
Emotional Stabilization techniques
Sensory-motor approach to fear management
Acta Biomed 2021; Vol. 92, Supplement 2: e2021508 5
FG3.1.02 “... we found ourselves without very spe-
cific settings ... we found ourselves directly in people’s homes
... therefore people who perhaps also had difficulties in us-
ing information technology”.
FG4.1.09 “... it was a new mode, that is the one of
the call or the video call, so there is a whole different feel-
ing, so it is also different to make your presence felt to the
user. And certainly also trying to do something in that time
frame we had ”.
FG2 3.07 “Then spend, an hour on the phone with
people … clearly still became difficult ... being able to un-
derstand, ... the silences for me it was quite difficult, and
therefore, in some moments a bit of a sense of helplessness ...”.
Theme 3: Support of colleagues and gratitude as
strategies to stress management
e comparison with colleagues, was configured
as community support, that allowed the exchange of
experiences, materials, that represented a resource to
address the difficulties that emerged during the psy-
chological support intervention:
FG2 5.04 satisfaction in the sense that the experi-
ence, then, is not just a positive experience. heavy, I am also
considered very lucky. In the sense that not only my dearest
loved ones, our family and friends, have been affected, nei-
ther directly nor indirectly, by the COVID”.
FG3.8.02 “But what helped you was the referral
from the people themselves who continued to thank they
said they were relieved at the end of the interview and this
was a reason no, to go on it gave a lot of strength, it gave
meaning to that what we were doing”
Theme 4: needs of skill and tool in pandemic emer-
gency intervention
e need that emerges from voluntary psycholo-
gists is most of all to have time dedicated to exchange,
discussion with colleagues. Particularly the support
tools provided by the anti-stress meetings, the super-
vision and knowledge sharing sessions: FG2.3.32 “I
felt the need for moments of this kind... exchange between
more informed colleagues, more or less experienced, but
who in any case have all had the same experience, to be-
ing able to understand what the formative space to fill
could be “.
Emerged needs for specific training for the pan-
demic emergency, given by the initial difficulty in adapt-
ing to the new methods with digital tools (telephone ,
video calls) that transform the physical relationship:
FG2 7.05 “There were situations in which at times, I
struggled to understand where to go... what my role was as
an emergency psychologist and I could not unravel the prob-
lem…sometimes just the feeling of not understanding where
to guide the user…So you clearly don’t have a direction to
take...”
Psychologists volunteers reported evolution re-
ferred to service users that required a continuous adap-
tation of the type of intervention. Initially users required
indications on how to manage the state of anxiety, sense
of loneliness, abandonment, sleep problems, fear of con-
tagion: FG 2 3.01“ I saw a bit of the evolution of requests
over time ... at the beginning ... first of all the sense of loneli-
ness. Even those who lived with family or people ... the sense
of abandonment, they felt, alone and under stress”.
FG 2 6.01 “There were users who brought requests, es-
pecially on behalf of third parties, so there was a bit of fear
of not being able to help perhaps the elderly parent, who was
at a distance, so requests were made for the parents, for the
father, for the mother, for the grandfather, so above all the
part of the elderly was a bit carried by the others...”.
Furthermore, the traumatic characteristics of the
COVID pandemic have brought to the surface, in a
more acute way, previous psychological problems, the
fatigue of isolation, parents bereavement, economic dif-
ficulties, difficulty in manage family members at a dis-
tance:
FG3.6.06 “The anxiety of contagion, the fear of conta-
gion and I also followed some users who were infected who
had been hospitalized in intensive care. There were then
some referrals, because the need was certainly also to have to
continue there was an elaboration of the disease, there were
also post-traumatic symptoms that developed immediately”.
FG 1.4.05 With most of the cases, perhaps ... it was an
acute or recurrence of situations ... previous or already ... or
existing, so mmm yes, certainly the effect of Covid, but not
only...”
Theme 5: integrated psychological intervention
e psychologist uses different techniques to al-
low the patient to externalize their moods, emotions
and to reduce the state of anxiety, stress and activation
(e.g., techniques for rebalancing the nervous system,
Acta Biomed 2021; Vol. 92, Supplement 2: e2021508
6
techniques of relaxation and grounding):FG 1. 3. 02
“Empathic listening…psychoeducation with respect to
symptoms… very useful techniques in stabilization and ...
in the moment of fear management”.
FG 3.6.08 “I think that having skills in neurophysi-
ology can also be useful for the emergency psychologist and
try to think that there is not only a cognitive level but that
there may also be body levels that are fundamental”.
FG1. 5. 01 “The most useful techniques were cer-
tainly the stabilization techniques…I went to recover some
techniques in particular on the breath, for example square
breathing is a technique that I was able to notice that for
someone it worked, psychoeducation and also to use tech-
niques which provided for a re-orientation. “
Discussion
is study explore the experience of volunteer
psychologists during outbreak of Covid-19 pandem-
ic. From findings resulted five themes: psychological
distress of rescuers; online intervention setting; sup-
port of colleagues and gratitude as strategies to stress
management; needs of skill and tool in pandemic
emergency intervention; integrated psychological in-
tervention.
e front-line psychologists, to face population
psychological needs, took part in an extraordinary
type of intervention, due to pandemic mutability of
the spread of the Covid-19 virus. Furthermore, it was
characterized by a continuous evolution of the emo-
tional involvement of psychologists, and prolonged
exposure to stress events. ey have been exposed to
traumatic event, that caused symptoms of traumatic
stress reactions afterwards (10).
e peer-groups dedicated to the emotional sup-
port and supervision meetings, helped psychologists
to find out strategies to adapt and face the traumatic
exposure, of being victims of the pandemic and rescu-
ers themselves. e psychologists have been required
to manage these changes through the integration of
different kind of approaches derived from emergency
psychology (34) to stabilize the symptoms of anxiety
and fear. From cognitive and sensory-motor approach
to manage symptoms correlated to traumatic stress
(35, 36). is scenario led them to feel a lack of tools
assessment and intervention to use, in pandemic psy-
chological support .
An effective preparation of operators implies the
education and continuous training of emergency op-
erators, an essential element for anyone who wants
to work in the emergency field. Natural disasters and
extreme emergencies often have predictable patterns
of psychological and behavioral problems in the com-
munity (11).
Conclusions
e study showed the need to address the adverse
impact of the pandemic on staff engaged in psycho-
logical support of the population. Not only due to the
effects related to the characteristics of the type of pan-
demic emergency, but also due to the lack of guidelines
for intervention practices. erefore, it could be useful,
in expectation of pandemic events, to implement and
develop the intervention strategies of mental health
professionals on the front-line, to protect their well-
being from the impact of stress, and to make psycho-
logical interventions efficient on the population.
Further research is required in this field.
Acknowledgments
We thank the voluntary psychologist of SIPEM ER SoS Emil-
ia Romagna, the students of the Master in Psychotraumatol-
ogy and Emergency Psychology of the LUMSA University of
Rome who collaborated in the research, Psychologists of the
Gestalt Institute HCC Italy, the researchers of the Department
of Medicine and Surgery of the University of Parma
Conflict of interest: none to declare
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Correspondence:
Received: 30 May 2021
Accepted: 30 November 2021
Sandra Rossi,
Department of Medicine and Surgery,
University of Parma, Italy
Via Gramsci, 14 - Parma
E-mail: sandra.rossi@unipr.it
