Direct Exposure To The Attacks example essay topic

Posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) are two stress disorders that occur after a traumatizing experience. PTSD is defined as a disorder that follows a distressing event outside the range of normal human experience and that is characterized by features such as intense fear, avoidance of stimuli associated with the event, and reliving the event. Acute stress disorder is defined as a disorder that is characterized by feelings of anxiety and helplessness and caused by a traumatic event. It also usually occurs within a month of the event and lasts from 2 days to 4 weeks.

Dealing with experiences like the Oklahoma City bombing in 1995 and the World Trade Center and Pentagon attacks in 2001 were difficult for people and easily classified as traumatizing experiences. For times like these when a large number of people experience a traumatizing experience and will probably develop PTSD or ASD, there is no precedent for how to treat them. The only tool that can be used at these times is the Diagnostic and Statistical Manual (DSM), to classify the disorder. No real solution exists for a treatment process for an incident of this scale. The three journal articles I will be using show statistical data about how people dealt with these experiences and what percent of them developed PTSD or ASD.

They also show how many people showed signs of these disorders but never contacted a professional to help treat it. Even as far away as Brussels, expatriates of the United States felt the effects of the attacks of September 11th. Empirical Research The first article was a study done on the Oklahoma City bombing in 1995 and the body handlers who sorted through rubble and human remains to find all the victims of the tragedy. Going through experiences like these will often lead to stress disorders, such as PTSD. This study tests that idea using 51 of the body handlers and a survey to see what they went through psychologically at the time of the event and how that relates to their mindset years later.

It also set out to test the idea that age, gender, physical exposure to the bombing, knowing a victim, or having disaster experience would change the likelihood of acquiring an anxiety disorder. It was also predicted that using "positive coping strategies including humor, favorable organizational and managerial factors, social support, level of training and use of rituals" (Doughty et al, 2002) would help reduce the chances of a disorder. Two years after the bombing surveys were mailed to 135 of the participating body handlers, including career medical examiners, pathology residents, and dental residents and students, with 51 responding. The ages of the participants ranged from 25 to 56 with an average age of 35. The majority of the participants were also married, Caucasian, men. The survey consisted of 100 questions that asked the participants questions about previous disaster experience and training, how closely connected to the bombing they were, depression symptoms at the time of the bombing and 1 year later, alcohol use after the bombing, their feelings about the work, and problems they had coping.

A point system was used to measure each of these and eventually put into a formula to measure each aspect. For example, to measure physical exposure, a 4-point scale was used to test the degree of hearing and feeling the blast. This then gave each person a score of 2 to 8. Other questions asked were on a simple yes or no scale, giving a score of 1 for yes and 0 for no. Such questions consisted of, did the participant know anyone who was killed or injured or have they ever worked in a disaster scene before. The final scale used was for questions like, how often the participant had nightmares or had intrusive thoughts about the event.

These were rated on a verbal scale of never, almost never, sometimes, fairly often, or often. After all of the participants finished the surveys, they were compared and put into statistical form. They compared post traumatic stress and depression reported at the time of the incident to scores 1 year later. The scores were then compared to see the relation between stress disorders and possible predictors, like age, gender, physical exposure to the blast, and many more. The scores were also used to compare the relationship between post traumatic stress and increased alcohol use, physical problems and seeking mental health treatment. The scores finally compared the relationship between using positive coping techniques and post traumatic stress 1 year later.

The results showed that the post traumatic stress scores and the depression scores decreased dramatically after 1 year. The results also showed that "gender, age, physical blast exposure, knowing anyone killed or injured, prior professional disaster work, and personal disaster experience were not significantly correlated with post traumatic stress" (Doughty et al, 2002). Increased alcohol use was reported by only 10% of the participants, but those were the individuals who were most likely to seek professional health treatment. Physical problems were also very low, with only 1 person reporting experiencing them often. Coping was also used by all the participants after the bombing, with spending time with others and focusing on the positive being the most widely used.

"There were no significant differences between those who had used and had not used each coping technique on mean difference in post traumatic stress, difference in depression, change in alcohol use, or seeking mental health treatment" (Doughty et al, 2002). Overall this study showed that the event had almost no long-term effects on the majority of body handlers, except for a few cases of increased alcohol use. The next article was done using a survey as well, of 124 New York City workers after the attacks on the World Trade Center. It set out to predict the symptoms of PTSD related to direct exposure to the attacks of 9/11, worries about future terrorist attacks, and reduced confidence in self. Those surveyed were not directly exposed to the attacks, but between being evacuated, seeing the buildings collapse from a distance, constant media coverage and trouble returning to their homes, all the participants were indirectly exposed. The hypothesis that the researches had come up with was that individuals with greater direct exposure would have more symptoms of PTSD.

The sample tested consisted of 124 New York City municipal workers, 70% being employed full-time, and 30% categorized as being seasonal or welfare work. Participants were mostly unmarried, ethnic minority members, and female. Education varied from didn't completed high school to a graduate degree. Age ranged from 19 to 60 years. And the three quarters of the incomes were below $40,000 a year. The anonymous surveys were distributed by graduate social work students 25 weeks after the attacks, and were all collected by 3 weeks after distribution.

Overall response rate was 93% of all those asked to participate. "The survey assessed exposure to the September 11 disaster, prior experiences with disasters, concerns about future attacks, PTSD symptoms, seeking counseling, symptoms of anxiety and depression, coping strategies-including seeing a therapist or counselor; perceived levels of social support, religiosity and spirituality, and demographics" (Brannen & Piotrkowski 2002). In addition, it also asked participant to rate their household income in 1 of 4 categories ranging from under $20,000 to over $50,000. The first scale used was a 0 to 6 scale to measure exposure to the attacks. Next was a 5-point scale to measure the participants thought of the possibility of a future attack, with answers from not at all to extremely. Then was another 5-point scale on if they thought they lived in an unsafe world, with answers from not al all true to extremely true.

Lastly a 17-item measure was used to calculate the symptoms of PTSD. The results showed that 42% of participants had no direct exposure to the attacks. "The most common exposures were personally witnessing the attacks and / or the collapse of the WTC (32%) and trouble getting home after the attacks (37%) " (Brannen, 2002). Although most people were not directly exposed to the attacks, and the worst problem any of the participants had was getting home, most of them still knew someone who was directly affected. Brannen (2002) states that 65% reported they knew someone who escaped the area of the attacks, 32% knew someone who died, and 21% knew someone who was physically injured in the attacks on the WTC.

As seen, most of the participants were not directly exposed to the attacks, but that did not keep them from worrying about future attacks. "Almost everyone (85%) worried at least a little about another terrorist attack; 43% worried a lot. About 8 out of 10 respondents worried at least a little about biological terrorism, whereas one third worried a lot" (Brannen, 2002). This constant worrying also lead to PTSD symptoms in many of the participants. "Only 16% reported no symptoms of PTSD, whereas 37% reported one to three symptoms, 19% reported four to six symptoms, and 28% reported seven or more symptoms, and women reported significantly more symptoms of PTSD than men" (Brannen, 2002). So the hypothesis that more direct exposure would result in more signs of PTSD was incorrect in the respect that almost all participants displayed some symptoms of PTSD even though non of them were directly exposed.

The last article was a study conducted in Brussels after the Terrorist attacks on the World Trade Center and the Pentagon on September 11th. The purpose of this study was to observe if "expatriates witnessing the attack of their country from afar can develop acute and post traumatic stress reactions" (Speckhard, 2003). A nonrandom sample of 50 expatriates living in Brussels was taken in the 10 weeks following the attacks in the United States. 'The participants were recruited at their workplaces in U.S. facilities in and near Brussels, including the U.S. Embassy to Belgium, the U.S. Mission to the European Union, the U.S. Mission to NATO, SHAPE, and NATO Support Activity, and hence represented diplomats serving in the foreign and commercial services and the armed forces, as well as civilian government workers and their spouses" (Speckhard, 2003). They were given a 2 page survey that included 30 items designed to reflect signs of a stress disorder. The items covered 5 fields including, "dissociative symptoms, reexperience, avoidance, increased arousal, and symptoms impairing psychological, social, and occupational functioning, including questions regarding coping or failure to cope, issues of conflict with significant others, and desire for professional help" (Speckhard, 2003).

Possible answers to the items were never, rarely, sometimes, and often. These were followed by questions about their chief worries, stress responses, coping mechanisms, family concerns, and what support they felt was missing. They were also asked to give general information about themselves like age, sex, marital status, type of government or civilian service, and rank. Age ranged from 19 to 61 with an average age of 42. The gender of participants was even with 52% male, 42% female, and 6% not specifying. 62% of the participants were government or military employees, 2% were civilian workers, 28% were spouses, and 8% failed to identify themselves.

And military ranks ranged from sergeant to major. The results showed that even though it was only 10 weeks after the attacks, people's fears and symptoms of distress had gone down. The only symptom that persisted was that people avoided talking about the event. Most of the categories people were grouped in had no real difference in higher stress levels, only gender and military status were significant, with women and civilians having higher stress responses to the attacks.

These results appear to demonstrate that military personnel are more tolerant of exposure to this type of event because of their training. Of the sample, 10% showed signs of ASD immediately after the attacks with 4% persisting. "It is significant to note that 20% of the respondents experienced all four areas of dissociative symptoms (on the sometimes to always level) -de realization, numbing, dazed and partial amnesia-and 10% persisted with these symptoms beyond the first week" (Speckhard, 2003). This all proves the hypothesis that researchers had predicted that stress disorders can even be present for people not living in the U.S. at the time of the attacks. As Speckhard (2003) states "witnessing one's country being attacked, even from afar, can be cause for post traumatic responses, especially in this day of live television coverage and endless replay. However, it is also clear from the statements made by respondents that it was not only the terrorist attacks that contributed to their ASD symptoms but also the possibility of further attacks and the heightened sense of arousal caused by this increased threat".

Conclusion Finally, these studies all seemed to have their own strengths and weaknesses. They all showed the data and results clearly, but did not always prove anything. The Oklahoma City bombing study, for instance, set out to show how this event would have greater effects and even some long term effects on the people who handled the bodies. The study only came away with the fact that a few of these people developed drinking problems. Besides that, the study was a waste of time, in my opinion. The second study, which showed how the events in New York City affected even municipal workers who had no direct contact with the attacks, was a beneficial study.

It showed how a large scale disaster like the attacks on the World Trade Center affect large masses of people and can contribute to disorders like ASD or even PTSD. I agree with Speckhard (2003) when he states that "psychologists need to think creatively about what can be done to ameliorate stress responses and about how to prevent the development of PTSD in large populations following acts of mass terrorism". Most of the people in that study did not receive any professional help, even though they may have needed it. Both of the studies on the WTC and Pentagon attacks show this need for a plan that will be able to help large masses of people cope with such an attack or disaster.

Reference PageBrannen, S.J., Piotrkowski, C.S. (2002). Exposure, Threat Appraisal, and Lost Confidence as Predictors of PTSD Symptoms Following September 11, 2001. American Journal of Orthopsychiatry, 72 (4), 476-485. Doughty, D.E., Jones, D.E., Jordan, F.B., Nixon, S.J., Pfeffer baum, B., Tucker, P., (2002). Body Handlers After Terrorism in Oklahoma City: Predictors of Posttraumatic Stress and Other Symptoms. American Journal of Orthopsychiatry, 72 (4), 469-475.

Speckhard, A. (2003). Acute Stress Disorder in Diplomats, Military, and Civilian Americans Living Abroad Following the September 11 Terrorist Attacks on America. Professional Psychology: Research and Practice, 34 (2), 151-158.