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What to Expect in the Wake of Mass Violence

Mass violence events happen with alarming frequency. Large-scale shootings in public places—malls, workplaces, entertainment venues, and schools—receive the most attention in the media, but incidents in which two or more people are the victims of serious violence happen regularly. These deadly crimes may be committed using guns, knives, fire, bombs, or even cars and trucks.

Events of extreme violence may cause a range of responses in people who were directly exposed to them and in those who are more remotely affected. It is known from the research on mass shootings that the people who were directly involved are likely to have more severe traumatic stress reactions, and that these reactions will last longer.

In the midst of mass violence, there is often also bravery, service, and compassion. Emergency responders rush to the scene. Strangers come together to apply first aid and transport victims to hospitals. Doctors and nurses work long hours to save lives and give comfort. After the immediate crisis has passed, communities may hold vigils or events to remember their neighbors and friends.

Common Reactions

Almost everyone who was at the scene of an act of mass violence will have stress reactions in the immediate aftermath. The initial relief to be alive may be followed by distress, fear, survivor guilt, or anger. Survivors of mass violence, or their family members, colleagues, and friends, may find it hard to stop thinking about what happened, have trouble sleeping, or feel keyed up or on edge. For most people, reactions will lessen over the first few weeks after the event. For those who were injured, have experienced prior trauma, lost someone they knew, or were present when the violence happened, reactions may be more intense and longer lasting.

What is affected after mass violence?

Sense of Safety

Mass violence harms people's sense of security and safety. This is true for individuals, communities, and society as a whole. The unpredictability and scale of mass violence can make people feel at risk for similar events—even if they were not directly affected.

Ability to Remain Calm Emotionally

People who were directly exposed to mass violence may feel a range of reactions that occur on and off, even years later. Anger, frustration, helplessness, grief, sadness, fear, and a desire for revenge are frequent reactions to crimes like these. Physical symptoms and sleep problems also occur. These reactions are normal—and common—but they can cause a lot of distress. Getting community support, practicing good self-care, and taking advantage of mental health counseling can help.

Coping After Mass Violence: Immediate Needs

After mass violence, people's reactions, needs, and priorities will vary depending on many factors. In the immediate aftermath of mass violence and disasters, most people have a core set of priorities that are related to five key needs:

• Reestablishing a sense of safety
• Regaining control and calm
• Connecting with loved ones and others
• Getting through the crisis
• Feeling hope, optimism, faith, or the belief that things will work out

Feelings of distress following mass violence or disaster cannot be resolved by a simple fix, but there are some important principles to remember:

• There's no "right way" to deal with these things. Everyone needs to find the way that works for them, and be patient in applying simple, ongoing strategies.
• Talk when you need to; listen when you can. It sometimes helps to hear the perspectives of other people who share your values and experiences. Take what helps, and leave the rest.
• You don't have to talk when you don't feel like it. Survivors sometimes do better when they are given space. If you are the loved one of a survivor, respect the survivor's desire not to talk if that is what they want. Give them space, and check back later.
• Resilience—being able to adapt to what life presents—often means rolling with the punches. Disasters highlight the forces in life that are much bigger than you are, and remind you that there's only so much you can do.
• Social support is key. Positive social support plays a crucial role in helping people recover from threat, trauma, and adversity. Reconnect with those you feel closest to, or reach out to others who have had similar experiences or who are caring and wise.
• Give it time. Resilience means that you bounce back in time; it doesn't mean that you never feel the impact of traumatic events. Learning to accommodate the things you experience is a continual and potentially lengthy process.

Coping After Mass Violence: Long-Term Needs

Most people who experience mass violence directly or through contact with affected colleagues or loved ones will recover. Having strong reactions in the immediate aftermath does not mean that you will have symptoms forever. People who were injured, have experienced prior trauma, lost someone they knew, or were present when the violence happened are more likely to have long-term reactions. Recovering may take time, and it may require you to learn how to adapt in new ways. What you need in the long term may be different from what helped you immediately after the event. In the following section are some strategies to help you continue to recover over time.

Strategies for Managing Ongoing Distress

As time moves on, if you still feel distressed or have trouble functioning, it is important to continue with general self-care activities. You may also want include some of the following strategies:

• Safety—To lessen worries, it can help to stay focused on specific routines of day-to-day living and seek out positive ways that help you to increase your sense of safety.
• Media viewing—Turn off the television if watching coverage of the event is increasing your distress.
• Problem-solving—Take an active, problem-solving approach to ongoing challenges by breaking problems into smaller chunks, coming up with creative solutions, and planning for simple, achievable steps toward those solutions.
• Schedule positive activities—Try to engage in positive, healthy, or meaningful activities, even if they are small, simple actions. Doing things that are rewarding, meaningful, or enjoyable, even if you don't feel like it, can make you feel better.
• Offering support—Being supportive to others, either informally or through volunteer work, may also be a way to find meaning. Helping others can also help you stay focused on something positive and build relationships with people who share your interests or values.
• Managing emotions—Look for positive coping strategies that help you manage your emotions. Listening to music, exercising, practicing breathing routines, talking with others, spending time in nature or with animals, journaling, or reading inspirational text are some simple ways to help manage overwhelming or distressing emotions.
• Social support—Spend time with people who give you a sense of security, calm, or happiness, or those whom you feel you can support.
• Helpful thinking—Ask yourself if your thoughts, especially those that are persistent and intrusive, are helpful to you right now. If you weigh the costs and benefits of holding on to negative thoughts or behaviors, and find there are more costs than benefits, there are actions you can take. Try to find other thoughts that can break you out of that unproductive loop or that activate you toward more helpful thoughts or actions. You can also reframe or divert your attention by practicing simple strategies like focusing on something or someone else in your life, finding ways to accept what has happened, praying, or practicing mindfulness.
• Meaning making—Try to find meaningful ways to honor those who have suffered or who were lost, either on your own or through contact with others. You can also shift your expectations about what is considered a good day, and reconfirm the people, values, and goals in your life that you realize are most important to you.

There is no standard timeline for recovering from an event as intense and potentially traumatic as a mass shooting. Depending on how close you were to the event, it may take a long time to feel better. If you develop your own ways of adapting to ongoing events and situations, you may gain a stronger sense of being able to deal with challenges, a greater sense of meaning or purpose, and an ability to mentor and support others in similar situations.

When to Consider Professional Help

Those who are most at risk for developing mental health problems following mass violence are the people who were closest to the event. If you or a loved one were present during the mass violence, or knew any of the people who were killed, you may be at higher risk for more serious or longer lasting distress or trouble functioning. If you are distressed or unable to function well, consider seeking help. Even if you are a provider and know what to do during such events, talking to someone else can be especially helpful.

There are competent and caring professionals available who can effectively treat the most common responses to mass violence, like depression, anxiety, posttraumatic stress disorder (PTSD), and complicated grief. The most effective treatments give you tools to problem-solve, mourn and make sense of what happened, deal with numbness or intense emotions, and foster resilience. It is a good idea to try meeting with a mental health professional at least once. The sooner you get help, the sooner you will feel better.

For those in need of more intensive services, research supports trauma-focused psychotherapy for PTSD as an effective treatment following disaster. Trauma-focused psychotherapy is a broad term that refers to several specific psychotherapies for PTSD. Trauma-focused means that the treatment focuses on the memory of the traumatic event and its meaning.

Trauma-focused psychotherapies use different techniques to help you process your traumatic experience. For example, some involve visualizing, talking, or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. They usually last about 8 to 16 sessions.