Second Aid is built on two forms of evidence: established psychological research behind each of its methods, and two years of real-world data from people using its core "Help Me Calm Down" exercise during naturally occurring distress. Together, they provide a rare form of evidence for immediate support: people in distress using the intervention themselves.
The Research Challenge
The greatest limitation in evaluating any immediate-support intervention is that distress cannot ethically be induced in a study: researchers cannot cause someone to have a panic attack in order to test whether a tool helps them.
Even if it were possible, a planned study would not be valid: the research setting itself, from the environment to the awareness of being observed, would alter participants' psychological state, so the results would not reflect distress as it naturally occurs.
Evidence that immediate support works in the moment can only come from real-world use; a controlled study would require unethical induction of distress, and would further not represent naturally occurring distress.
The only way to obtain direct-use evidence is to make an intervention publicly available and observe its use during naturally occurring distress. This is the approach taken with Help Me Calm Down™ (HMCD), which has been used independently by people during real distress since 2024 and is now the "Help Me Calm Down" exercise in Second Aid.
"Help Me Calm Down" is Second Aid's core stabilisation exercise and its most important. It is the first option users see in distress, alongside "Talk to someone", with all other exercises shown only after selecting "See more".
Evidence Across Approaches
Each approach is supported by a different form of evidence, reflecting how it is delivered.
| Approach | Primary evidence basis | Direct-use evidence |
|---|---|---|
| PFA | Expert consensus (WHO, 2011) | No |
| MHFA | Training outcomes: trainees' knowledge, stigma and helping behaviour | No |
| HMCD | Established psychological methods, plus two years of real-world use | Yes |
Second Aid therefore draws on two distinct forms of evidence:
- Scientific research provides a basis for the individual psychological methods used in the exercises.
- Two years of real-world data from HMCD, the original standalone version of the "Help Me Calm Down" exercise, provide direct-use evidence: whether people voluntarily access, independently use and report benefit from a self-use stabilisation intervention during naturally occurring distress.
Neither evidence source, by itself, establishes the clinical effectiveness of Second Aid as a complete system.
Psychological First Aid
Psychological First Aid (PFA) is an established approach to providing humane, supportive and practical assistance following highly distressing events. The World Health Organization's 2011 guide describes PFA as support that respects an individual's dignity, culture and abilities.
PFA may involve helping somebody feel safe and calm, listening without pressure, identifying immediate needs, providing practical assistance and connecting them with information and social support.
Second Aid is informed by aspects of this framework, particularly the importance of immediate stabilisation and access to further assistance. However, traditional PFA commonly involves another person providing support. Second Aid addresses a different delivery question: can some immediate stabilisation support be accessed directly by the person experiencing distress?
Its purpose is not to reproduce the full scope of PFA. Self-stabilisation and human-delivered psychological support can operate alongside one another.
The broader Psychological First Aid framework is explained at: https://psychologicalfirstaid.com
Psychological Methods
Each Second Aid exercise combines methods drawn from established psychological therapies, including CBT, ACT, mindfulness-based therapies and grief therapy. The research behind each method provides a rationale for its use, but does not by itself establish the effectiveness of the complete exercise in which it is used.
- Paced breathing
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Slow diaphragmatic breathing with a longer exhale, associated with increased parasympathetic activity and reduced physiological arousal.
Used in: Calm
- Affect labelling and emotional differentiation
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Naming and distinguishing emotions, linked to reduced limbic reactivity to distressing stimuli.
Used in: Calm, Grief, Clarity
- Cognitive defusion
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Observing thoughts and emotions rather than identifying with them, a core process in Acceptance and Commitment Therapy.
Used in: Calm, Loneliness
- Emotional processing and reappraisal
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Revisiting emotions and changing how they are interpreted, to reduce emotional intensity and strengthen positive affect.
Used in: Calm
- Expressive writing and continuing bonds
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Writing to process unresolved emotions and maintain connection while adapting to loss, widely used in grief therapy.
Used in: Grief
- Meaning reconstruction
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Placing loss within a broader context to reduce perceived isolation and support emotional adaptation.
Used in: Grief
- Behavioural activation and cognitive load regulation
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Identifying mental and physical overload, then guiding practical adjustments to restore balance and control.
Used in: Overwhelm
- Shadow work and self-disclosure
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Acknowledging hidden parts of the self to reduce shame, increase self-acceptance and weaken perceived disconnection.
Used in: Loneliness
- Parts work and metacognitive awareness
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Relating emotions to different parts of the self to increase self-observation and insight.
Used in: Clarity
The exercises draw on these therapies but are not therapy themselves. The core "Help Me Calm Down" exercise has been evaluated in real-world use through the HMCD study below.
Two-Year Study
Publicly available from April 2024, Help Me Calm Down™ (helpmecalmdown.com) was the predecessor to Second Aid: an immediately accessible self-use calming tool for people experiencing acute emotional distress. It now forms Second Aid's core exercise of the same name, making this evaluation the evidence base for Second Aid's most important stabilisation tool.
Unlike an intervention delivered through a recruited clinical study, HMCD was available through ordinary websites and mobile applications. People could independently discover and initiate the exercise without a researcher, therapist or trained facilitator. This is what makes the data direct-use evidence: it reflects people using the intervention themselves, during real distress.
A retrospective evaluation examined activity and feedback collected between 4 April 2024 and 4 April 2026.
The study asked one central question: can people self-stabilise with a self-use tool during acute emotional distress?
The evaluation was observational, not a randomised controlled trial; as above, acute distress cannot ethically be induced, and a controlled setting would alter the psychological state being studied.
The HMCD Tool
The intervention consisted of three stages.
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Abdominal Breathing
Users followed an animated breathing exercise designed around paced diaphragmatic breathing. The exercise guided inhalation and exhalation using visual instructions. The purpose was to support a reduction in heightened physiological and emotional arousal.
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Emotion Check-In
Users were presented with a structured list of emotions. They identified their current emotional state by indicating whether individual emotions were present, partially present or absent. This stage drew on affect labelling and emotional differentiation.
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Embracing Peace
Users revisited selected emotions within a guided breathing exercise. The process encouraged attention to emotional states while following structured regulation prompts.
The intervention combined established or conceptually related psychological techniques into one continuous self-guided experience, supported by calming audio and visuals. The combined sequence had not previously been established as a clinical treatment.
Available Data
HMCD generated real-world data through both its website and its mobile applications. Over the two-year study period, Cloudflare and Google Analytics recorded the following website activity:
- 494,939website visits
- 83,863completions of Step 1
- 64,136completions of all steps
Over the same period, the HMCD mobile applications recorded 5,041 installs, together with 154 ratings and 60 written reviews. These ratings and reviews are essential to the study: self-reported by users after real use, they show not only that the intervention was used, but how effective users found it.
The study therefore focuses its analysis on the mobile application data.
No participant was recruited: each of the 5,041 users independently chose to access the intervention. As set out in The Research Challenge, this is the only way direct-use evidence can be obtained, making these users the study's direct-use participants. Even as a focused subset of HMCD's total use, this represents a substantial participant pool in comparison with the original guidance for PFA and MHFA.
Participants Across Approaches
The original guidance for PFA and MHFA was developed through expert consensus, while the HMCD study draws on people using the intervention directly.
| PFAIndirect: expert reviewers | MHFAIndirect: expert panel | HMCDDirect users | |
|---|---|---|---|
| Participants | 601 | 1672 | 5,041 |
| Basis | International peer review of the WHO guide (2011) | Delphi consensus study for the first MHFA guidelines (2008) | Real-world use (2024–2026) |
The PFA and MHFA figures refer to the experts who shaped their original guidance. The HMCD figure, by contrast, reflects people using the intervention themselves at the point of need: the form of evidence most relevant to evaluating a self-use stabilisation tool.
Study Data
Over the two-year study period, the HMCD mobile applications were installed 5,041 times and received 154 ratings:
- 5,041total app installs
- 94.2%of ratings four or five stars
| Android (Google Play) | iOS (App Store) | |
|---|---|---|
| Total installs | 2,963 | 2,078 |
| Written reviews | 48 | 12 |
| Ratings | 77 | 77 |
| Five stars | 67 | 68 |
| Four stars | 3 | 7 |
| Three stars | 3 | 1 |
| Two stars | 1 | 0 |
| One star | 3 | 1 |
| Four or five stars | 70 (90.9%) | 75 (97.4%) |
| Average rating | 4.69 out of 5 | 4.83 out of 5 |
94.2% of ratings were four or five stars, from people who sought out a calming tool for themselves: an unprompted verdict from the very people it was built for.
These ratings provide evidence of acceptability among users who chose to rate the intervention. They are not direct measures of psychological or clinical outcomes.
Reported Self-Stabilisation
The evaluation also examined written feedback from people who reported using HMCD. Across the written reviews, the following themes were reported:
| Theme | % of written reviews |
|---|---|
| Felt calmer, more relaxed or relieved | 58.3% |
| Stabilised anxiety or stress | 26.7% |
| Stabilised panic attacks | 11.7% |
| Stabilised anger, crying or fear | 11.7% |
| Helped with sleep | 5.0% |
| Wanted slower pacing or more time | 6.7% |
| Felt worse | 1.7% |
Each review is a first-hand account of real distress, met with a self-use tool and no one else present. This is the evidence that, as set out in The Research Challenge, no planned study could produce.
Some users described becoming calmer during or after the exercise. Others described being able to sleep, continue an activity, regain composure or take a next step after using it. Some described recommending it to friends, clients, therapists, nursing students and others experiencing distress. These first-person reports are important because they describe real-world use during naturally occurring distress rather than participation in a supervised study.
Accessibility & Non-Benefit
Not all user feedback was positive:
- Some users described breathing instructions or pacing that were difficult to follow.
- One report described emotional-processing instructions that felt rushed or anxiety-provoking.
These observations are relevant to the safety and accessibility of self-use interventions. They indicate the importance of adjustable pacing, clear stopping options, alternative approaches and continued monitoring for worsening symptoms or physical discomfort.
What the Evidence Establishes
The current evidence supports several conclusions.
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Direct-Use Evidence Exists
The "Help Me Calm Down" exercise is supported by evidence from people using it themselves during naturally occurring distress, collected over two years of real-world availability: a form of evidence rarely available for immediate-support approaches.
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Independent Access Is Feasible
HMCD was publicly available and voluntarily accessed by substantial numbers of users without recruitment or facilitation. This supports the feasibility of distributing a self-use stabilisation intervention through ordinary digital channels.
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Self-Stabilisation Is Possible
The intervention was designed for independent use. Available written reports describe people using it in ordinary circumstances without another person administering the exercise.
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Acceptability Is Supported
The available Android and iOS ratings were strongly positive among users who chose to submit ratings. This provides an acceptability signal, although ratings may not represent the experience of all users.
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Users Report Immediate Benefit
Available first-person accounts describe calming and improved composure during naturally occurring distress. These reports support the conclusion that self-reported stabilisation occurred among some users.
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Clinical Efficacy Is Not Yet Established
The study did not measure validated psychological outcomes before and after use across a representative sample. It did not include random assignment or a control group. Therefore, it cannot determine a causal effect size, the proportion of all users helped or the intervention's comparative clinical effectiveness.
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System-Level Outcomes Are Not Yet Established
The study did not evaluate suicide rates, mental-health service demand, workplace absenteeism, healthcare expenditure or population-level outcomes. These remain proposed effects requiring further investigation.
The study confirmed people can self-stabilise with a self-use tool during acute emotional distress.
Ongoing Research
Further evaluation is required to measure the performance of Second Aid as a complete infrastructure. Priority questions include:
- How often do users report improvement after using an exercise?
- Which emotional circumstances are associated with reported benefit?
- Which users encounter accessibility difficulties?
- How often do users seek further human support?
- How does physical QR deployment affect discovery and access?
- Does Second Aid change patterns of support-seeking in organisations?
- What are the longer-term effects, if any, on service demand and serious outcomes?
Second Aid has introduced a simple end-of-exercise helpfulness question to support additional anonymous evaluation. Further research should preserve the low-friction, private nature of the intervention. The objective is to obtain stronger outcome evidence without introducing unnecessary barriers for people experiencing distress.