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Distress, Traumatic Stress, and PTSD in the Wake of the Boston Bombing

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The events of the Boston bombing and subsequent violence in Cambridge and Watertown have shocked the country and left many wondering what the psychological effects will be for those close to the events, as well as those who are affected from afar. The National Center for PTSD has been involved in understanding the impact of disasters and terrorism for over a decade, and we've come to understand that of all types of disasters, terrorism is correlated with higher rates of traumatic stress reactions, across larger areas of the population, and for longer durations.

Terrorist acts erode the sense of security and safety people usually feel, both at an individual and community level. They challenge the natural need to see the world as predictable, orderly, and controllable. The scale, unpredictability, novelty, and high threat nature of terrorist attacks have a wide-ranging impact on perceived risk for being harmed in additional attacks. At times like this, there may be a need to differentiate daily between the likelihood that another attack will occur and the likelihood that it will happen to you personally, and a need to move towards accepting a level of risk in order to permit normal functioning. It may take time to learn that you can engage in normal routines and realize that you will not be harmed. These types of approaches have resulted in improvements in both distress and functioning in those living in situations of ongoing threat. We also know that positive social support cannot be underestimated in helping people recover from threat, trauma, and adversity. In fact, situations such as this can remind us of the preciousness of loved ones in our life, the importance of family and friends, the unyielding desire to engage in life, and the value of reaching out and caring for others in need.

Many people directly exposed to mass violence will have traumatic stress reactions, and such reactions may occur off and on, even years later. These reactions should not necessarily be regarded as pathological responses or even as precursors of subsequent disorder. Nevertheless, they may be experienced with great distress, and require community support, and at times clinical intervention. Anger, frustration, helplessness, grief, sadness, fear, and a desire for revenge are expected and common reactions to terrorism. We do know that acting on anger and desire for revenge can increase rather than decrease feelings of anger, guilt, and distress. It's important to note that the majority of people are generally resilient, have developed ways of coping ideally suited for their particular circumstances, and usually use their social networks very effectively. Most will return to pre-event levels of functioning over the weeks and months following the event.

Rather than traditional diagnosis and clinical treatment, the majority of people are more likely to need support and provision of resources to ease the transition to normalcy, assistance in maintaining or reestablishing their sense of identity and values, support to respond flexibly to the demands of a changed world, and encouragement to engage in their life as much as is possible. In general, interventions that have been found to be effective in the early phases after mass violence promote a sense of safety, calming, connectedness with others, self and community efficacy (the feeling that you can cope no matter what happens) and a sense of hope. Along these lines, self-care for those who are distressed can include:

  • Reminding yourself that stress reactions after disaster are common, rather than feeling "weak" or guilty for feeling distressed
  • Acknowledging those people, values, and goals in your life that the disaster highlighted as most important to you
  • Realizing that you may not be able to function as effectively, and getting help with tasks and problems you're facing
  • Spending time with, or helping others
  • Finding a way to honor losses
  • Taking time outs and channeling your energy productively, if you're feeling angry
  • Checking your thoughts and looking for ways to change them or distract yourself from them, if they are contributing to you feeling worse about yourself or the world
  • In general, taking an active, problem-solving approach to ongoing problems created by the events
  • Reducing the amount of media viewing you are engaging in if it is increasing your distress or interfering with your functioning
  • Shifting your expectations about what is a "good day."
  • Creating specific routines for day-to-day living will lessen worries beyond those routines
  • Proceeding with life's necessities, which will help develop and maintain a continued engagement in life.

If a your level of distress is extreme, or your ability to function is severely hampered, don't hesitate to seek help. There are effective treatments for acute stress disorder, PTSD, and complicated grief, and the sooner help is sought, the sooner you will feel better. That National Center for PTSD has a number of fact sheets describing these interventions. See: Where to Get Help for PTSD.

Situations such as these recent events can be particularly painful for those with previous histories of trauma, and can serve as a reminder of past events, so they should be particularly careful and conscientious about taking care of themselves, and seek support from others. Those with mental health conditions may also be particularly vulnerable to increased distress. Additionally, exposure to gruesome images in the media has been shown to contribute to PTSD in those with previous history of trauma exposure or mental health diagnoses, and the more media viewing they engage in, the higher their levels of distress seem to be. For more information, see: Acts of Violence, Terrorism, or War: Triggers for Veterans.

To assist following the bombings at the Boston Marathon, the National Center for PTSD posted these custom materials containing a wealth of resources:

www.PTSD.va.gov The National Center for PTSD, U.S. Department of Veterans Affairs, has a history of providing public education as well as professional consultation and training during times of national disaster, with involvement in the Nation's response to the Loma Prieta earthquake, 9/11, the Oklahoma City bombing, hurricane Katrina, and the Newtown, CT, school shooting. Beyond immediate assistance, The Center has conducted disaster-related research and, with the National Child Traumatic Stress Network, developed interventions such as Psychological First Aid and Skills for Psychological Recovery.