The Golden Hour and Its Relevance in PTSD

Immediately after an adverse and traumatic experience, a decisive window opens for psychological treatment. In fact, if emotional help is received right after a painful event, the mental impact is less.
The Golden Hour and Its Relevance in PTSD
Valeria Sabater

Written and verified by the psychologist Valeria Sabater.

Last update: 15 April, 2023

Have you ever experienced any kind of emotional trauma? If we were to ask this question to the entire population, many would answer with an emphatic “yes”. Some people may even have suffered more than one. In fact, none of us are immune to those unexpected twists of fate when adversity arrives and our equilibrium collapses.

Many people who deal with psychological trauma emphasize the loneliness they felt in these experiences. Indeed, immediately after the event, sufferers seldom receive specialized assistance. These types of circumstances are extremely diverse and sensitive. Furthermore, many sufferers remain silent.

For example, children. They don’t usually share experiences such as abuse or mistreatment with other adults. Even when adults suffer the loss of loved ones or experience something rather complex, they don’t always seek specialized help immediately. They let time go by assuming, perhaps, that the passing of days will alleviate the pain.

However, in these cases, the wound closes with the pain still inside. But, what would’ve happened if they’d been given assistance immediately after the event? We’ll explain.

If we let days and months pass without addressing the impact of a painful experience, the likelihood of post-traumatic stress disorder increases.

Person in striped field who needs support during golden hours
The golden hour represents the window of opportunity for treating an individual immediately after trauma.

The golden hour

When an individual has an accident and receives a blow to the head, they’re admitted to the hospital and receive immediate medical assistance. Doctors assess the possible presence of a brain lesion and take immediate action. They don’t stop and speculate. Obviously, the same isn’t true when people suffer emotional trauma. That said, early intervention would change everything.

As a rule, the golden hour refers to the time immediately after a traumatic injury when it’s likely that prompt intervention will usually prevent death. The term can also be applied in respect of psychological treatment immediately after trauma. Indeed, early clinical care avoids both the short and long-term appearance of numerous psychological disorders, large amounts of suffering, and lives cut short due to experiences of high emotional pain.

Although it’s true that each individual faces these experiences in a different way, an extremely high percentage will end up developing mental health problems. Unsurprisingly, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) includes this concept of the golden hour and its relevance. Moreover, research conducted by the National Post-Trauma Center in Sheba, Israel, confirms its usefulness.

It seems that the time immediately after a traumatic event is decisive in receiving the relevant clinical interventions. In addition, timely intervention reduces the appearance of post-traumatic stress disorder (PTSD).

Psychological traumas are like physical traumas: the more specialized assistance the sufferer receives, the less likely it is that they’ll experience problems in the future.

The mechanisms carried out in the golden hour

Dr. Joseph Zohar, director of psychiatry at the aforementioned Sheba Medical Center, is one of the leading specialists regarding the golden hour. He’s frequently spoken about the most recommended actions in these cases. He’s also suggested which actions should be avoided when dealing with someone who’s just undergone a traumatic experience.

It must be understood that, sometimes, even if an individual’s intentions are the best, certain of their actions may be completely counterproductive. Therefore, let’s explore the most successful mechanisms in these delicate contexts.

1. The blurring of certain facts so that traumatic memory isn’t established

A traumatic event is never forgotten. However, its impact can be minimized so its imprint in the brain isn’t marked by images, thoughts, and emotions that are difficult to handle. In reality, this means that professionals must ensure that the sufferer diverts their attention away from the threat and doesn’t focus on its unpleasant aspects.

Although it may sound surprising, repressive coping mechanisms are useful in this case. They mean the victim places themselves on another mental plane immediately after the trauma. They allow them to not focus on specific details that might unbearably intensify their memory of the event.

2. Provide security, protection, and comfort

One of the essential pillars that must be provided to the victim during the golden hour is protection. Their exposure to stress must be reduced. Therefore, they should be taken to a space where they feel protected and safe. It must also be taken into account that not only is their mind fractured, but the trauma might also be impregnated in their body.

Offering them comfort and restoring an adequate physiological balance is decisive. For instance, providing food, drink, warmth, etc. These factors provide them with security.

3. Expectations of normality and information

After a dramatic, complicated, or stressful experience, the individual remains at a maximum activation level. In effect, their brain is in survival mode. Consequently, their only responses may be fight, flight, or freeze. Professionals must approach them in a calm and relaxed manner, so as not to further intensify their confusion.

Despite the gravity of the situation, it’s most important to provide the sufferer with an image of closeness and empathy, as well as normality. The professionals should share with them all the information about what’ll happen from that moment on, assure them that they’re safe, that they’ll receive help, and, of course, that they’re not alone.

After an adverse event, the following hours are decisive. During them, basic needs such as protection, comfort, and understanding must be met.

4. The three Ps rule

The golden hour window pays special attention to the time immediately after the adverse event. During this period, experts in psychological trauma carry out the three P rules. This is as follows:

  • Avoid psychoactive drugs. Now isn’t the time to administer anxiolytics or relaxants. There’s no need to narcotize or numb the sufferer’s expression of pain or tears.
  • Don’t pathologize. The emotional reaction that the individual is suffering is completely normal given the circumstances. Tears, questions, and feelings of anger and bewilderment are understandable in these contexts.
  • Don’t psychologize. During the golden hour, psychological therapy isn’t useful. All that’s required is support and protection. Also, the victim should be guided to focus their attention on stimuli that don’t further intensify the emotional imprint of the trauma.
holding hands to represent how to help during the golden hours
After a traumatic experience, the sufferer should feel protected and supported.

Final reflection

The psychological first aid provided during the golden hour will mediate the sufferer’s subsequent recovery. It’ll also help in the way they handle their traumatic experience. You might think these strategies are pretty basic. They aren’t really. However, the professionals must carry them out in a meticulous and professional manner and in accordance with the individual circumstances of each victim.

Finally, it’s essential that the sufferer receives the kind of support that prevents any further trauma from being generated. Time and assistance are decisive in this respect. In fact, this treatment is something that every trauma sufferer should receive.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Carmi L, Fostick L, Burshtein S, Cwikel-Hamzany S, Zohar J. PTSD treatment in light of DSM-5 and the “golden hours” concept. CNS Spectr. 2016 Aug;21(4):279-82. doi: 10.1017/S109285291600016X. Epub 2016 Jul 13. PMID: 27405848.
  • Gil S, Caspi Y, Ben-Ari IZ, Koren D, Klein E. Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study. Am J Psychiatry. 2005 May;162(5):963-9.
  • Ginzburg K, Solomon Z, Bleich A.Repressive coping style, acute stress disorder, and posttraumatic stress disorder after myocardial infarction. Psychosom Med. 2002 Sep-Oct;64(5):748-57.
  • Resick PA, Miller MW. Posttraumatic stress disorder: anxiety or traumatic stress disorder? J Trauma Stress. 2009 Oct;22(5):384-90. doi: 10.1002/jts.20437. Epub 2009 Sep 22. PMID: 19774665.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.