Cognitive Flexibility as a Mechanism of Change: The Relationship Between Cumulative Trauma Exposure and Stress Reactions Before and After Psychological First-Aid Training

Purpose: Cumulative exposure to stressful and traumatic incidents can lead to mental deterioration, often resulting in overwhelming feelings of fear, threat, and helplessness. Previous studies revealed that cognitive flexibility plays a significant moderating role in the relationship between trauma exposure and such aversive emotional outcomes. The aim of the current study was twofold: first, to examine the potential impact of participation in a psychological first-aid cognitive-focused training on cognitive flexibility, as well as on feelings of fear, threat, and helplessness. Second, to test whether cognitive flexibility serves as a mechanism of change. Specifically, to determine whether it moderates the relationship between cumulative trauma exposure and feelings of fear, threat, and helplessness following (but not before) the training. Methods: One-hundred seventy-two educational counselors, whose professional routine includes constant exposure to trauma and stress, were assessed before and after a 10-week psychological first-aid training, which equipped them to respond effectively and support others during traumatic incidents. Results: The results revealed increased cognitive flexibility and reduced feelings of fear and helplessness following the training. Moreover, before the training, trauma exposure was positively associated with feelings of fear, threat, and helplessness, with no specific role for cognitive flexibility. Following the training, cognitive flexibility moderated the relationship between traumatic exposure and feelings of threat, acting as a protective factor that mitigates this effect. Conclusions: The results highlight the importance of psychological first-aid training in reducing aversive feelings, improving cognitive flexibility, and prompting it as a protective factor against the deleterious effects of cumulative trauma exposure.