Some 500,000 people are believed to have developed post-traumatic stress disorder in New York following the fall of the World Trade Center, according to the Journal of the American Medical Association. This rate is nearly three times the national rate per capita. Thousands were directly affected - either having fled the building or the immediate vicinity or having lost a loved one or worked on recovery efforts.
So what are the best ways to cope with the anniversary? Whether you have been severely or moderately affected, experts agree that there are several key considerations to keep in mind in order to reduce stress and maintain optimal mental health. The entire month of September this year will be filled with reminders of the attack, so it is important to pay close attention to how you and those close to you are coping not just on the date itself, but during the weeks surrounding it. As the anniversary approaches, calls to 1-800-LIFENET, the helpline for mental health services which people can call to access Project Liberty, a free counseling and referral service for New Yorkers affected by the attacks, have steadily increased. "We've had a hundred additional calls a week for at least three weeks," statewide director April Naturale said in late August, when there were about 500 calls a week. "And it's climbing every day."
On the anniversary itself, experts say that there is no single best way to spend the day, whether you stay at home or participate in any of the planned ceremonies or events. "Trust your gut," says Dr. Richard Shadick, assistant director of Pace University's Counseling Center. "If you are already feeling very nervous, it might be good to have quiet reflection. But if you are craving information and connection with your community, it makes sense to find a way to participate." Shadick, who witnessed the attack and has provided pro-bono 9/11 therapy throughout the year, agreed to participate in Gotham Gazette's live chats on the day of the anniversary to counsel readers about how to cope. Naturale recommends keeping things "low key, because the emotions themselves may be overwhelming." Small community memorial ceremonies, private rituals like saying prayers or lighting candles, religious services, or just spending time with loved ones and friends can help. "We don't recommend isolating yourself," she adds.
Media attention to the anniversary, in this world capitol of media, will be nonstop and hard to escape entirely. "If you have been traumatized," says Naturale, "We recommend avoiding the images of the planes flying into the towers." For Project Liberty's tips on viewing 9/11 related TV, click here.
Dr. Nancy Smyth, Associate Professor at the University of Buffalo School of Social Work, is an expert on psychological trauma. "We have reason to suspect that the more people watch the images on TV, the more likely they are to have psychological symptoms of post-traumatic stress disorder including anxiety and depression." she says.
Smyth says the research can't determine whether people who are more traumatized are more likely to seek to watch the replays or whether the replays themselves are producing extra stress -- and some experts believe that repeated viewing could lead to desensitization, which might help in some cases. But, Smyth adds, "I have informally collected a lot of anecdotal data and people who have experienced a great deal of sleep disruption report that when they turn off the TV, they feel better."
Smyth advises minimizing exposure to the images of the disaster on television, particularly those which are most gruesome and explicit. She stresses particularly that people should not feel obligated to watch. "Many people felt they had to watch to show that they cared, and felt guilty turning it off. They felt relieved to have permission to stop watching." she says.
New Yorkers seem to be doing more of everything in their attempts to cope: While drinking, smoking and drug use have increased, so have gym memberships. Equinox is reporting a 25 percent increase in profits since 9/11 and New York Health and Racquet Club is also seeing increased demand, according to Crain's New York Business.
Exercise is one thing all the experts agree on as an excellent way of dealing with stress, and the time surrounding the anniversary is no exception. Whatever type of activity appeals to you - from rollerblading, rock climbing and running to dancing, swimming or even just walking -- moving your body can help you feel better.
One reason this is true is because focusing on your physical experience in the moment helps shift attention away from disturbing memories. Smyth cites research showing that traumatic memories seem to be stored in the brain differently from other memories; unlike ordinary recall, traumatic memories seem to involve an actual physical replay of previous events as experienced emotionally through sensations like elevated heart rate and heightened anxiety.
If you can calm those sensations from the past with physical activity now and focus on the current physical activity instead, this can help you overcome them. Therapy for traumatic stress often involves this kind of refocusing -- as well as trying to translate the memories from being disconnected physical and emotional snapshots into a coherent story, like normal memory.
"If you find yourself coming across images that are upsetting or intrusive, take time to sit down and write out what you feel and then go do something soothing." says Smyth. Both writing and talking with others can help people make sense of the traumatic experience and integrate it into normal memory. If you have intrusive memories, trying to put them out of your mind without giving them this kind of context tends only to produce more flashbacks and increased symptoms.
It's kind of like those thought experiments where people are told not to think of a certain subject, for example, white cats, say experts. Trying not to do so almost always fills your head with thoughts of pale felines; similarly, trying to suppress memories of an event that has upset you often calls up more of them until you can make sense of it and it no longer stands out so much.
Both Smyth and Naturale emphasize doing something that is meaningful to you personally to mark the anniversary, whether it be as short as observing a moment of silence, or whether you want to attend a memorial or plan a get-together with people close to you.
Finally, if you feel you need help, don't be afraid to seek it. Smyth says that the time to seek help is when talking to friends or taking other self-support measures aren't working and you continually feel low or have flashbacks. Project Liberty's hotline offers access to free, licensed mental health care services through 1-800-LIFENET, and the hotline can be accessed 24/7.