Who is affected?
What people may experience
What you can do to help yourself
What you can do to help others
PTSD
Seeking help

The recent terrorist attacks on the US were the type of events we thought could never happen. Like other types of disasters, they were unexpected, sudden and overwhelming. When terrorist acts occur, people generally look for ways to cope with the acute stress and trauma. The violent action was intentional, unprovoked, and targeted at defenseless citizens. Trying to cope with irrational information that is beyond normal comprehension can set off a chain of psychological events that culminate in feelings of fear, helplessness, vulnerability, and grief.

Who is affected?

People who experience the trauma fall into the following categories: those who personally witnessed or were victims of the attack; those who experienced traumatization from learning of relatives, friends and acquaintances who were subject to the violence; or from exposure to repeated media accounts of the trauma.

What people may experience

People's responses range from no reaction at all to an intense emotional response, with stops at every point in between those two polarities. All are normal. Sometimes people who do not feel much of a reaction feel (or are made feel) guilty that they should be more emotional. That guilt is unnecessary. Shock and denial are typical responses to terrorism, especially shortly after the event. Both shock and denial are normal protective reactions. Shock is a sudden and often intense disturbance of a person's emotional state that may leave the person feeling stunned or dazed. Denial involves not acknowledging that something very stressful has happened, or not experiencing fully the intensity of the event.

The person may temporarily feel numb or disconnected from life. In the wake of a terrorist act many fears enter into people's minds. One of the greatest fears stems from loss of control. When people learn of a plane crash, some decide that they are never going to fly again. When they hear about a shooting incident, they decide that they are not going to visit certain sections of town. By making these decisions people feel like they can control what is happening. The bombing has shattered people's illusions of security.

Many people now ask the question: "Where do I go to feel safe? "It is not unusual to feel rage and anger after a traumatic event. People need to allow themselves to feel it. We create more problems when we push down our feelings then when we allow ourselves to feel the full range of our emotions. However, it is important to understand that there is a difference between feeling an emotion and doing something about it. It is not okay to express the rage in inappropriate ways. One of the more common inappropriate expressions of rage is to blame an entire country or culture for an incident such as this, rather than to give responsibility to the individuals who committed the atrocities. The point is for a person to acknowledge that the rage he or she has is an honest emotion and reaction to this traumatic happening, but then to rationally control his/her actions. As the initial shock subsides, reactions vary from one person to another.

The following, however, may occur:

• Recurring thoughts of the incident.
• Stopping usual functioning, not maintaining daily routines.
• Feelings become intense and sometimes are unpredictable. A person may become more irritable, and his/her mood may change back and forth dramatically.
• Tremendous sense of loss and grief.
• "Survivor guilt."

What you can do to help yourself:

• Identify the feelings you may be experiencing. Understand that your feelings are a normal reaction to an abnormal situation.
• Remember that you have overcome adversity and trauma in the past. Try to remember what you did to overcome the fear and helplessness in that situation.
• Talk to others. It's okay to ask for help.
• Don't let yourself become isolated. Maintain connections with your community, friends, relatives, neighbors, co-workers, or church members.
• Make efforts to maintain your usual routine. Try to keep family rituals in place. These will help you feel that your life has a sense of order.
• Realize that things will get better. Be realistic about the time it takes to feel better.
• Know the actions our government is taking to combat terrorism and restore safety and security.
• Limit exposure to media coverage.
• Don't make any big life decisions or changes immediately. During periods of extreme stress, we all tend to make misjudgments.
• Eat well-balanced regular meals and get rest.
• Be kind to yourself.
• When you feel rotten, remember that those around you are also under stress. This is a difficult time and everybody's emotions are closer to the surface.
• Seek professional help when severe reactions persist and continue to interfere with daily living.

What you can do to help others:

• Listen and empathize.
• Spend time with the traumatized person. There is no substitute for personal presence.
• Don't tell traumatized people that they are "lucky it was not worse." They are not consoled by such statements. Tell them instead that you are sorry such an event has occurred, and that you want to understand and assist them.
• Respect a person's need for privacy and private grief.

PTSD

Some people may develop reactions to the tragedy that go beyond those mentioned above, such as post-traumatic stress disorder. PTSD is characterized by the development of specific symptoms that exist beyond 30 days. The symptoms may include:

Re-experiencing the trauma. This can occur in a variety of ways. It can involve mental images, thoughts, and re-experiencing sensations of the event. It can involve distressing dreams of the event. It can involve feeling as if the event is recurring or acting as if the event is recurring. This can involve:

• Illusions
• Hallucinations
• Depersonalization
• Flashbacks
• Distress at reminders
• Physiological arousal

Avoidance and numbing. This amounts to the individuals attempting to protect themselves in primitive and basic ways from similar emotional assault:

• Avoidance: It can include a refusal to associate with people, places or activities that remind the person of the traumatic event.
• Zombie-like characteristics.
• Robbed of the future: Some individuals may also carry within them the belief that their future is foreshortened and they will not be able to carry out their role as father, spouse or to succeed at their career objectives. They would have a sense of being robbed of their future life.
• Emotional drain.

Risk factors for developing PTSD: Essentially, any prior experiences that have evoked terror, horror, or helplessness appear to lower the threshold for developing PTSD. People who have been exposed to childhood abuse, marital abuse, or prior traumatic events such as assaults or rapes are now likely to develop PTSD if they encounter new traumatic events. It is also thought that pre-existing psychological disorders lower the threshold.

Seeking help

Important distinctions as to whether a person should seek professional help would include the person's own determination of how bothersome the symptoms are. In determining this, it is useful to consider the judgment of people who are important in the individual's life such as family members, friends, and co-workers. These people may help the affected individual realize the necessity of obtaining treatment. Job performance is another measure. If symptoms are causing impairment of the individual's ability to perform their normal job (or other important functions) then counseling is indicated.