Compassion, calming down and providing aid are common ways of helping people in need soon after traumatic events. However, such forms of help were seldom tested and other research suggests that active coping may have more positive long-term effects. The SIX C's model was created to provide simple and effective evidence-based Psychological First Aid guidelines that help shift the person from helpless into active and effective activation in a very short time. The model emphasizes the need for cognitive communication as well as effective activation in contrast to the previous concepts of calming and emotional communication

This retrospective cross-sectional study examined empirically the SIX C's Model's basic concepts. We checked the association between whether people received activating versus more passive forms of aid during crises, their self-efficacy and post-traumatic stress disorder (PTSD) symptoms. 428 participants completed scales on the type of aid received during past traumatic events including activating aid (encouraging active and effective responses) versus passive aid (receiving compassion, calming down and general aid), as well as their current general self-efficacy (GSE) and PTSD symptoms

Results revealed that passive aid was not related to PTSD while activating aid correlated inversely with PTSD. Importantly, both resilience and GSE emerged as mediators and moderators between activating aid and PTSD. The moderation showed that receiving activating aid was associated with less PTSD only in people low on resilience or GSE

The study revealed a major role for self-efficacy in protecting people from PTSD. Self-efficacy not only statistically mediated the relationship between active aid and PTSD but also moderated this relationship. The findings underline the importance of encouraging the person to act effectively during the event and to maintain cognitive communication. This type of aid leads to increased self-efficacy and contributes to the reduction of risk for PTSD.