On the subject of 9/11 and related trauma, we spoke with Yuval Neria, PhD, professor of clinical psychology (in Psychiatry and Epidemiology). Dr. Neria is the director of the Trauma and PTSD Program, New York State Psychiatric Institute. Dr. Neria published a commentary in the Journal of the American Medical Association on Sept. 8, 2011, co-written with Gregory M. Sullivan, MD, assistant professor of clinical psychiatry, titled “Understanding the Mental Health Effects of Indirect Exposure to Mass Trauma Through the Media.”
He also is the lead editor of the book “9/11: Mental Health in the Wake of Terrorist Attacks,” published in 2007 by Cambridge University Press, and the author of numerous publications from his 9/11 studies.
Q: Dr. Neria, does post-traumatic stress disorder (PTSD) related to an event like 9/11 differ from the PTSD people develop from other types of trauma, such as being a soldier or a victim of domestic violence?
Dr. Neria: Yes and no. The premise is true, that a single traumatic event that involves high levels of stress and fear, as 9/11 did, may create a spike of fear-related symptoms initially, which may decline over time. This is what the 9/11 data is showing.
However, where there is ongoing, repeated exposure – different levels and types of exposure – we can expect a more stable PTSD trajectory over time, that may be more enduring and comorbid with substantial mental health problems beyond PTSD.
Q: What have you found in your research related to people being exposed to 9/11 only through the media?
Dr. Neria: Right after the attacks, a number of papers were published showing an interesting association between number of hours of exposure to the media and mental health symptoms, especially PTSD. Consequently, some even suggested that media exposure – especially to live TV during the attacks – may have resulted in PTSD.
This is a little too much to expect or predict. The data clearly show that even if this association exists, it probably exists for the short term. For those who kept showing PTSD symptoms over time, my data from 9/11 has shown that they had significant pre-exposure vulnerability that put them at high risk for PTSD, almost regardless of the severity of the exposure. I didn’t find a single subject or patient that had PTSD due only to exposure to the media. The commentary in JAMA addresses this issue.
Q: What factors appear to influence the development of PTSD in people you have studied related to media exposure and the attacks on 9/11?
Dr. Neria: Pre-exposure vulnerability is a factor and can be associated with pre-9/11 traumatic exposure, pre-9/11 psychiatric history, or family history of psychiatric illness; all three factors predict the possibility that PTSD may be resulted from indirect exposure to the attacks, including exposure to the media. If none of these factors exists, however, we did not find that indirect exposure to the media resulted in PTSD.
Q: How might the large-scale remembrances of 9/11 affect people who are dealing with 9/11-related PTSD?
Dr. Neria: I have two impressions, although I have not done research on this topic. My impression from talking to victims and colleagues is that for those who have a direct link to 9/11 – they were personally involved, such as first responders and those who lost loved ones in the attacks – for those people, forgetting 9/11 would be a painful experience, almost a second disaster. Knowing that the city, and the nation, is memorializing 9/11 is an important factor for them to feel adequately recognized by the public. For some, the 9/11 10-year anniversary is an opportunity to recall, to mourn and perhaps to reach some closure.
However, I would suggest that hyper reporting, and especially through the electronic media, of 9/11 images and terrifying testimonies, may be quite painful to those who still endure 9/11 grief, and PTSD. The question is whether we, and the media, can respect that and remember this important event in a more proportional, not over-the-top way. This would be my message.
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