By Beau Black

School shootings have become an unfortunate constant in American life, and they leave communities, administrators, teachers, parents, and students scrambling to deal with the trauma they leave in their wake. Any violence can cause trauma, whether you’re personally involved, a witness to it, or indirectly affected. Mass shootings, especially in a school setting, can be uniquely traumatizing.

Wide-Ranging Effects

Large-scale violent events, such as school shootings, “can lead to grief, depression, addiction, PTSD, and somatic symptomology, in addition to suicide,” Health Affairs explains. Absent effective treatment, these mental health problems can lead to a laundry list of adverse effects on “quality of life and social, emotional, and cognitive functioning.”

“Across the country,” they observe, “survivors of school shootings return to their schools to attend classes, date, play sports, and try to define a new sense of normalcy, all the while struggling with grief, survivor’s guilt, PTSD, and symptoms of anxiety and depression.”

It’s no wonder. “Mass shooting survivors may be at greater risk for mental health difficulties” than survivors of other kinds of trauma, according to The American Psychological Association (APA).

The APA cites a SAMHSA (Substance Abuse and Mental Health Services Administration) study identifying three stages survivors may move through in their post-shooting experience: “the acute phase immediately after the event, the intermediate phase several days and weeks afterward, and the long-term phase” in the months that follow.

3 Post-Shooting Stages for Survivors

• ACUTE – immediately after the event
• INTERMEDIATE – several days and weeks afterward
• LONG-TERM – in the months that follow

SOURCE: SAMHSA.gov

Helpful Responses for Each Stage

During the initial stages, making helpful resources available to the survivor and keeping them connected to others are important, reassuring first steps that may ease their transition into recovery. In the intermediate phase, survivors may find themselves experiencing fear, anger, depression, and other symptoms that would benefit from “trauma-informed care.”

The APA references two programs, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) and Skills of Psychological Recovery (SPR), that are helpful in giving survivors tools to navigate their response to trauma. Other successful strategies for treatment include focused Cognitive Behavioral Therapy, and Eye Movement Desensitization and Reprocessing (EMDR).

In the longer term, survivors may no longer need regular treatment, but they may still be at risk, as untreated behavioral reactions surface in the form of flashbacks, debilitating anxiety or self-medicating. Without appropriate treatment, these can transform into mental health or substance use disorders.

Lingering Effects

Anniversaries of mass shootings can trigger or reactivate PTSD symptoms. And the closer the survivor was to the shooting or its victims, the greater the risk for PTSD.

Indeed, one year after the Virginia Tech shootings, researcher Heather Littleton, PhD, observed that elevated PTSD symptoms persisted among survivors. She also found that “local mental health care providers … noted an influx of survivors who sought treatment as time went on — after community focus and media attention had shifted.”

Feeling that others in their environment have “moved on” from the traumatic event may leave some survivors feeling lost or disconnected, according to Littleton. This makes follow up from mental health professionals and loved ones particularly important.

In addition to PTSD, survivor guilt and traumatic bereavement are common responses. the Psychiatric Times reports. “Survivor guilt occurs when individuals believe they have done something wrong in surviving a traumatic event in which others have perished. It has been described among Holocaust survivors and combat veterans as well as by survivors of natural disasters, airplane crashes, acts of terrorism, and mass shootings.”

One manifestation of this is risk of suicide among survivors. Two survivors of the Parkland shooting and the father of one of the victims of the Sandy Hook shooting committed suicide in March 2019, according to PT. All occurred within a 10-day period, and two of the three reportedly struggled with survivor guilt. Research has identified this as one of five factors that influences suicide attempts in veterans with PTSD.

Traumatic bereavement focuses primarily on grief, not guilt, after loss of a loved one, which may result in an over-developed focus on the deceased, anger, and bitterness.

Finding Successful Treatment

Successful treatment recognizes the wide-ranging mental and physical impact of trauma and responds with a combination of therapeutic approaches. Meadows Senior Fellow Bessel van der Kolk writes in his influential bestselling book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma that“unresolved trauma … leaves traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems.”

Trauma can rewire the amygdala, the body’s “smoke detector,” so that it alarms to the wrong stimuli. In PTSD, the balance between the amygdala and the part of the brain that oversees it is thrown off, leaving the body feeling constantly under threat. This balance must be restored in treatment that reintegrates the mental and physical, according to Dr. van der Kolk.

“Talking, understanding, and human connections help, and drugs can dampen hyperactive alarm systems.” But he also advocates for such diverse holistic practices as meditation, yoga, dance, and kickboxing.

“The imprints from the past can be transformed by having physical experiences that directly contradict the helplessness, rage, and collapse that are part of trauma, and thereby regaining self-mastery,” he says.