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Anxiety and Fear are Normal Reactions

by Stephanie Sampson, M.A.

Although recovering emotionally from the tragic events of September 11th will take time, mental health experts believe that most people will cope and eventually feel better.

"As people are getting over the shock of what has happened, they may now feel sad, anxious, angry and even fearful," says Rachel Yehuda, Ph.D., Professor of Psychiatry and Director of the Traumatic Stress Studies Program at the Mount Sinai School of Medicine in New York City. "These feelings are part of the normal emotional response to trauma and are likely to be temporary. In the long run, most people will find ways to cope and eventually recover."

Helping Ourselves-and Others
How can we help ourselves recover from traumatic events? Mental health professionals have identified several steps we can take to help us cope with trauma:

Talk about your feelings and allow others to express theirs. "Talking helps, but may not be easy for everyone. Being willing to listen is one of the best things we can do for one another," says Yehuda. Experience with trauma victims has shown than denying grief and bottling up emotions significantly interferes with recovery.

Remind yourself of your own resources-emotional, spiritual, economic and social. Remember that you have overcome adversity in the past: what did you do for yourself and others that helped? Share your own particular skills with others. Reach out to your social support networks-your church or synagogue, book club or your running partner-for a sounding board and support. "I've come to appreciate that there is a broad range of responses to trauma and loss," says Yehuda. "People will find their own way to grieve. There are no 'shoulds' here."
Be good to yourself. Jerilyn Ross, M.A., L.I.C.S.W., President and CEO of the ADAA, suggests that it is important to take care of yourself, physically-get enough sleep, exercise and go easy on the alcohol and caffeine. And be gentle with your psychological self: expect some forgetfulness and concentration problems, even weepiness. Things will get better.
Get back to routines. Going back to work, getting neglected housework done, even planning a night out are ways people may get back to former routines and begin to make a transition. Children particularly are helped by a return to the household routine; parents should enforce their normal rules about homework, piano practicing, bedtimes and so forth (see below, "Helping Children Cope with Trauma").

If You're Not Feeling Better
Grieving takes time. But anger, anxiety or depression that lasts for three or more-or an inability to function at home or on the job-may be signs of clinical depression or chronic Post Traumatic Stress Disorder (PTSD). Rescue and medical personnel at the crash sites, people who escaped from the World Trade Center or Pentagon, and those who witnessed the attacks at close range are most at risk for developing PTSD. Symptoms of PTSD include recurring images of the traumatic event, nightmares, tensions and anxiety, and a tendency to startle easily. The symptoms may begin immediately or not surface for six months, a year, or even longer. People with PTSD tend to withdraw from the world, becoming disinterested in people and activities that were once important to them. They may try to cope by abusing alcohol, drugs or smoking. Guilt, depression, and sudden outbursts of aggressive behavior may also surface. Professional help may be needed for those with symptoms that persist.

Fortunately, experience with natural disasters and other terrorist events reveal that a relatively small proportion, about 10-25%, of those who experience such events go on to develop chronic PTSD. "We don't want to 'pathologize' what is a natural response to stress," says Yehuda, who warns against pushing a reluctant person into therapy. "People often find a way to use natural supports such as family and friends. This is positive in the early phases after trauma. We should not insist that people seek help if they do not feel up to it, but make it easily available. We also need to be sensitive to the fact that each individual has his or her own timetable for recovery," she says.

The challenge will be moving forward without suppressing the emotions that are apt to surface over the next months. Continuing to talk about feelings and to seek social contact and support will give people the strength to go on. "The good in people is coming out now," says Yehuda who lives in New York and says everyone is pulling together and showing acts of great kindness and generosity. "I think people have decided that what we have here is worth fighting for-together."

Helping Children Cope With Trauma

After a catastrophic event, like those that took place at the World Trade Center and the Pentagon, children may be fearful, sad, or apprehensive. However, most children recover from their feelings of fear in a short time.

A key element in recovery is the support children get from parents, teachers, and other adults. "In assisting children in coping with trauma, assume that every child will have some level of reaction, although most will be relatively mild," says Andrew L. Berger, Ph.D., A.B.P.P., Director of Psychological Services for the State University of New York (Farmingdale) and a psychologist in private practice in Commack, New York. "All children will benefit from active involvement and awareness of a concerned adult, instead of a more passive approach which delays action until significant problems are observed."

According to Berger, children may be particularly vulnerable due to their more limited coping and communication skills, the powerful influence of media exposure such as television, and the often insufficient attention focused on early identification and intervention for children affected by traumatic events. To help deal with kids' feelings after a traumatic event, Berger recommends that parents:

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Anticipate needs. Take the initiative: approach children to chat, to talk about their feelings and concerns about a traumatic or scary event before they bring it up. It is easier for children if the adults anticipate their needs and open up the lines of communication, particularly in difficult times. This also sends the message that a topic is OK to talk about with adults.

Berger also recommends looking at these discussions as a process. "Use brief, frequent chats, rather than a single all-inclusive presentation, as a way of exploring feelings and thoughts. Such chats are more natural and allow for observation and interaction and are less likely to be overwhelming or 'preachy' to children."
Use candor-with discretion. This should be the theme of all adult-to-child communication on traumatic incidents. Be honest, but give details and explanations at a level commensurate with the child's cognitive and emotional capacity. It is healthy and appropriate to begin with more limited sharing that provides a foundation for future elaboration. "We can do much to assist children in dealing with reality but cannot and should not attempt to rewrite reality for children," says Berger.
Let kids know how you feel. While adults dealing with children in distress should maintain a moderate level of composure, it is often helpful to let children know that adults, too, experience upsetting feelings. Children need to know that adults are sometimes scared and seek support from those around them and that it is OK to hurt-but that the pain does get better with time.

Most children and teenagers will recover from their fear. If, after a month, a child is still showing signs of distress, professional help may be indicated. Signs of distress include not sleeping or eating; excessive clinging; re-experiencing the event through nightmares, recollections or play; emotional numbing; or persistent fears about disaster. If a child or adolescent is experiencing these symptoms, seek the assistance of a school counselor or other mental health professional.

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