POSTED 10 SEP 2002
Veterans, rape survivors and refugees alike sometimes suffer from post-traumatic stress disorder (PTSD) -- an agonizing "hypervigilance" in which you can't stop thinking about the thing you desperately want to stop thinking about. Images of murder or other violence intrude on your consciousness. Or you spend hours trying to still memories of torture, rape or war.
One of the many memorials throughout New York. This
photo was taken in December, 2001, outside the firehouse at Engine 24,
Ladder 5 in Manhattan. Courtesy U.S.
Dept. of State.
While only those who have personally suffered can be diagnosed with PTSD, similar symptoms have afflicted some of the millions who witnessed the murderous 9/11 attacks on television.
For most of these people, the symptoms gradually subsided. But what does it take to minimize the psychological aftershocks of this kind of trauma? What makes us more likely to suffer?
Last fall, Roxanne Silver, a psychologist at the University of California-Irvine, and some colleagues set out to answer that question. They sampled a group of American households that have received WebTV access in return for agreeing to answer web-based surveys.
National
Science Foundation.
Within three weeks of the attacks, respondents were asked if they had symptoms of traumatic stress associated with the attacks. The symptoms resembled those of PTSD -- repeatedly reliving or avoiding -- images and memories of the attacks, or feelings of extreme arousal, such as fear or anxiety.
The survey also inquired about childhood abuse, other sources of trauma, and "coping strategies" used to come to terms with the tragedy. The researchers repeated the process two months, then six months, after the attacks, to track changes in the symptoms.
The researchers focused on people who did not live in or near New York City. About 17 percent of those people had PTDS-like symptoms at the two-month survey, and 5.8 percent had symptoms at six months. The symptoms were more common among women, people separated from marriage, or those with pre-existing anxiety or depression.
Surprisingly, however, the biggest influence on the presence of stress symptoms was the type of coping strategy used after 9/11.
Hiba
Bashir, (L) a junior in the UW-Madison College of Letters and Science, has blood
drawn by Red Cross nurse Doris Splinter. Bashir was one of 125 students
donating blood during a Red Cross blood drive. Photo by
Michael Forster Rothbart (c) UW-Madison University Communications
"Active coping strategies" included donating blood or money to help victims. The researchers asked about active coping with statements like: "I've been concentrating my efforts on doing something about the situation" or "I've been taking action to make the situation better."
A second coping style included denial, "checking out," or seeking distractions from the horrific news.
It turned out that trying to do something about the tragedy -- active coping -- was key to avoiding or overcoming the PTSD-like symptoms. "The most surprising thing was the potency of the coping strategies," says Silver. "Before this research, I would not have predicted they would have been this important in explaining the ongoing symptoms.... I would have said the number of childhood traumas, or lifetime traumas" would be more important.
Myth exposed
The study also dispelled what Silver calls "harmful
myths about coping," including "an assumption that individuals who were
not directly exposed would not experience the stress." In fact, plenty
of people who saw the tragedy on television had symptoms of PTSD.
New
Yorkers flee after a tower collapses. Department of State.
A second myth that the study called into question was whether talking about a tragedy can reduce stress symptoms. This strategy, which Silver calls "venting," neither alleviated nor intensified the post-traumatic stress, she says. (She adds that the researchers did not ask about those conversations. Presumably, it would be more effective to talk with a counselor rather than with someone less able to deal with emotional issues.)
Similarly, while the research found a correlation between active coping and reduced symptoms, it did not prove the benefits of active coping. Perhaps people who were predisposed to PTSD-like symptoms were also those who habitually cope with denial.
The
study, in other words, found a correlation, not a cause, Silver says.
"We did a variety of analyses to try to rule out alternative explanations,
but all we can do is say the data are suggestive. We can't say one thing
causes the other."
Still, she reiterates, early coping strategies do seem affect the duration of psychological aftershocks, especially when, as after 9/11, the trauma stays in the headlines week after week. "There are certain strategies that probably are not adaptive. Disengaging when a trauma continues is probably not an adaptive strategy."
-- David Tenenbaum
BIBLIOGRAPHY
Nationwide Longitudinal Study of Psychological
Responses to September 11, Roxanne Silver et al, JAMA, Sept. 11, 2002,
pp. 1235-44.
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