The Psychological Response to Terrorism as an Extraordinary Stressful and Traumatic Life-Event: Coping with the Traumatic Stressors

The Psychological Response to Terrorism as an

Extraordinary Stressful and Traumatic Life-Event: Coping with the Traumatic Stressors

           

Introduction

                                                                                               

            Extraordinary stressful and traumatic events such as the unspeakable acts of terrorism that took place on Tuesday, September 11^th, have a significant impact on the physical, emotional, psychological, and overall well-being of individuals. Regardless of how close one is to the “epicenter” of such shocking events that took place in New York and Washington, D.C., it is quite common and expected that we may feel the emotional aftershocks or secondary traumatic stressors for weeks and perhaps even months after this critical incident. It is important that we try and make “ordinary sense” out of an extraordinary stressful and traumatic event in order to cope effectively with our physical, emotional, and psychological well-being.

            The following information has been developed for the purpose of identifying some of the possible emotional “triggers” and the wide range of human responses that are typically experienced in the aftermath of stressful and traumatic events such as acts of terrorism. In addition, this material will offer coping and prevention strategies that will support our emotional and psychological well-being by helping us to cultivate a caring, supportive, and safe community of survivors.

General Psychological Response to Terrorist Acts

            Terrorism threatens the independence, autonomy, and the cultural-lifestyle that have cultivated in America, engendered by feelings of fear and helplessness among our citizens. Acts of terrorism seek to hold us hostage by fear of destruction and harm to ourselves, family, and friends. It evokes a fundamental fear of helplessness by instigating violent actions that are random, unprovoked, and intentionally directed at defenseless citizens.  Some of us may experience the terrorist attacks of September 11th, as a multitude of losses, including the loss of: (a) having control over one’s life, (b) faith in one’s God or Higher Power, (c) a sense of fairness or justice in the world, (d) one’s security and emotional well-being, (e) one’s physical and mental health, and (f) one’s professional lifestyle.  Consequently, when we try to cope cognitively with these irrational traumatic events, this sets off a chain of psychological responses that goes beyond ordinary comprehension. Thus, we are left with feelings of fear, helplessness, vulnerability, and grief.

            Our emotional and psychological reaction to the crisis we have just experienced is much like a loss or grief response. However, we may react with extreme anger against all Muslims, Arab-Americans, or other people that “look like they are from middle-eastern countries.”  It is important to be aware that it is an unhealthy coping response to condemn an entire group of people by associating them or believing that they are involved with terrorist activities. Anger and violence against groups of people that are not involved with terrorism will not make us more safe because these actions do not punish the real terrorists. This type of retaliation would only increase the problem of terrorism. Thus, an unhealthy or ineffective coping response would compromise our current emotional functioning and cultivate a pattern of hate and threaten our basic American values. 

            Most of us in eastern North Carolina have the collective experience of dealing with the wind, rain, and flood events related to past hurricanes. Extraordinary stressful and traumatic events, whether they are human-made or natural disasters, produce a variety of individual human responses. Consequently, some of us may have a heightened sense of vulnerability as the events of September 11^th may have triggered past traumatic memories.  This is because we typically respond to current extraordinary stressful and traumatic events, in the same manner as we have responded to past experiences of stress and trauma, such as death of a family member, divorce, child abuse, loss of a job, or loss of our health. For those individuals who have been exposed to past traumatic events, it may be difficult to differentiate between painful events in our past and present recurrent traumatic thoughts and emotions.

            People who have personally witnessed or have been survivors of stressful and traumatic events (referred to as primary survivors), will usually be individuals most affected psychologically. However, other people are affected as well. They are exposed by learning of the event through relatives, friends, acquaintances, or exposure to repeated accounts by the media. These persons, who comprise the majority of Americans, are referred to as secondary survivors. Accordingly, many persons may experience secondary traumatic stress which may be as real as those persons considered to be primary survivors. This does not mean that you are “going crazy”. It simply means that you are likely experiencing a normal response to a very extraordinary irrational and traumatic event.

            Individuals affected by critical events on a persistent and long-term basis may exhibit one or more of the following reactions which include, but are not limited to the following:

*          Recurring thoughts and emotions of incidents of terrorism.

*          Difficulty concentrating and maintaining focus with important daily routines.

*          Persistent feelings that are sometimes very intense or unpredictable.

*          Difficulty in expressing your emotions about the attacks on America.

*          Becoming afraid of your regular everyday routine, not wanting to leave the house, or perhaps isolating yourself.

*          Decreasing or ceasing your typical or daily routines (e.g., exercise, diet, job, hobbies)

*          Feelings of “survivor guilt” (e.g., why did I survive while others perished? I should not be enjoying my vacation at the beach)

*          Feelings of a sense of loss or chronic sadness.

*          Interpersonal relationships often become strained, perhaps more frequent arguments with family members and coworkers.

*          Changes in personality, attitudes, or behavioral changes such as crying, anger, frustration, externalized hostility, denial of the event, or constant negativity.

*          Physical symptoms may include: dizziness, diarrhea, constipation, headaches, loss of appetite, restlessness, fatigue, inability to sleep, or a preexisting health-related condition that may be exacerbated.

*          Increase in the use or abuse of tobacco, caffeine, alcohol, and other addictive substances.

If the above symptoms persist for more than one month, these may be emotional and psychological indicators that the person should seek help from a psychologist, counselor, or mental health professional.

Coping and Managing Acute Traumatic Stress

            When adversity strikes and bad things happen to innocent people, it is difficult to bring ones’ life back into balance again. We may try hard to make things emotionally normal again for ourselves and others around us. Psychologists and mental health experts suggest that avoiding or repressing a crisis event does not provide us with the opportunity to work-through our experience of loss and it is unlikely that we can adjust, resume a balanced life, or even find meaning in our suffering. Victor Frankl, a famous psychiatrist and psychotherapist who survived the experience of living in a Nazi concentration camp during World War II, suggests that it is not necessarily the nature of the traumatic event itself that most affects one’s ability to cope with adversity and its consequences, rather, it is one’s own attitude towards that traumatic event. Accordingly, persons that are more resilient in times of tragedy typically have better coping skills than those that are consumed by a traumatic event. Inviting understanding and bringing meaning to acute traumatic stress can provide us with an opportunity to cope effectively with our feelings, thoughts, and behaviors that will ultimately lead to our healing.

            It is important to be mindful that there is not just one way to manage or cope with the acute stress. However, first we must realize that traumatic events such as those in New York and Washington, can be enormously painful and the psychological and emotional impact on individuals can vary greatly. Some individuals’ stress response may occur immediately, while others may have delayed reactions. Second, reactions may change over time and some primary or secondary survivors of the terrorist attacks may feel energized initially, only to become discouraged or depressed weeks or months later. Finally, it is paramount to understand that people cope with adversity and heal in different ways and at their own rate. Thus, cultivating healthy coping responses may take longer for some individuals.

            Managing and coping with traumatic stress can become overwhelming for some individuals.  They may require assistance from a professional counselor or a peer-support group. This does not imply that the person has “mental problems” or is “emotionally weak”.  Rather, it simply demonstrates the variety of human responses in a crisis event some of which may be too powerful for some persons to manage emotionally on their own. There are a number of things you can do for yourself to help restore emotional balance and regain a sense of control in your life.

1.                   Recognize Yourself and Others as Survivors-  Viewing yourself or others as a “victim” of terrorism or any type of traumatic, painful, or extraordinary stressful event, discounts the person’s survival skills.  Although the person may feel like a “victim” of terrorism, the “survivor” is someone who is resilient, knows how to ask for help, and has the ability to develop positive coping behaviors.

2.                  Accept that an Acute Stress Reaction is an Ordinary or Even Expected Response to an Extraordinary Traumatic and Stressful Event- The research suggests that at least 50% of those persons directly affected by such critical events as the terrorist attacks, will acquire some degree of post traumatic stress and may need counseling to effectively deal with the stress.  Additionally, 10-30% of those persons who have been indirectly affected as secondary survivors, may acquire some level of acute stress which can be treated successfully with more short-term solution focused individual and group therapies. Having some type of support does not imply that persons are more adjusted. Rather, it simply implies that the emotional responses exhibited are a human response to a very inhumane act that has occurred outside the range of ordinary human experience.

3.         Persons Heal at Different Rates- There is no set time limit for a person to feel normal again, or get back to a regular routine. The perception of the intensity and loss associated with a traumatic event may be the best predictor of the person’s resiliency and coping abilities.  Persons should anticipate that they may have some “good days” and “bad days”.  Allow yourself time to mourn the loss you have experienced and be at peace with the things you cannot control.  Coping strategies require a day-to-day focus. Negative thoughts about how life will be in the future typically increases feelings of anxiousness.

4.         Preexisting Personal Experiences May Intensify the Person’s Response to a Stressful and Traumatic Event and Hinder Coping Ability- It is important to recognize that when traumatic events occur, persons who have had prior emotional, or physical difficulties, or lack a supportive environment may have more difficulty coping with the terrorist attacks. This event may actually open older emotional wounds and become an “emotional trigger” for someone who has experienced the loss of their home in a flood, or someone who has had previous exposure to death events.

5.         Primary and Secondary Survivors’ Response to a Crisis May be the Same- Because all reactions are personal and contextualized, a person indirectly exposed to a traumatic event (secondary survivor) may respond with the same level of emotional intensity as those who are directly affected (primary survivor).  Each person must be viewed in terms of their own unique characteristics and socio-cultural environment. It is self-defeating and destructive to challenge someone else’s emotional response to the terrorist attacks. Keep the focus on yourself and the things you can change. You cannot control others’ emotional response to a crisis event.

                                                Prevention and Coping Strategies

            Remembering negative critical events such as the terrorist attacks on New York City and Washington, D.C. is a very painful process.  This process sometimes triggers unwanted emotional responses that may be uncomfortable for individuals. Verbalizing feelings and asking for support from family, friends, or a professional counselor is a healthy coping and preventative approach. Persons that have been involved, either directly or indirectly with terrorism in America have a common core of experience with others at home, work, or within their community. The following strategies are recommendations to begin or continue the coping: process.

Coping Strategies for Persons Affected both Directly and Indirectly

1.                  Allow time for yourself to transition back into your day-to-day routine such as school or work

2.         Talk with others about your feelings and experience about the terrorist attacks. Talking and listening to others will help you express feelings in a helpful way.

3.         Focus on day-to-day routine things that you are able to do and try to keep regular schedules such as exercise, mealtimes, hobbies, and so forth.

4.         Ask for support and establish regular contacts with friends and family members. Be familiar with the resources available in your community that will support your coping and adjustment.

5.         The most important resource you have is one another!

Coping Strategies to Help Co-Workers, Friends, and Family

1.         As difficult as it may be for you as a teacher, supervisor or family member, allow and invite the person to talk about their feelings of stress, grief, and anxiety of future critical incidents of terrorism. Be an active listener for the person but do not get “hooked” into the role of counselor.

2.         Identify friends and family members that may be “at-risk” physically, psychologically, or emotionally and suggest professional help and support for that person. Be mindful that some persons may be emotionally overwhelmed by intense and persistent thoughts and feelings about terrorism.

3.         Establish regular contact with the survivor to ensure that the person is safe and has the appropriate social and emotional support.

4.         While you may not be a professional counselor you are capable of being a good listener.

5.         After the person has been through a crisis, it is likely that they will have a difficult time focusing on schoolwork or their job. Allow the person time to transition back to their day-to-day school or work routine.

6.         Be sensitive to the emotional needs of the person. Take a “time-out” from your regular structure for an “emotional check-in”with the persons.  You may want to begin class or the workday by allowing persons to ventilate their thoughts and feelings concerning recent past horrific events.

7.         Familiarize yourself with, and promote educational or wellness-type resources on campus or in the person’s community. 

8.         Be aware that you may also be experiencing some stress-related symptoms related to dealing with the survivor’s emotional aftershocks. The secondary stress you may be experiencing is a natural response of being a caring individual listening to others’ stories of their experiences.

9.         Emphasize the person’s strengths by reinforcing positive aspects of current functioning or productivity level.

Advice on Talking with Children & Adolescents

1.         Spend more time with your kids and most importantly- model tolerance, compassion, and avoid stereotyping people or countries that might be home to terrorists.

2.         Allow children to regress emotionally, socially, cognitively for a brief while, and reassure them that you love them and that they are safe- they will eventually become secure again.

3.         Provide play experiences to help establish contact, communication and relieve stress/anxiety.

4.         Encourage adolescents to talk to you or their friends about their thoughts and feelings.

5.         Observe for signs of prolonged isolation, persistent sadness, detachment, and academic dips.

6.         Keep regular family schedules for mealtimes, leisure, recreational activities, and bedtime to help restore a sense security and normalcy.  

Resource List

           

            American Counseling Association (ACA) {a comprehensive list of materials and links to multiple helping resources on dealing with traumatic stress}.   www.counseling.org

            American Psychological Association (APA). {material on managing traumatic stress and tips for recovering from disasters and other traumatic events}. http://helping.apa.org/therapy/traumaticstress.html

            Davis, M., Robbins Eshelman, E., & McKay, M. (1995). The relaxation & stress reduction workbook (4^th ed.). Oakland, CA: New Harbinger Publications.

            Kushner, H. (1981).  When bad things happen to good people. New York: Avon Books.

            McKay, M., Davis, M., & Fanning, P. (1997). Thoughts & feelings: Taking control of your moods and your life. Oakland, CA: New Harbinger Publications.

            Mitchell, K.R., & Anderson, H. (1983). All our losses, all our griefs: Resource for pastoral care. Philadelphia: Westminster Press.

            Mitchell, J.T., & Everly, G.S. (1996). Critical incident stress debriefing: An operations manual for the prevention of traumatic stress among emergency services and disaster workers. Ellicott City, MD: Chevron Publishing.

            National Mental Health Association (NMHA). {material for the individual and family on coping with disaster}.  www.nmha.org

            National Association of School Psychologist (NASP). {material on talking to children and adolescents about our national tragedy}. http://www.nasponline.org/NEAT/tolerance.html

            National Organization for Victim Assistance (NOVA).

            Rando, T.A.  (1984).  Grief, dying, and death. Champaign, Il.: Research Press.