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Dr. Andrew Baum: Coping with traumatic stress

Andrew Baum, Ph.D., is Professor of Psychiatry and Psychology at the University of Pittsburgh and is currently Deputy Director of the University of Pittsburgh Cancer Institute. He has studied chronic stress and long-term consequences of traumatic or persistent stressors, specifically on mental health and psychological and physical symptoms of victims of disasters, and on the mental health and health related consequences of rescue and recovery work at disaster sites. He joined the chat room from Pennsylvania.

CNN: Thank you for joining us today, Dr. Andrew Baum, and welcome.

BAUM: Hello, everybody.

CNN: What psychological effects might people experience as a result of the crashes?

BAUM: Clearly, there will be changes in people's senses of security and vulnerability. Some people will experience a good deal of anxiety and apprehensiveness, and one might expect to see some people being confused, although much of that should be past. People's reactions to events like these change over time, and most of the reactions people have are normal and widespread.

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CNN: What are some methods that people can use to cope with this situation?

BAUM: Perhaps the primary method of coping that people would have used early on is to gather as much information about what happened. Clearly, the media coverage played an important role in that effort. At this point, people are coping with conflicting sources of stress. There is fear and apprehensiveness about what will happen next, and for those kind of concerns, continuing to monitor and seek out information should be common.

Other issues will include an inability to stop thinking about the event, or an upsetting or stressful focus on aspects of the event that are particularly upsetting. There, people will try to distract themselves, or otherwise explain what's happened in less threatening terms. Overall, I would expect people to be spending much of their energy trying to understand and explain to themselves what has happened, and why it happened.

Events like this challenge many of the assumptions that we make as part of our basic daily life, and until those assumptions can be repaired, people find themselves having some difficulty. Again, this kind of problem is very normal, and the only difference I would expect to see is not whether they have this kind of concern, but rather how long it lasts.

CHAT PARTICIPANT: I am having a great deal of trouble grasping what happened. It still feels very unreal. Is this a reaction you see often?

BAUM: For this event, absolutely. There are a number of reasons for that. This was a very, very powerful event, and nothing like this has happened before. So, it challenges more than just our basic assumptions. On top of that, we have come to see these events in movies and in other countries, although nothing like this, and most of our experience with these things have been in unreal contexts, so it's not surprising that people would have trouble dealing with them as though they're real. But this is a horrific event, and people need to distance themselves from it, so they can process it. This is not something that can be dealt with quickly and all at once, but is probably best dealt with in small pieces, as people come to grips with what has happened.

CHAT PARTICIPANT: Do you think Americans are trying to shield their children too much from this tragedy, instead of helping them cope with the reality of it?

BAUM: I don't know what people are doing. My own children are aware of what's happened. I think that depending on their age and maturity level, some of the details might be withheld. But I don't think, unless they're very young, that they should not know what's happened. My daughter has asked many questions about fundamental human nature that I didn't realize she was old enough to ask, suggesting that this event has catalyzed her thinking about issues children normally don't think about. So, I don't know whether people are shielding their children or not. I don't think they should be shielded entirely, but discretion should be used. Children are not as sophisticated copers as adults, in most cases.

CHAT PARTICIPANT: Do you consider giving blood as a worthwhile grieving ritual, despite the fact that hospitals have more than enough blood?

BAUM: They may have more than enough blood for the people directly affected by this event, but blood donation is always a good thing. Whether it is a grieving process, or a way to cope by finding a way to help, but if it makes people feel better, and makes them feel like they have contributed to the recovery of the victims and their loved ones, then it's a positive act. My understanding is that at this point, cash donations are being sought, and they would be equivalent, although blood is more symbolic, and provides more of a link to the victim.

CHAT PARTICIPANT: Do you think that religion should play an important role in the search for answers ?

BAUM: I think religion is important for those who believe in it, and are helped by it, and rely on it. I wouldn't want to suggest that everyone turn to religion, but we do know that religious beliefs and rituals are very powerful aids to people in times of crisis.

CHAT PARTICIPANT: How long should this concern last? Is there a time frame, or order of grief?

BAUM: If nothing further happens, although I would not want to set a specific time line for it, three or four weeks should be adequate for most to feel some relief, and if not recovered, feel well on their way to recovery. Unfortunately, there are likely to be other events, either more attacks on us, or perhaps attacks on someone else, or war. We're not really sure at this point what will happen. Further events will complicate any recovery trajectory that one could imagine. I could see some of those events helping people to recover, particularly if they are seen as ways of minimizing the likelihood of any further calamity.

CHAT PARTICIPANT: What psychological effect does viewing the crashes into the towers on television have on people watching?

BAUM: I don't know. I'm saying that because this is unprecedented. We rarely have the kind of window on an event that we had on this. In some ways, it makes it more frightening, and provides people with images that they continue to see in their minds that they suffer from.

On the other hand, seeing the events over and over again may serve to make people more used to what has happened, may make the events more real, and may help them process the information that they've been given. I've found that the phone calls and the content of the phone calls to be potentially more reactive, perhaps not more, but equally reactive. They've caused a great deal of distress, because they're so poignant, and they reduce the tragedy to a one-to-one personal level. I think people may identify with some of those phone calls. Clearly, they put a very human face on the disasters.

CHAT PARTICIPANT: How will the psychological progress affect people's idea over how the U.S. government should react?

BAUM: Clearly, there will be, or has already been, a good deal of anger as a result of these events. That will fuel resentment, demands for decisive action, and so on. Again, these responses are normal and expected. They are not of concern, unless they take on disproportionate dimensions. We need to be careful that our anger and grief do not give us license to harm innocent people, and to the best of our ability, we need to try to avoid that.

CHAT PARTICIPANT: Dr. Baum, don't you think that average Americans are stronger than some think, and should be able to recover from this in a timely fashion?

BAUM: I agree that people are strong and resilient. This is not limited to Americans, but to most people. I agree that most of us will recover and move forward as we have from so many other events, and as we will continue to do. One of the most striking aspects of working in an area like this, such as disasters or terrorism, is that people have a remarkable capacity to cope with severe stress.

CNN: Do you have any final thoughts to share with us?

BAUM: Nothing more than I've suggested. You should keep in mind that this won't remedy itself overnight. If your expectations are that you'll wake up and feel fine, it's probably unrealistic. Continued stress and apprehensiveness about the events of last week shouldn't necessarily be taken as a sign that something is wrong with you. I'd be more concerned about people who show little or no response.

CNN: Thank you for joining us today.

BAUM: You're welcome.

Dr. Andrew Baum joined the chat room by telephone and CNN provided a typist. This is an edited transcript of the chat which took place on Monday, September 17, 2001.

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