The SIX Cs Model Integrating Empathy: A Structured Cognitive Framework for Psychological First Aid During Acute Threat

Abstract

This article presents a theory-driven case study examining the integration of empathy within the SIX Cs Model of Psychological First Aid (PFA) during a real-time, life-threatening event involving two children trapped during a terrorist attack in Israel. Empathy, encompassing cognitive, emotional, and compassionate components, is essential in psychological support, yet its application during acute stress requires structured delivery that sustains cognitive functioning. The SIX Cs Model targets core features of the Acute Stress Response (ASR), including confusion, perceptual narrowing, helplessness, and impaired executive functioning. Through a descriptive, theory-guided analysis of publicly aired segments from a twelve-hour phone conversation between a Social Worker (SW) and the children, the conversation was coded according to SIX Cs components and types of empathy. The findings demonstrate how structured empathic communication can enhance prefrontal engagement, reduce loneliness, sustain cooperation, and preserve functional behavior during extreme threat. Real-time behavioral indicators are interpreted through neuropsychological mechanisms associated with prefrontal cortex dominance, amygdala regulation, and dopamine-mediated reinforcement. The case provides rare ecological insight into pediatric PFA during acute danger and illustrates the clinical relevance of integrating empathy within cognitive-based emergency intervention models.