Coping with Terrorism and Other Traumatic Events

In the wake of September 11, 2001, the need for information and mental health skills that help people cope with catastrophic events became greater than ever. It is our hope that the following information will be useful.

What psychological reactions are we likely to experience following acts of terrorism?

We should expect to experience a full spectrum of strong emotions, ranging from stunned disbelief and shock to anger, grief, fear, numbness, guilt, and/or resolve. These feelings are normal. Some might experience post-traumatic stress disorder (PTSD), an understandable response to overwhelmingly dangerous and sudden events. Although PTSD is more likely to occur following stressful events, it is not inevitable.

Is the current state of mental health care in America adequate to the challenge of treating terrorism-related psychological problems?

It is not. There are presently too few mental health professionals to treat even the everyday mental disorders that are prevalent in the

nation. Our best hope is to prevent mental illness by developing psychological and spiritual resilience and coping skills.

What we can do to help ourselves, our families, and our communities to cope?

1. Accept the full range of feelings as normal. At some point, when it is appropriate, allow yourself to feel the painful feelings, to cry, to shake, or to experience whatever naturally occurs. As calmly as possible, process what has happened by writing or talking about the troubling events—what happened, and what you are thinking and feeling. This kind of journaling/talking has been found to significantly improve mood and physical health, following an initial drop in mood as we confront the reality of what has happened. Feelings are part of who we are. Confronting the depths of painful feelings also enables us to discover our reserves of strength and to heal. Those who avoid painful feelings are paradoxically at higher risk for post-traumatic stress disorder. Be a resource for family and friends. Compassionately encourage others to communicate their feelings. Listen to and validate those feelings. It is gaining comfort with the full range of emotions that builds psychological resilience, not denying feelings.

2. Keep what happened in perspective. Terrorism is the work of evil that does not represent the majority of people in the world. Acts of terror are not personal, but reflect the pain and irresponsible scapegoating of the perpetrators. Despite the horror, most of the country is intact. We are a resilient nation and we will survive what has happened with resolve. What we stand for—decency and freedom—is stronger than fanaticism. Especially, hold an image of love and decency that is greater than the image of evil. This wholesome image might be of a loving God or of loving and decent people. Some find solace in the spiritual perspective that no eternal defeat befalls decent individuals.

3. Keep a calm resolve, focusing on what you individually want to do, be it giving blood or other donations, caring for loved ones, consoling the bereaved, seeking justice, rededicating to the common good, praying for our leaders, etc.

4. Guard your physical health, especially as distress becomes prolonged. Exercise regularly, which expends the energy of stress. A brisk walk of twenty minutes or more on most days is remarkably therapeutic. This is especially important as we sit around the television watching distressing scenes. Stress that is not discharged physically becomes locked in the mind and body and may emerge later in the forms of nightmares, intrusive thoughts, anxiety, etc. Get adequate sleep and nourishment, avoiding as much as is prudent medications or substances that interfere with mental clarity and with the processing of the traumatic events.

5. Avoid thoughts that excessively arouse the nervous system. Such thoughts include catastrophizing ("This is awful. I can't stand it. I'm losing my mind."), shoulds ("I shouldn't be feeling so afraid or weak"), and all-or-nothing ("I'm either strong or I'm a weakling").

6. Watch for subtle alterations in breathing. Breathe abdominally, or slowly and quietly without moving the upper body. Remember to think of the area around your navel as if it were a balloon, inflating on the in-breath and deflating on the out-breath. This is important in helping to prevent panic attacks and many symptoms of anxiety. Following exposure to traumatic events, many people first alter the way they breathe, then experience panic attacks, then suffer dissociation and post-traumatic stress disorder. Other tips for coping with panic include: (a) Greet fear cordially. Say, "Hello, fear." Let it enter, flow with it like a reed blowing in the wind, knowing that even the worst panic attacks are simply stress responses that typically run their course in a few minutes, (b) Think, "This traumatic event is really happening. It is difficult, but I'll focus on what I need to do. I'll get through this." (c) Ground yourself, perhaps by touching a wedding band, rubbing your leg, saying a calming prayer, etc.

7. Stengthen your faith, through worship, prayer, family evenings at home, or any other method that reminds us there is a larger order than the present crisis. Recommit to holy living. Create an inner peace of conscience that is steadfast in the face of chaos.

8. When the crisis has passed, grieve. Many who are so preoccupied with survival forget that something is always lost in trauma, something that requires grieving. Rituals and symbols of love, farewells, hope, and resolve often help.

9. Do not allow yourself to be consumed with hatred. It not only lowers us to the level of the perpetrators but also increases the risk of psychological illnesses such as post-traumatic stress disorder. We can resist terrorism and take strong countermeasures without hatred.

10. Anticipate future occurrences of terrorism. Be prepared, but do not obsess about their possibilities. Preparation might include storing, without hysteria, supplies of food, water, fuel, clothes, etc., to sustain one's family in the event of future upheavals. Once prepared, remind yourself and your family that wholesome recreation is not only permissible but is essential to maintain balance.

11. Cultivate the attributes of resilient copers, namely, reasoned optimism, self-esteem, flexibility, meaning and purpose, altruism, sense of beauty, morality, spirituality, sense of humor, sociability, emotional intelligence, calmness under duress, balanced living, and active problem solving (i.e., anticipating and actively planning for difficult times). Conversely, minimize isolation, severe emotions (e.g., excessive panic, guilt, or hatred), and avoidance/dissociation.

12. Show physical and verbal affection to your family members to provide a sense of security. Children should not be repeatedly exposed to media images of terrorism. Discuss what has happened after watching such scenes together once. Assure your children that very capable people are doing all they can to bring the perpetrators to justice and to protect us. Ask them what they think they can do to help themselves and their friends, family, and nation. Remember, active problem solving protects against psychological distress. Passivity and avoidance are risk factors.

13. If symptoms do not resolve in a few weeks, become overwhelming, or interfere with your ability to work or relate to people, seek help from a mental health professional who specializes in treating post-traumatic stress disorder. A range of new approaches can be very helpful. Bear in mind that a present trauma might reactivate unresolved past traumas. This can be a useful signal to resolve such emotional wounds. Signs of post-traumatic stress disorder include:

• Reexperiencing the distressing event(s) by intrusive thoughts, nightmares, flashbacks, etc.

• Arousal, including sleep difficulties, excessive anxiety, hypervigilance, increased startle response, or inability to concentrate

• Avoidance of any thing/person/activity that reminds us of the traumatic event, social withdrawal, emotional numbness, or a pessimistic inability to think of or plan for a normal future

What can we learn from resilient World War II survivors?

From interviewing WWII survivors who lived well-adjusted lives in the decades after combat, we have learned that there are certain recurring qualities that contribute to resiliency. The survivors did their duty without animosity and were men of faith, decency, and moral character. They maintained their sense of humor and hope. And they acknowledged their fears and then acted anyway.

Notes

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