Managing Mental Health After a Mass Shooting
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I was asked to write a post on managing fear after a mass shooting. More specifically this was requested by someone in my community after learning about the Gilroy, California shooting. The Office for Victims of Crime (OVC) and the American Red Cross define mass violence as the following:

An intentional violent criminal act, for which a formal investigation has been opened by the Federal Bureau of Investigation (FBI) or other law enforcement agencies, that results in physical, emotional, or psychological injury to a sufficiently large number of people to significantly increase the burden of victim assistance and compensation for the responding jurisdiction as determined by the OVC Director. (U.S. Department of Justice [DOJ], Office of Justice Programs [OJP], OVC & American Red Cross, 2005, p. 3 as cited by SAMSA, 2017).

1. Consider Counseling

Although this post is meant for those that learn of a mass shooting either in their own community or somewhere in the world, if you are reading this and were a direct victim of the tragedy, directly witnessed the shooting, you are linked to someone directly impacted by the shooting, or you experienced repeated or extreme exposure to the details of the shooting (such as if you were a first responder) some of the information in this article may be useful to you, but I have a stronger urge that you seek counseling if you are experiencing signs of acute or post traumatic stress. If you are experiencing intrusive memories of the traumatic event, having nightmares or flashbacks, experience a dramatic shift in your mood, struggle to experience pleasure, feel fearful or on edge, feel as though you’re in a daze, have issues with your memory or concentrating, feel a sense of emptiness or loss, are avoiding certain triggers that remind you of the event AND these symptoms are hindering your ability to function (such as socialize or engage the community, work, engage in leisure activities, manage your health or living situation), then counseling would be my first go-to suggestion. This suggestion also applies to those that have learned of the shooting in their community if one of more of the aforementioned issues are occurring and you believe your functioning is also being negatively impacted (you, of course, may also seek counseling if your functioning is not impacted and you believe counseling may be helpful for you). I have added a link at the bottom of this post for a website that is pretty much the Google for finding therapists. If you want tips on what type of therapist to look for, please email me and I can give you a quick pointer on this.

2. Remove Added Stimuli and Reminders

Ah, our cell phones and televisions can be such handy tools, but as you may already have guessed, there are many downfalls them.  If you are experiencing distress or fear after learning of a mass shooting in your community or the world (or are a direct victim) then continuously receiving reminders of the tragedy is unhelpful (to put it simply). More often than not, I prompt my clients to do this after they learn of a tragedy and are starting to experience more stress, fear and other uncomfortable emotions and symptoms. Witnessing constant reminders include visuals and replays of the aftermath, as well as witnessing other people’s emotions (online or on television) can exacerbate psychological symptoms.  One study has found that those who continuously watch images or video in the media about a tragedy had higher levels of PTSD symptoms (17.4%) and depression (14.7%) than those who avoided this type of stimuli (Ahern et al. 2002, as cited by SAMSA, 2017).  I normally prompt my clients to take 7 days off from social media and specific type of TV programs. That means zero Facebook, Instagram or other social media platforms as well as watching the news or political TV channels.

3. Seek Community

What I mean by seeking community is talk to your friends and family about your thoughts and emotions so you may share your experience and receive their support. I recommend finding community that will remain open minded and patient with you and provide you validation, but not add to your fear. I want you to keep going outside and living your life, so if certain friends or family are projecting their fears on to you (causing you to feel more uneasy) then they might not be the best candidates for this.

4. Get Involved

While working with my clients who have a stress response to learning of a mass shooting, a theme I’ve noticed is they feel as though they do not have control. I realize we are limited when it comes to controlling mass shootings, but getting involved in helping out with the aftermath of a shooting may provide a sense of purpose or control. This may be in the form of fundraising, volunteering for a 24-hour help line, donating to a charity (to ensure a charity is legitimate you can look them up on Charity Navigator or Charity Watch) or donating blood. Getting involved also gives you something to focus your attention on in the moment, which leads me to my next suggestions.

5. Ground When Experiencing Fear

I 100% acknowledge that experiencing fear after a mass shooting is an understandable response. A few days to a few weeks after a tragedy like this may feel out of the norm and emotions and mental health symptoms may be on high, but after some time it is important to try our best to remain in the here-and-now. To experience fear about a tragedy weeks after it occurs means we are focusing our attention on the past (thinking of the tragedy) or the future (worrying about it happening again). At that point it becomes imperative to ground your body, especially when you go back out to the community and public, crowded spaces. What I mean by this is managing the physiological symptoms associated with the fight-or-flight response (such as rapid heartbeat, difficulty breathing, sweatiness, dizziness), which becomes activated when we are afraid. I have personally talked to people in the past few days who are fearful of going to crowded places like the mall or night club. They explained to me that they do in fact want to go but after getting dressed and ready their hesitation sets in. I told them to ground so that they aren’t walking around the mall with adrenaline (among other chemicals) coursing through them and experiencing physiological symptoms of getting ready for a life or death situation when in fact they want to take their children school shopping.  You can do this with alternative nostril breathing, square breathing, or more simply put breathing SLOWLY and DEEPLY, in through the nose (4 seconds) and out through the mouth (5, 6, 7 to 8 seconds or more) and repeat this 5-10 times. Make your mouth the size of a Cheerio when you exhale, and breathe with your belly. This activates the parasympathetic system in the body and helps keep you out of the physiological fight-or-flight state associated with fear.

6. Self-Talk

Yes, I want you to talk to yourself. You don’t need to do this out loud (as that may feel a bit odd), but I do want you to engage in a dialogue with yourself that hits various points. Remember, we cannot tell the future (if we could, my job would be a lot easier). We only know what we know in the present moment, so if you have a fear of a tragedy happening, ask yourself 1) What exactly am I thinking is going to happen?, 2) Do I have evidence that this thought is true?, and 3) Is there another angle to view this situation from? For a more detailed description of this see my post titled Do I Have Evidence?

7. Stay Present

To put it simply, practicing mindfulness and being in the here-and-now takes us out of our future or past focused thinking, even if for a few seconds. If you continuously do this throughout the day, you’ve spent a huge chunk of your day in the present versus in your mind, which is where the narratives are created which contribute to fear. A way to practice this is to notice your five senses (or one or two at a time) as much as you can with each step it takes to get to and engage the environment you’d like to be in. Again, it’s OK if it’s a few seconds at a time, just keep trying to repeat it. So as you step out of your house, into your car (or however you would get there) and enter the surrounding you’d like to be in (e.g. mall, club, venue), pay attention to your senses. What do you see, hear, and smell? Feel your feet touch the ground. Notice your calf muscle as you walk. Feel the clothes on your back. Are you chewing gum? Focus on the taste, sensations and movement of chewing. As soon as a fearful or unhelpful thought comes in, GROUND, notice the thought, engage in self-talk, then focus your attention back to your breath, then back to your senses (and repeat).

With Love,

Dr. L

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SAMSA (2017, September). Disaster Technical Assistance Center Supplemental Research Bulletin Mass Violence and Behavioral Health. Retrieved from https://www.samhsa.gov/sites/default/files/dtac/srb-mass-violence-behavioral-health.pdf

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