Bearing "Media Witness" to Terrorist Attacks, Destruction Can Lead to Acute Stress Disorder

BUFFALO, N.Y. -- The image of an airplane flying into the second tower of the World Trade Center and exploding in flames, played over and over on television following the Sept. 11 terrorist attacks, will remain in America's collective consciousness for a long time.

For all, that image forever will represent a national tragedy. But for some, there will be a more profound personal effect, said Nancy Smyth, Ph.D., associate professor in the University at Buffalo School of Social Work.

Smyth is an expert in psychological trauma, including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). For people suffering from those conditions, she says, film clips and other reminders of the tragedy will generate more than bad memories.

"They're not just remembering what happened," she said. "They actually feel like it's happening again."

Feelings of distress, anxiety, depression, irritability, difficulty concentrating, intrusive thoughts, numbing, withdrawal and nightmares all are some of the symptoms of ASD, which occurs during the month that follows a traumatic event, and PTSD, which can have a delayed onset and can occur months or years later, Smyth said. When someone has ASD symptoms for more than a month, they then are considered to be symptoms of PTSD.

The conditions are not limited to people who actually experienced an event. Those who immersed themselves in round-the-clock media coverage of the terrorist attack on the World Trade Center and the Pentagon also may find themselves struggling to cope.

"Even though they haven't actually been through the traumatic event personally, if feels like they have," according to Smyth

Researchers don't know why some people will develop ASD or PTSD, although there are factors that indicate those who may be at increased risk.

People who have suffered a lot of trauma or losses in their lives are at greater risk, Smyth said, as are those who identify with some aspect of the event and imagine it happening to them.

Conversely, people who feel strongly disconnected from the event as they are going through it also are at risk of developing PTSD, she added.

"The more they disassociate from the tragedy at the time, the more likely they are to develop PTSD," she said. "The fact that you're not perceiving and not connected to the event means you're not processing the information the way it should be."

Neither ASD nor PTSD is limited to adults. Children also can be affected, Smyth said.

While children may exhibit the same symptoms as adults, the signs may be more subtle because they lack the language skills and self-awareness to define what they're feeling.

"What you're more likely to see in children is daydreaming," Smyth said. "When kids get stressed, they go somewhere else in their heads." Their behavior may regress, or a child who is potty trained may begin wetting the bed.

Children's symptoms also may bear close resemblance to attention deficit hyperactivity disorder (ADHD), or separation anxiety, she added.

Adolescents are not immune to feeling of distress, especially if they have been exposed to a lot of the television coverage of the terrorist attack. "Teens are still kids," Smyth said. "The don't have the emotional experiences that adults do. It's a vulnerable time in their lives and they don't have the coping repertoire of adults."

Smyth says individuals can take steps to work through their feelings.

For example, she suggests, "If you have something intruding in your head, you may need to spend 20 to 30 minutes writing about it, and then put the paper aside and tell yourself you're done with it for the moment and redirect yourself to an activity," Smyth suggested.

Hard physical exercise, prayer, music, art, yoga, relaxation tapes, massage, playing with children and walking also can help, she said. In addition, avoid excessive alcohol, caffeine and sugar, maintain a balanced diet and sleep cycle, and return to your normal routines as soon as possible.

She also encourages those who are struggling with recent events to talk about their feelings and concerns with others who are supportive.

"People secretly feel that they're going crazy. There's a sense of relief in talking about what you're experiencing," Smyth said.

For some, the acute distress will pass. Others may need professional assistance. When should someone seek help?

"When talking isn't helping," said Smyth. "Talking to family and friends can help to a degree, because you feel less isolated and alone. But if that's not helping and if your feelings don't decrease somewhat within two or three weeks, you might want to seek out a mental health professional. While symptoms need to last at least one month after a trauma to be considered PTSD, people struggling with ASD symptoms don't have to wait that long to seek help if they are having a particularly difficult time."

Treatment need not be a prolonged, time-consuming prospect, she added. On average, one to three sessions may be all that is needed.

Smyth has a word of advice for anyone feeling overwhelmed by the terrorist attack on the World Trade Center and Pentagon: turn off your television.

"I would encourage people who are having trouble coping to limit their TV time to 20 minutes -- enough to get informed -- and then turn it off. Images are very powerful traumatic stress triggers for most people," said Smyth.

While knowing what has happened is an important coping strategy, she added, knowing when to turn off the news coverage is equally important.