The United States has never seen terrorist attacks such as those experienced on September 11, 2001. Following the attacks, many individuals have struggled with how to best address the vulnerabilities of American society relating to terrorist activity. This article identifies several issues that can affect the previously open nature of the American lifestyle with impending threats of biological warfare. This turbulent environmental context has caused the American people to experience a level of stress never before experienced. The purpose of this article is to present a brief overview of America's policy on terrorism stressing the application of Roberts' seven-stage model of crisis intervention as one means to address the growing fears of the American public. All helping professionals, whether or not they're working directly with a crisis survivor, need to be aware of basic crisis intervention techniques. Application of this model is stressed as one way to provide education in this area while highlighting how to best help individuals cope when faced with the continual threat of a new and different type of war. Recommendations for therapeutic content are made within the current time-limited practice setting. [Author Abstract] KEY WORDS: crisis training; stress management; bioterrorism; terrorism; terrorist attacks; aftermath of September 11; crisis management

The September 11, 2001, attack on New York City was the the largest human-made disaster in United States history. In the first few days after the attack, it became clear that the scope of the attacks (including loss of life, property damage, and financial strain) was unprecedented and that the attacks could result in substantial psychological sequelae in the city population. Researchers at the Center for Urban Epidemiologic Studies at the New York Academy of Medicine designed and implemented an assessment of the mental health of New Yorkers 5-8 weeks after the attacks. To implement this research in the immediate postdisaster period, researchers at the center had to develop, in a compressed time interval, new academic collaborations, links with potential funders, and unique safeguards for study respondents who may have been suffering from acute psychological distress. Results of the assessment contributed to a New York state mental health needs assessment that secured Federal Emergency Management Agency funding for mental health programs in New York City. This experience suggests that mechanisms should be in place for rapid implementation of mental health assessments after disasters. [Author Abstract]

Posttraumatic stress and depressive symptoms were assessed in 51 body handlers (aged 25-56 yrs) after Oklahoma City's 1995 terrorist bombing. Participants completed a survey assessing demographics, previous personal and professional disaster experience and training, bombing exposure, posttraumatic stress and depression symptoms at time of body handling and 1 yr later, alcohol use following bombing, feelings about the work, and problems and coping at time of interview. Although many handlers were inexperienced and knew someone killed, symptoms were low postdisaster and decreased significantly after 1 yr. Higher symptomatology and seeking mental health treatment correlated with increases in alcohol use and new physical problems but not with demographics, exposure, or experience. Four respondents with the highest posttraumatic stress symptoms at both time points reported high physical and alcohol use problems and mental health treatment use, suggesting that these should be carefully assessed in body handlers postdisaster. Coping techniques are described, as well as possible reasons for unexpected resilience in the majority. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

In this article, the author provides a theoretical framework and clinical guidelines for work with children and adolescents in the general population and in clinical populations in light of the terrorist attacks and bio-terrorist anthrax attacks in the United States. Recommendations for mental health providers, parents, and other caregivers are provided. Reactions are discussed from a developmental perspective and are organized by developmental stages of infants and toddlers, preschoolers, elementary school, middle school, and adolescence. Clinical perspectives are organized according to DSM-IV-TR classifications of anxiety disorders, mood disorders, and dissociative disorders. There is focus on symptom recognition and intervention strategies. [Author Abstract] KEY WORDS: adolescents; children; developmental perspective; depression; mental health professionals; PTSD; terrorism; trauma

The terrorist attacks on the World Trade Center in New York City and the Pentagon in Washington DC, as well as the strong possibility of future similar attacks have obliged school crisis responders in our country to rethink usual ways of helping. In planning CISM services in U.S. schools, it now may be practical and necessary to use large-group approaches to assessment and service planning similar to those provided in war-affected nations. This paper reports on an extension of the CISM approach in schools as a guide in developing large-scale assessments and action plans. Such actions may be led by school CISM teams in collaboration with school site teams. Examples of collaborative assessment and action planning are included from CISM team and training experiences in New York City, El Cajon, and Long Beach, California. [Author Abstract] KEY WORDS: Critical Incident Stress Management (CISM), school crisis response, school violence, terrorism, community mental health

Like many people in the United States and internationally, the author was profoundly affected by the terrorist attacks on September 11th and the massive deaths in New York City, Washington, D.C., and Pennsylvania. The unprecedented numbers of innocents murdered and the massive media coverage combined to form an extraordinarily indelible imprint on hundreds of millions of people worldwide. The objectives of this commentary are to identify (a) the range of normal and expectable reactions to the acts that have been and are being experienced by millions of Americans -- and especially those who were distant from the trauma sites, and (b) the relationship between people's personal reactions to the acts and several related social and national policy issues and choices Americans are facing. The author offers this from his perspectives as a proud third-generation Syrian American, Vietnam veteran, social worker, and someone with a long-standing involvement in the field of PTSD. [Author Abstract] KEY WORDS: PTSD, trauma, terrorism, September 11, World Trade Center

A consecutive series of 91 patients (aged 17-73 yrs) with posttraumatic stress disorder (PTSD) resulting from a car bomb which exploded in the centre of Omagh, Northern Ireland in August 1998 were treated with cognitive therapy, along lines advocated by A. Ehlers and D. M. Clark (2000). There were no major exclusion criteria and 53% of patients had an additional axis I disorder (comorbidity). Therapists were NHS staff with heavy caseloads and modest prior training in cognitive behavioral therapy for PTSD. A brief training in specialist procedures for PTSD was provided. Patients received an average of eight treatment sessions. Significant and substantial improvements in PTSD were observed. Degree of improvement was comparable to that in previously reported research trials. Comorbidity was not associated with poorer outcome, perhaps because comorbid patients were given more sessions of treatment (average 10 vs 5 sessions). Patients who were physically injured improved less than those who were not physically injured. Overall, the results indicate that the positive findings obtained in research settings generalize well to a frontline, non-selective service. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Studies have not previously considered postdisaster adjustment in the context of psychiatric disorders. After the Oklahoma City bombing, a volunteer sample of 181 firefighters who served as rescue and recovery workers was assessed with a structured diagnostic interview. The firefighters had relatively low rates of PTSD and described little functional impairment, positive social adjustment, and high job satisfaction. PTSD was associated with reduced job satisfaction and functional impairment, providing diagnostic validity. Turning to social supports, seeking mental health treatment, and taking medication were not widely prevalent coping responses. Postdisaster alcohol use disorders and drinking to cope were significantly associated with indicators of poorer functioning. Surveillance for problem drinking after disaster exposure may identify useful directions for intervention. [Author Abstract] KEY WORDS: PTSD, rescue workers, coping, disaster, alcohol use disorder, Diagnostic Interview Schedule

OBJECTIVE: After the September 11 terrorist attacks, many adults and children received counseling. The authors assessed the prevalence and correlates of counseling for experiences related to the disaster received by children aged 4 to 18 years living in Manhattan. METHODS: From a representative sample of 1,008 adult residents of Manhattan who were living below 110th Street five to eight weeks after the attacks, the authors interviewed 112 parents or primary caretakers about their child's level of exposure to the disaster, the extent of loss, receipt of counseling services, and behavioral reaction. RESULTS: Overall, 22% of the children had received some form of counseling related to their experiences after the disaster. More than half of the counseling received (58%) was delivered in schools. Predictors of counseling in a multivariate model were male sex (odds ratio = 5.3), having a parent with current PTSD related to the attacks (OR = 4.3), and having at least one sibling living in the household (OR = 3.6). CONCLUSIONS: Parents' own level of posttraumatic stress was associated with whether their children received counseling related to the September 11 attacks. This finding has important implications, because parents act as decision makers for their children in seeking health care. After the terrorist attacks, school and health care personnel provided early intervention counseling in Manhattan. [Author Abstract]

How did the 1995 Oklahoma City bombing differ from prior disasters and what implications did it have for disaster mental health services and service delivery? The federal disaster mental health approach in this country developed largely out of experiences with natural disasters. The 1995 Oklahoma City bombing differed in several important ways, including the large number of human casualties, higher rates of psychopathology, and an extended period of concern due to the criminal investigation and trials, which suggested the need to consider modifications in the program. Outreach was extensive, but psychiatric morbidity of direct victims was greater than that of victims of natural disasters, emphasizing the need for attention to the triage and referral process. Other concerns that warrant consideration include practices related to record keeping and program evaluation. [Author Abstract]