The Path of Greatest
Resilience

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The authors are conducting their research within the RAND Center for Domestic and International Health Security.

Given the continuing threat of terrorist activity in the United States, it is important for U.S. leaders to promote a national sense of psychological resilience. As researchers, we know from our own work and from the expanding literature base that disasters and terrorist activity can produce severe and persistent emotional and behavioral consequences. Our goal is to create better prevention and response strategies for the future.

AP/WIDE WORLD PHOTOS/PATRICIA MCDONNELL Americorps volunteers Derek Haddad, 18, left foreground, and Eddie Galan, 18, right, join 1,000 new Americorps members for a kickoff rally in Boston on Oct. 19, 2001. Americorps members volunteer for one year to work in community service.

The strategies will rely on a greater understanding of the emotional and behavioral consequences of terrorism. These consequences depend on many factors, including the way people process information, the way people behave in the immediate aftermath of an event, and the relationship between a person's emotional responses and psychological symptoms. Often such emotions as fear, anger, and worry can lead to psychological symptoms of anxiety and depression. Different populations of people may also respond in different ways.

Good and Bad Consequences

On Sept. 11, 2001, Americans experienced widespread symptoms of fear, anxiety, sleeplessness, and depression. Such reactions are to be expected. The very definition and intent of terrorism is to elicit horror and generate fear in a broad audience. But how these symptoms are expressed, recognized, and handled may determine how they affect people over the long term.

For some people, the consequences may be severe and persistent. For many others, the symptoms are likely to subside over time. But even if the emotional responses are ephemeral, they could trigger important behavioral responses to terrorist events, in both the short term and the long term.

For individuals and groups alike, the behavioral consequences could be both positive and negative. Positive responses could include saving more money, connecting more with others, and taking appropriate precautions. Negative responses could include drinking more alcohol, functioning less productively at work, or losing confidence in society and government. The consequences could vary depending on the characteristics of the people exposed to the trauma, the nature of the trauma to which they are exposed, the extent of exposure, and the nature and extent of support they receive afterward.

Research has demonstrated that one need not be present to experience the stress and trauma associated with disasters, violent crimes, terrorism, and war. With the immediacy and expanding reach of media coverage, people are repeatedly exposed to terrifying images, increasing the likelihood of some psychological response.

We also know from psychological theory and research that the different ways of perceiving and interpreting risk will influence people's emotional and behavioral responses to that risk. Thus, it is important to consider how risk is communicated to the public, since this can influence the ability and willingness of individuals and communities to follow response strategies, precautions, and evacuation instructions.

It Takes a Community

Disaster research indicates that the fabric of communities and of society can provide resiliency and protection against psychological consequences. Probably the best protective factors are the communities in which potential victims live, work, and interact. Conversely, it has been suggested that the erosion or alteration of a social or community fabric (e.g., closing schools, churches, or other social institutions; quarantining individuals without letting them communicate with the outside world) can cause psychological harm.

The importance of the social fabric implies the need for innovative community strategies to provide information and reassurance while maintaining an ongoing surveillance of community threats. The new approaches may also require an expansion of the concepts of local "emergency responders," "relief workers," and "trauma counselors."

Currently, the roles of emergency responders, primary care physicians, and specialty mental health services are fairly distinct. In the future, emergency response strategies may need to incorporate each of these service-provider roles. Although psychiatrists, psychologists, and other behavioral health specialists are needed to address severe emotional and behavioral consequences of traumatic events, many of these professionals today have no specialized training in emergency response. Likewise, although primary care and emergency care workers are mostly responsible for tending to the survivors of terrorist attacks, their priority is assessing and treating physical, not psychological, injuries.

Policymakers should also think about ways to capitalize on the strengths of a broader range of social institutions and organizations beyond the health care system. Deploying emergency mental health personnel to the site of an attack is insufficient. Terrorism spreads fear and disrupts lives far beyond the immediate site. A much broader capability is needed—to ensure an effective workforce in times of duress, to prevent mass panic that can seriously weaken the strength of our society and economy, and to protect children from the damaging effects of anxiety on learning and development.

In this regard, researchers, clinicians, and policymakers should avoid "over-medicalizing" the problem and should provide other kinds of important services and support systems. Policymakers should view employers, religious organizations, and schools as part of the response strategies and create roles for them in mitigating any potential long-term psychological harm. At the same time, clinicians and policymakers should recognize that some of the victims, especially those most directly affected by an attack, will need specialty mental health services. It is important that those services focus on both immediate and long-term needs.

Research can help prepare the nation for the vast array of emotional and behavioral consequences that could affect individuals, communities, and societal well being. We at RAND plan to assess current response capabilities and to model the effects of different policies, strategies, and programs that could be used for different terrorism scenarios.

Ultimately, we hope to share a better understanding of the psychological consequences of terrorism with government leaders so that they can develop better communication techniques to help the nation as a whole respond and recover. With proper planning, better prevention, and optimum response strategies, Americans from many walks of life—policymakers, clinicians, emergency response workers, employers, and community leaders—can work together to minimize the psychological effects of terrorism and maximize the national resistance to it.