9/11 Changed the Way Psychologists Treat PTSD
When the airplanes flew into the World Trade Centers on September 11, 2001, thousands of first responders were called to Ground Zero where they spent days digging through the rubble in search of victims and survivors, and spent the following months cleaning the site of the attacks. The aftermath of the attack included a long list of health problems for those around Ground Zero, with the psychological condition, post traumatic stress disorder, being the most common among the population. The Guardian estimated that at least 422,000 New Yorkers suffered from post traumatic stress disorder (Templeton & Lumley, 2002). However, the attacks were not only limited to the World Trade Center, but also to the Pentagon in Washington D.C. and another plane, which instead of making it to the hijacker’s target, landed in a field instead. Although post traumatic stress disorder is not a new mental disorder that was manifested solely by 9/11, PTSD from the terroristic attacks occurred on such a large scale and was so uncommon that it challenged mental health care practitioners, changed the way mental health is assessed and treated, and prompted professionals to question mental health care treatments that were unmeasured before September 11, 2001.
Post traumatic stress disorder is developed when a person experiences a terrifying or dangerous event and can be developed at any age. Sometimes, the death of a loved one can cause the development of post traumatic stress disorder, or PTSD. In order to be diagnosed with PTSD, one must suffer from symptoms for at least one month and according to the National Institute of Mental Health, the symptoms of diagnosed PTSD are so severe, they interfere with work and relationships (NIMH » Post- Traumatic Stress Disorder). There is a wide range of symptoms of PTSD that include having flashbacks, nightmares, or terrifying thoughts, avoiding anything that may remind the sufferer of the event, feeling tense and easily startled, suffering from insomnia, or having poor anger management. Symptoms also include the inability to remember details about the event, having negative thoughts, feelings of guilt, or loss of interest in activities that were enjoyed prior to the traumatic event (NIMH » Post-Traumatic Stress Disorder). Young children with PTSD may develop problems with bedwetting, inability to speak, or unusual behavior, and older children may feel guilt or they may feel the need for revenge, which can lead to destructive behavior.
For over a decade after the attack at the World Trade Centers, The New York City Health Department World Trade Center Health Registry has been studying the effects of the attack on people surrounding Ground Zero. They have found that different factors in regards to the attack at the World Trade Centers contributed to PTSD among the adults and children affected by it. These factors include “injury, being on a high floor at WTC, evacuating late, working for an employer that experienced loss of life, witnessing horror, knowing someone who was killed in the attack, event- related job loss, [and] having little social support” (What We Know — 9/11 Health). Also, those who were closer to Ground Zero at the time of the event were more likely to develop PTSD than those who were further from Ground Zero (Tull, 2016). Post traumatic stress disorder did not only affect workers and volunteers who contributed towards recovery and clean up, and survivors from inside the World Trade Centers, but it also affected children in schools proximal to the area of the attack.
Research has been conducted over numerous aspects of PTSD and some studies are continuing until this very day. Because the trauma of the World Trade Center attacks happened on such a large scale, researchers have found that older methods for treating PTSD are not efficient (Harmon 2011). Debriefing, an old method to prevent the onset of PTSD in patients, allows individuals exposed to trauma in talk in group sessions that may a few hours to talk about what they have experienced and their feelings about the event. The goal of this method is to allow the individuals to grasp the details of the traumatic event and to reduce the severity of the distress from the trauma; however, studies have found that debriefing may prevent an individual from recovering from a traumatic event (McNally 2004). The process of debriefing can often be misused and can provoke anxiety because the individual must relive the event again (Regal 2010). Thus, debriefing often fails to benefit the individual who has experienced a traumatic event.
Another study has found that people are resilient in times of distress, and can recover on their own without treatments such as debriefing. Having resilience allows an individual to adapt to trauma and cope with an event, meaning they suffer from one or no symptoms of post traumatic stress disorder. In a study that took place following the attacks at the World Trade Center, researchers have found that in a sample of 2,752 randomly selected residents of New York City, 65.1% of the whole sample population were found to be resilient to experiencing PTSD after the catastrophic terrorist attack despite being highly exposed and having many risk factors. However, when broken down into multiple categories, such as income, race, gender, age, level of education, and proximity of residence to the World Trade Center. The rate of resilience among individuals living closer to the World Trade Center was 54.5% (Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D., 2006). Also, the rate of resilience in married couples was higher than other groups under the category of marital status. This can be explained by the resilience factors listed by the National Institute of Mental Health, which includes having support from family, or a support group. More resilience factors include having a good coping strategy and having the ability to respond effectively following the traumatic event (The National Institute of Mental Health, 2016).
Oddly enough, the attack on the World Trade Center did not affect only Americans. A study completed in Denmark after the attack on 9/11 shows evidence that although the attack occurred on American soil, citizens of Denmark, who have no immediate relations to the United States, were also affected. After the attacks, the researchers found that rate of trauma and stressor related disorders increased by 16% and lasted for about one year after the attack. In the study, the researchers stated that their research recognizes the mass media’s transmittance of stressors to audiences that are outside of the vicinity of the 9/11 attacks (Hansen, Østergaard, Sønderskov, & Dinesen, 2016). This supports another study in which researchers hypothesized that the usage of media may affect the reactions to the attack on the World Trade Center. The footage of the attack and the aftermath was viewed on almost every media outlet that existed in 2001, including international media outlets. In this study, they interviewed subjects for thirty consecutive months after the attacks and found that the season was also a varying factor in the severity of PTSD symptoms along with a list of other mental health issues. As expected, they found that the symptoms for PTSD was at its highest around the anniversary of the attack. They also found that the patients who suffered (Cohen, Kasen, Chen, Gordon, Berenson, Brook, & White, 2006).
In an article published by Scientific American, the author states that “trauma-response field has been moving toward what is known as psychological ‘first aid,’” which aims to lower the anxiety and promotes adaptive functioning, the ability to interact with society and can care for one’s self. Psychological first aid also includes providing survivors of traumatic events with resources that will help them rebuild their lives, allowing them to maintain their jobs, education, and relationships with others (Harmon, 2011). The main difference between psychological first aid in contrast to other methods of mental care is that psychological first aid is mostly self- dependent. This method is meant to be simple enough to use regardless of the setting and situation that the user is in (Psychological First Aid, 2016).
Therapists have turned to a form of therapy used to treat the psychological conditions specifically caused by the terroristic attack on the World Trade Center called cognitive behavioral therapy. Individuals who suffer from post- traumatic stress disorder from the attack on 9/11 reprocess the details in a supportive setting in order to better understand their thoughts and feelings while still feeling safe in their environment (Harmon, 2011; Cherry, 2016)3. However, one of the limiting factors with cognitive behavior therapy is that this form of treatment may not work for all patients, depending on the severity of the condition. This is because cognitive behavioral therapy fails to focus on the underlying problem (Cherry, 2016). Becoming aware of ones’ feelings and clarifying the details of the attacks on 9/11 does not make a memory any less terrifying for some sufferers of PTSD.
Prolonged exposure therapy, which according to a therapist at a Veterans Affairs hospital has had 85% success rate, is designed by Edna B. Foa and is mainly used to treat post- traumatic stress disorder (Morris, 2015). Since the symptoms of PTSD are characterized as similar to the body’s “fight or flight” response, prolonged exposure therapy allows the patient to “unlearn” the sufferer’s response to small triggers of the trauma. This is done by asking the patient to place themselves back into the event and retell the details. The idea of this method is that the more the event is relived and retold, the memory will transform into a less traumatic memory, therefore desensitizing the patient of irrational fear (Morris, 2015; Prolonged Exposure Therapy for PTSD, 2015).
Another form of psychological relief from PTSD caused by the attacks is eye movement desensitization and reprocessing. Like prolonged exposure therapy, eye movement desensitization and reprocessing, or EMDR, was developed in the 1980’s. The psychologist responsible for this method, Francine Shapiro, found that her negative emotions decreased when her eyes darted from side to side while on a hike. Using what she discovered about herself, the patient is instructed to following the therapist’s hand movements with their eyes while recalling the traumatic event which has caused the patients’ PTSD (EMDR: Eye Movement Desensitization and Reprocessing, 2015). A study completed a few years after the attack on the World Trade Centers tested the efficiency of EMDR. The participants included sixty five people ranging from six to sixty-five years old who had lost someone in the attacks, or witnessed the attacks or aided in rescue, recovery or clean up. On average, the results of the treatment were significantly positive among patients. However, the researchers and clinicians found that the longer the patient waited for treatment, the more the patient experienced disturbances, therefore this treatment is more effective immediately after the traumatic event (Silver, Rogers, Knipe, & Colelli, 2005).
As a result of the attacks on the World Trade Center on 9/11, the mental health of many people including witnesses, survivors who escaped from the towers, and workers and volunteers who aided in rescue, recovery and clean up, was compromised, and many suffered from post- traumatic stress disorder. This prompted funding for many mental health care practitioners and researchers to test multiple methods of relieving distress from this traumatic experience in order to find the method that is most beneficial and efficient in easing traumatic experiences, changing the way post traumatic stress disorder, along with many other mental health disorders, is approached and treated. Among the methods tested were psychological first aid, cognitive behavioral therapy, prolonged exposure therapy, and eye movement desensitization and reprocessing.
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