PTSD: National Center for PTSD

What to Expect in the Wake of Mass Violence

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Mass violence events happen with alarming frequency. Large scale shootings or riots in public places—malls, workplaces, entertainment venues and schools—receive the most attention in the media, but incidents in which 2 or more people are the victims of serious violence happen regularly. These deadly crimes may be committed using guns, knives, fire, bombs or even cars and trucks. Some of these events may be hate crimes where victims are chosen because of their race, religion, ethnicity, gender, sexuality or other social factor.

Events of extreme violence may cause a range of responses in people who were directly exposed to them and in those who are more remotely affected. We know from the research on mass shootings that the people who were directly involved are likely to have more severe traumatic stress reactions, and that these reactions will last longer.

In the midst of mass violence, there is often also bravery, service and compassion. Emergency responders rush to the scene. Strangers come together to apply first aid and transport victims to hospitals. Doctors and nurses work long hours to save lives and give comfort. After the immediate crisis has passed, communities may hold vigils or events to remember their neighbors and friends.

Common Reactions

Almost everyone who was at the scene of an act of mass violence will have stress reactions in the immediate aftermath. The initial relief to be alive may be followed by distress, fear, survivor guilt or anger. Survivors of mass violence, or their family members, colleagues and friends, may find it hard to stop thinking about what happened, have trouble sleeping, or feel keyed up or on edge. For most people, reactions will lessen over the first few weeks after the event. For those who were injured, have experienced prior trauma, lost someone they knew, or were present when the violence happened, reactions may be more intense and longer-lasting.

What is affected after mass violence?

Sense of Safety. Mass violence harms our sense of security and safety. This is true for individuals, communities, and society as a whole. The unpredictability and scale of mass violence can make people feel at risk for similar events—even if they were not directly affected. If the violence was also a hate crime, the people who share identities with the victims may feel even more on edge.

Ability to Remain Calm Emotionally. People who were directly exposed to mass violence may feel a range of reactions that occur on and off, even years later. Anger, frustration, helplessness, grief, sadness, fear and a desire for revenge are frequent reactions to crimes like these. Physical symptoms and sleep problems also occur. These reactions are normal—and common—but they can cause a lot of distress. Getting community support, practicing good self-care and taking advantage of mental health counseling can help.

Coping After Mass Violence: Immediate Needs

After mass violence, people’s reactions, needs and priorities will vary depending on many factors. In the immediate aftermath of mass violence and disasters, most people have a core set of priorities that are related to 5 key needs:

• Reestablishing a sense of safety
• Regaining control and calm
• Connecting with loved ones and others
• Getting through the crisis
• Feeling hope, optimism, faith, or the belief that things will work out

Feelings of distress following mass violence or disaster cannot be resolved by a simple fix. But there are some important principles to remember:

• There’s no “right way” to deal with these things. We each need to find the way that works for us, and be patient in applying simple, ongoing strategies.
• Talk when you need to; listen when you can. It sometimes helps to hear the perspectives of other people who share your values and experiences. Take what helps and leave the rest.
• You don’t have to talk when you don’t feel like it. Survivors sometimes do better when they are given space. If you are the loved one of a survivor, respect the survivor’s desire not to talk if that is what they want. Give them space and check back later.
• Resilience—being able to adapt to what life presents—often means rolling with the punches. Disasters highlight the forces in life that are much bigger than we are and remind us that there’s only so much we can do.
• Social support is key. Positive social support plays a crucial role in helping people recover from threat, trauma and adversity. Reconnect with those you feel closest to or reach out to others who have had similar experiences.
• Give it time. Resilience means that you bounce back in the end; it doesn’t mean that you never feel the impact of traumatic events. Learning to accommodate (or adjust or adapt to) the things you experience is a continual and potentially lengthy process.

Coping After Mass Violence: Long-Term Needs

Most people who experience mass violence directly or through contact with affected colleagues or loved ones will recover. Having strong reactions in the immediate aftermath does not mean that you will have symptoms forever. People who were injured, have experienced prior trauma, lost someone they knew, or were present when the violence happened, are more likely to have long-term reactions. Recovering may take time, and it may require you to learn how to adapt in new ways. What you need in the long term may be different from what helped you immediately after the event. Here are some strategies to help you continue to recover over time.

Strategies for managing ongoing distress

As time moves on, if you still feel distressed or have trouble functioning, it is important to continue with general self-care activities. You may also want include some of the following strategies:

• Safety. To lessen worries, it can help to stay focused on specific routines of day-to-day living and seek out positive ways that help you to increase your sense of safety.
• Media Viewing. Turn off the television and take a break from social media if watching coverage of the event is increasing your distress.
• Problem-solving. Take an active, problem-solving approach to ongoing challenges by breaking problems into smaller chunks, coming up with creative solutions, and planning for simple, achievable steps towards those solutions.
• Positive Activities Scheduling. Try to engage in positive, healthy, or meaningful activities, even if they are small, simple actions. Doing things that are rewarding, meaningful, or enjoyable, even if you don’t feel like it, can make you feel better.
• Offering Support. Being supportive to others, either informally or through volunteer work may also be a way to find meaning. Helping others can also help you stay focused on something positive and build relationships with people who share your interests or values.
• Managing Emotions. Look for positive coping strategies that help you manage your emotions. Listening to music, exercising, practicing breathing routines, talking with others, spending time in nature or with pets, journaling, or reading inspirational texts are some simple ways to help manage overwhelming or distressing emotions.
• Social Support. Spend time with people who give you a sense of security, calm, or happiness, or those who you feel you can support.
• Helpful Thinking. Ask yourself if your thoughts, especially those that are persistent and intrusive, are helpful to you right now. If you weigh the costs and benefits of holding on to negative thoughts or behaviors and find there are more costs than benefits, there are actions you can take. Try to find other thoughts that can break you out of that unproductive loop or that activate you towards more helpful thoughts or actions. You can also reframe or divert your attention by practicing simple strategies like focusing on something or someone else in your life, finding ways to accept what has happened, praying or practicing mindfulness.
• Meaning Making. Try to find meaningful ways to honor that those who have suffered or who were lost, either on your own or through contact with others. You can also shift your expectations about what is considered a “good day,” and reconfirm the people, values, and goals in your life that you realize are most important to you.

There is no standard timeline for recovering from an event as intense and potentially traumatic as mass violence. Depending on how close you were to the event, it may take a long time to feel better. If you develop your own ways of adapting to ongoing events and situations, you may gain a stronger sense of being able to deal with challenges, a greater sense of meaning or purpose, and an ability mentor and support others in similar situations.

When to Consider Professional Help

Those who are most at risk for developing mental health problems following mass violence are the people who were closest to the event. If you or a loved one were present during the mass violence, or knew any of the people who were killed, you may be at higher risk for more serious or longer lasting distress or trouble functioning. If you are distressed, or unable to function well, consider seeking help. Even if you are a provider and know what to do during such events, talking to someone else can be especially helpful.

There are competent and caring professionals available who can effectively treat the most common responses to mass violence, like depression, anxiety, PTSD, and complicated grief. The most effective treatments give you tools to problem-solve, mourn and make sense of what happened, deal with numbness or intense emotions, and foster resilience. It is a good idea to try meeting with a mental health professional at least once. The sooner you get help, the sooner you will feel better.

For those in need of more intensive services, research supports trauma-focused psychotherapy for PTSD as an effective treatment following disaster. “Trauma-focused” means that the treatment focuses on the memory of the traumatic event and its meaning. Trauma-focused psychotherapies use different techniques to help you process your traumatic experience. For example, some involve visualizing, talking, or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. They usually last about 8-16 sessions.

Learn more about Effective PTSD Treatments or compare treatments using the PTSD Treatment Decision Aid.

Tools and Resources

• PTSD Coach Mobile App
  This mobile app has tools that can help you deal with common reactions after mass violence, like, stress, sadness and anxiety. You can also track your symptoms over time.
• Resources for Survivors and the Public Following Disaster and Mass Violence
  Disaster and mass violence may lead to injury, death, and psychological distress. This page links to information to help affected individuals and loved ones deal with distress that may result from these events.