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Rising from the Ashes: Coping With the Aftershock of Trauma

As our country begins the slow process of grieving and retaliating for the terrorist attacks, mental health experts say one in three Americans is suffering from depression and anxiety.

Elizabeth K. Carll, PhD, is a psychologist who provided counseling after the Oklahoma City bombing in 1995 and the first attack on the World Trade Center in 1993. She is here to help us deal with the emotional aftershocks.

How does this attack on America compare to previous national crisis, in terms of the potential for mental health aftershock?

This is much larger an effect on the country than any other event. But at the same time, we feel that we are at war and have a feeling of cohesiveness to deal with a common enemy. We are in the midst of a crisis and we are experiencing stress and depression. One in three adults can't sleep, over 60% of men believe they are depressed, 70% of women believe they are depressed, and 20% of the people are experiencing acute stress and will go on and experience post-traumatic stress disorder. I think this is going to have a great ripple effect for many people.

We are all experiencing stress after this trauma. What is the difference between ordinary depression and post-traumatic stress disorder?

A lot of people are feeling sadness. They are having trouble concentrating and difficulty eating and sleeping. Flashbacks usually don't continue after the first month. If they do, post-traumatic stress disorder is more likely to occur.

Post-traumatic stress disorder is the most severe anxiety disorder, and the cause of it is an external event. The more vulnerable a person was to depression before this happened, the more vulnerable they are going to be to this kind of event affecting them and to high levels of anxiety and post-traumatic stress disorder. For most people, what we are feeling now is not the way we are going to continue to feel. This is a normal reaction to an event of this magnitude. The symptoms will subside in time, after about 4 to 6 weeks. I’m not saying that we will forget, but it will not take over our everyday life.

What are the signs of post-traumatic stress disorder? Post-traumatic Stress Symptoms in Adults:


  • Sadness and depression.
  • Forgetfulness and concentration difficulties.
  • Worsening of existing medical conditions.
  • Sleep disturbances, nightmares, and flashbacks.
  • Intrusive thoughts and feeling insecure in the world.

You are suffering from post-traumatic stress disorder if the symptoms continue past the 4- to 6-week period, the severity increases, you can't function, and if the symptoms are taking hold and flashbacks continue.

Other symptoms include:


  • A sense that life is out of balance.
  • Feelings of being "out of control."
  • Fears of "going crazy."
  • Disbelief.
  • Self-doubt.
  • Minimization of the critical incident.
  • Anger and irritability.
  • Socia withdrawal.
  • Emotional numbing.
  • Diminished sex drive.
  • Cold and flu-like symptoms.
  • Excitability.
  • Increased substance use.

How long do these symptoms take to reveal themselves?

For some people it's immediate. Others repress feelings and it is not until several days after the event that they begin to emerge. The rescue workers, the firemen, and police learn to compartmentalize their feelings in order to get the job done. They deal with the business of saving lives and cleaning up the site and then later start processing those feelings.

There are three very important things that you want to remember to do when you are experiencing this level of stress. Some self-help strategies are talking, eating, and resting?

Talking about feelings helps release stress and also helps us recognize that others are experiencing similar feelings. While it is helpful to encourage talking about feelings, it is important not to push those who prefe not to talk, as individual needs vary.

Getting adequate nutrition is important. You should try to maintain as normal a routine as possible and feed your body.

Make sure to rest your body and mind. Don't over extend yourself: That will worsen the stress. Also, it's very important to avoid new projects or making major decisions.

It is normal to experience any or many of the above, which can be expected to wax and wane. If the distress is very severe or continues more than 4-6 weeks, seek professional help.

What is survivor’s guilt?So many many people are experiencing this: Feeling guilty about doing things that give you pleasure is part of survivor's guilt. There may be some people who may not feel this intense, and that is okay too. A lot of people are just glued to their televisions.

What about our children? What is the difference between a normal reaction to this event and post-traumatic stress symptoms?

Post-traumatic Stress Symptoms and Reactions in Children:


  • Crying headaches, other headaches, other physical complaints.
  • Thumb sucking and depression.
  • Loss of bowel/bladder control.
  • Fears about weather.
  • Fear of being left alone.
  • Irritability, inability to concentrate, aggressive behaviors.
  • Confusion.
  • Withdrawal and isolation.
  • Clinging and fighting.
  • Immobility, withdrawal from peers.

What can we do to help them?

Maintain familiar routines, such as attending school and after-school activities, and maintain meal and sleep times. For young children, spend extra time at before bed to promote security. You should limit exposure to news and programs about the tragedy. Watching the news repeatedly can increase anxiety. In the evening, it is helpful to watch or read funny, light entertainment.

Permit children to participate in helping and restorative activities and spend more time with children as needed You should validate children's feelings as being normal responses to an atypical and stressful event.
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