9/11 Mental Health: What We Now Know About Trauma

In the days following 9/11, scores of mental health professionals and grief counselors rushed to directly-impacted areas, hoping to help people cope with the traumatic event.

Many gathered groups together -- asking survivors how they felt, what they thought and what the worst part of their experience was before providing them with basic stress management.

But in the 10 years since 9/11, many have abandoned the approach -- known as psychological or crisis debriefing -- in light of studies suggesting it does little to prevent post-traumatic stress. Instead, a growing number of psychologists support a new approach to helping children and adults who show signs of distress immediately after disasters: "Psychological First Aid."

In a new report published in a special 9/11 anniversary issue of the journal American Psychologist, Dr. Patricia Watson, a senior education specialist with the National Center for PTSD, and her co-authors explain the goal of the method is to reduce distress while linking survivors with key outside services. It is meant to be flexible -- highly specific and sensitive to factors including timing, age and an individual's personal preferences.

"Prior to PFA being routinely used, oftentimes providers would swoop in and try to 'help' everyone," Watson told HuffPost. "Implying that a disaster survivor 'needs' interventions in order to recover implies that they don't have the resources to recover on their own. They may accept this help, which actually removes an opportunity for them to work out their problems on their own."

The term Psychological First Aid has been used to describe a number of approaches over the years, but the National Child Traumatic Stress Network and National Center for PTSD (with which Watson works) codified a comprehensive model and operations guide, which can be used by all manner of providers including disaster response workers, in the years following 9/11 and other disasters like Hurricane Katrina.

That guide spells out eight areas of focus, including how to make initial contact and engage people in a non-intrusive way, how to calm disoriented survivors, how to help address their immediate concerns and how to point them towards services they might need down the road.

The method is highly adaptable, Watson explained. If providers only have a few minutes with an individual, they might focus on addressing immediate needs; if it is a week or two after a disaster and they have more time, they might run through all eight areas -- if they determine the individual needs them.

The real key to PFA, she said, is that it is not a one-size-fits-all approach to immediate post-disaster intervention.

"It is pretty common sense," said HuffPost blogger Dr. Lloyd Sederer, medical director of the New York State Office of Mental Health. In a blog post, he hailed the response to 9/11 as "the largest and most effective" mental health disaster responses in history, but explained that debriefing posed certain risks.

"There was this idea that you are supposed to talk about something in the immediate wake of it, but people process trauma differently," he said.

Indeed, Watson said providers should remember not to assume that everyone exposed to a disaster will actually be traumatized by it. In an essay introducing the special edition of American Psychologist, Roxanne Cohen Silver, a psychologist at the University of California at Irvine, explained that, while studies suggest the mental health impact of 9/11 may have been broader than anticipated, Americans also proved more resilient than many mental health professionals predicted.

"It became very clear after 9/11 that the impact of communal and collective trauma spilled over beyond the directly-impacted communities in New York City, Washington, D.C., and Pennsylvania," Silver said. "But in general, the message was one of resilience, rather than psychopathology. We saw normal reactions to an abnormal event."

Watson tweaked that message slightly, saying that what resulted were "understandable" or "expected" reactions to an abnormal event. PSA -- which she and her co-authors explain has not yet been systemically studied -- attempts to avoid labeling acute, immediate reactions as symptoms or disorders.

"It is not rocket science," said Watson. "It is trying to make a complete framework for intervening that is very conversational, very partner-oriented and very, very practical."