Va. Tech: Counselors Discuss Trauma Management

The short-term effects are invariably similar. Anyone connected-directly or indirectly--to the ghastly killings at Virginia Tech on Monday inevitably will be grieving in the days and weeks ahead. But what about the long-term impact of exposure to the massacre? In the past, trauma counselors believed everyone exposed to events like these were at high-risk for debilitating emotional problems. New research, however, suggests that most adults recover quite well and that only 10 to 20 percent of the population is at risk for severe or lasting problems like Post Traumatic Stress Disorder (PTSD).

Whether it's a school shooting, natural disaster, war or accident, most people respond to a horrible event with a combination of grief, surprise, anger or shock. "These emotions are completely normal," says Lawrence H. Bergmann, a certified trauma specialist and founder of Post Trauma Resources in South Carolina. "They are appropriate responses, but they will go away in time. In the past we believed that everyone needed to be treated like they would suffer severe psychological difficulties, but now we know it's only a few people who are at high risk."

People in the high-risk category are those who were immediately present during the actual event and may have felt their own life was at risk, or witnessed others' deaths firsthand. It also includes people who have suffered a prior trauma, work in a profession where they are routinely exposed to life or death situations, (such as EMT and rescue squad workers) or who have a history of problems with anxiety or depression. "Basically their body chemistry is primed to experience overload," says Chris Dunning, a leading trauma expert and professor of governmental affairs at University of Wisconsin-Milwaukee. "Chronic stress already predisposes them to depression and the new event can trigger a response [that freezes them there]."

Another common cause of long-term problems is feeling a sense of responsibility for preventing the attack. "I would say that 50 percent of that campus will believe 'if only they had been there, if only they had done something,' they could have prevented this," says Dunning. "It's cognitive restructuring-a way of trying to achieve mastery over the event by looking back and trying to find an omen that should have told us this was going to happen. But it's not rational." Dunning says hostage negotiators who had no reason to be at the crime scene often chastise themselves for not being there and not being able to talk down the perpetrator.

Also at risk are those who lack support. "People who have support systems and feel able to communicate with [loved ones] about their experiences tend to be more resilient to the effects of traumatic stress," says Bergmann. "People without an adequate support system are at more risk for developing psychological problems or difficulties."

When adults who are at risk are traumatized by a new event, they suffer from what psychologists call a "mental injury." Dangerous situations trigger a stress response that includes releasing adrenaline and cortisol to speed the heart and increase oxygen absorption while slowing nonessential tasks like tissue repair and digestion. The brains of people at high risk get stuck in this "fight or flight" position and so are strained by the hyper-vigilant biological state. "If you maintain a hyper-vigilant state over time, it's going to upset your whole system," says Elaine Leader, a psychologist at Cedars-Sinai Medical Center in Los Angeles. "This is what you see in children who grow up in homes where there's violence. These kids are repeatedly traumatized so they grow up hyper vigilant and it causes changes in the way the brain develops."

Dunning says once the brain gets "stuck in terror" it feels terror all the time, making victims constantly aware of their environment, their emotions constantly on edge. "It comes out in anger, conflict, people develop attention deficits because they're so invested in environmentally scanning, they lose abstract reasoning, act irrational checking doors, checking locks over and over," says Dunning. "We're talking about the point where it interferes with someone's life. That's when it's time to get help. "

As a result of these fresh insights into how many people are severely affected, trauma counselors have revised the way they respond to events like school shootings. One change: they no longer encourage everyone in the community to attend a "debriefing" where the event is discussed and examined in detail. Instead, trauma counselors affiliated with groups like FEMA, the National Institute for Mental Health and the International Society for Traumatic Stress Studies follow a protocol called Psychological First Aid, which focuses less on pushing everyone in the community to talk at length about the trauma (which increases their exposure) and instead focuses on identifying at-risk people, and lending support for whatever recovery systems they already have in place. "All the things grandma used to say-go back to work, get with your family, all those things turned out to be more effective than pushing mental health services," says Bergmann. "All this counseling and rushing to the scene turned out not to be so helpful. Turns out not everyone needs to discuss the situation and everyone has their own way to process, find support from family or friends." The fact that the shootings took place at a college rather than a school may also help to reduce the extent of long-term psychological damage. Psychologists expect college-age students to respond more like adults than adolescents to a traumatic event like this. In addition, they say, students are already aware that their campus is a less sheltered environment than a high school and may experience less of a sense of violation than younger witnesses of school shootings.

Experts say the most important response to tragedies like the Virginia Tech shooting is helping people who are at risk get the help they need. "People need to know that these kinds of problems may be bad and create stress, but that doesn't make [everyone] mentally ill," says Dunning. "People have mental injuries and they need to be attended to, but we are a nation that has resources and experts knows how to deal with what comes up. If they suffer this type of mental injury, they should go get treatment. They will recover." Bergmann agrees. "We're a fairly resilient country. Most people will do pretty darn good recovering emotionally even without professional help."