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Each individual is unique and as such the reactions to the exposure vary. Behavioral reaction to the same terrorist event may differ in various individuals. One may freeze, the other may run for his life and the third may behave heroically and help the wounded. Psychological and behavioral consequences of a terrorist attack may also vary. Positive reactions perhaps will include seeking out professional help, avoiding unhealthy coping behaviors such as excessive use of alcohol, cigarettes or drugs and sharing emotions and thoughts about the event with others. Examples of negative coping behavious that survivors may possibly turn to are self-isolation, substance abuse, aggressive behavior, reduced functioning levels etc.

Cognitive appraisal of the traumatic event and the ability of the survivor to regulate emotions contribute to the levels of resilience that the survivor will display (Ehlers & Clarck, 2000). For example, a survivor who is convinced that no place in the world is safe, no one is trustworthy and that life is not worth living will exhibit more psychological problems than a survivor who is convinced that the thoughts, reactions and the emotions that he is feeling are part of a normal process and are only temporary. The manner, in which one copes with the trauma, is in principle influenced by the meaning given to the traumatic event. The creation of a meaning to the traumatic event does not exist in a vacuum (Tuval-Mashiach et al., 2004). Cultural aspects as well as the survivors’ own personal perception shape the meaning given to a traumatic event. A religious survivor, for example, may believe that the reason for his or her survival is that god watched over him and protected him from harm.  A less religious survivor may just believe that he or she was lucky that time.

Religiousness and coping effectiveness were examined by Kaplan et al. (2005). The authors studied religious settlers in Israel who were exposed to terrorist attacks daily. Findings show that despite daily exposure to violent attacks, religious settlers reported less stress-related symptoms than secular individuals who lived in areas, which were less exposed to violent terrorist attacks. The authors hypothesized that deeply held beliefs systems provide high levels of resilience to developing stress-related problems. Faith in God or a higher power enables survivors of trauma to transcend beyond the pain and the tragic circumstances which surround them. High social cohesion also contributed to resilience of having to live under extreme dangerous conditions.

Survivors of terrorist attacks often display alert and checking behavior for suspicious factors in the environment. The anxiety, hypersensitivity and preoccupation with emotional or physical danger have negative influences on cognitive functioning procedures such as concentration, memory, efficient problem solving and the functioning level in different areas of life. Trauma survivors also tend to avoid public transportation or public places. Avoidance coping style is often highly utilized. It consists of minimization, wishful thinking, not thinking about the problem, withdrawal, externalization and expression of negative emotions i.e. shouting. Cognitive avoidance predicts more PTSD symptoms, which in turn predict more behavioral avoidance (Tiet et al., 2006).

Previous war experience and the occurrence of terrorist attacks can aggravate PTSD symptoms. The number of veterans who were treated for PTSD increased significantly after September 11 especially more than any other pathology (Weissman, et al., 2003). These findings indicate that veterans form a higher risk group within the general population. For veterans with PTSD each explosion of a terrorist bombing reactivates feelings of anger, frustration and depression. Each sight reawakens memories and intensifies flashbacks and/or nightmares. Ongoing and repetitive exposure to terrorist attacks influences therefore the severity and the persistency of PTSD symptoms. Beside PTSD symptoms, survivors of terrorist attacks often suffer from severe depression, memory deficits, sleeping disorders, hopelessness and helplessness.  The negative emotions, which they experience, are associated with lower self-reported self-efficacy (Fischer et al., 2006). The difficult psychological implications of terrorism have also been linked to suicidal behavior. Shortly after the occurrence of a terrorist attack, suicide rates in the general population decline. It is believed that the shocking reports of death of innocents (Salib, 2003) as well as the national grief influence the level of occurrence of suicidal behavior (Hawton et al., 2000). De Long and Neelman (2004) claim, however, that in the weeks after the September 11 attack there was an increase in reported suicidal behavior.

Some survivors get professional help and others live in silence with the symptoms as they try to survive another day in the harsh reality. The tendency not to ask for help may originate from various reasons. It may be due to the minimization of own needs. The survivor may think that others are worse off and therefore consider help-seeking behavior as inappropriate. The survivor may also feel guilt for surviving or even for having these psychological symptoms in the first place. Secondly, the survivor may attribute the symptoms to his or her personal weakness. There have also been cases in which survivors of terrorist attacks do not even realize that they were distressed due to the absence of attribution of the symptoms to the terrorist attack (Wilson et al., 1988).

In addition, civilians who live in countries in which terrorist attacks are recurring are highly conscious to security and precaution measures that need to be taken. The awareness that everyone demonstrates to suspicious activities or objects in the surrounding is high.The familiarization with the reports of another explosion does not decrease the psychological pain that is felt afterwards. In the last decade especially, terrorism has been spreading throughout the world and devastating the lives of many innocent people. It is a mission for researchers and mental health providers to identify risk factors as well as resilience factors of all potential psychological problems that result from terrorist attacks in order to provide everyone with the best care possible. 

De Long, A. W., & Neelman, J. (2004). The effect of September 11 terrorist attacks on suicide and deliberate self harm: A time trend study. Suicide and Life Threatening Behavior, 34, 4, 439-447.

Ehlers, A., & Clarck, D. M. (2000). A cognitive model of PTSD. Behavior Research and Therapy, 38, 319-345. 

Fischer, P., Greitemeyer, T., Kastenmuller, A., Jonas, E., & Frey, D. (2006). Coping with Terrorism: the impact of increased salience of terrorism on mood and self efficacy of intrinsically religious and non religious people.  Personality and Social Psychology Bulletin, 32, 3, 365-377. 

Hawton, K., Harriss, L., & Appleby, L. (2000). Effects of death of Diana, princess of Wales on suicide and deliberate self harm. British Journal of Psychiatry, 177, 463-466.

Kaplan, Z., Matar, M. A., Kamin, R., Sadan, T., & Cohen H. (2005). Stress related responses after three years of exposure to terror in Israel: are ideological and religious factors associated with resilience? Journal of Clinical Psychiatry, 66, 9, 1146-1154.

Salib, E. (2003). Effects of 11 September 2001 on suicide and homicide in England and Wales. British Journal of Psychiatry, 183, 207-212.    

Tiet, Q. Q., Rosen, C., Cavella, S., Moos, R. H., Finney, J. W., & Yesavage, J. (2006). Coping, symptoms and functioning outcomes of patients with posttraumatic stress disorder. Journal of Traumatic Stress, 19, 6, 799-811.

Tuval-Mashiach, R., Freedman, S., Bargai, N., Boker, R., Hadar, H., & Shalev, A. Y.  (2004). Coping with Trauma: narrative and cognitive perspectives. Psychiatry, 67, 3, 280-293.

Wilson, J. P., Harel, Z., & Kahana, B., (1988). Human adaptation to extreme stress: from holocaust to Vietnam.New York: Plenum Series.

Weissman, E. M., Kushner, M., Marcus, S. M., & Davis, D. F. (2003). Volume of VA patients with PTSD in New York metropolitan area after September 11. Psychiatric Services, 54, 1641-1643.

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