As the conflicts in Afghanistan and Iraq continue, all Americans will experience varying amounts of grief and fear. Nobody is unaffected by war. In military families, however, there is the added fear for the safety of loved ones who may be or already have been deployed, as well as the potential challenges of coping as a single parent.

You or someone you know may already be experiencing some of the following signs of the emotional impact of this stress, or these symptoms may arise over the coming weeks and months:

• Difficulty completing tasks
• Trouble concentrating
• Fear and anxiety about the future
• Apathy and emotional numbing
• Irritability and anger
• Sadness and depression
• Feeling powerless
• Extreme hunger/lack of appetite
• Difficulty making decisions
• Crying for "no apparent reason"
• Headaches or stomach problems
• Difficulty sleeping
• Excessive drinking or drug use
• Feeling withdrawn

Some people will try to get back into the routine of life as soon as possible to regain a sense of control, but others will have difficulty focusing for some time. Both reactions are common responses to crisis. The intensity of your feelings will decrease as time passes and you focus attention on day-to-day activities. Because everybody experiences stress differently, don’t compare your "progress" with others around you or judge other people’s reactions and emotions. While many people survive major life stressors without developing significant psychological problems, others may need assistance.

Here are some tips for coping during these difficult times:

Talk About It: By talking with others, particularly other military spouses, you will relieve stress and realize that other people share your feelings. Support groups exist at most military installations. If there’s one available to you, join; if not, consider starting one. If you feel overwhelmed, ask for help. It’s not a sign of weakness. Talk with a trusted relative, friend, family services staffer, minister or rabbi. Military chaplains can be helpful, as most receive training in pastoral counseling and crisis. Don’t let yourself become isolated.

Take Care of Your Physical Health: Get plenty of rest and exercise, avoid excessive drinking and drugs, and eat properly. Avoid foods that are high in fats and calories.

Limit your exposure to the news media: Especially avoid around-the-clock television news coverage and the Internet. The images, rumors and speculation can be very damaging to your sense of well-being.

Engage in activities that you find relaxing and soothing: Plant flowers, attend a concert, visit an art gallery, or take a long bath. Be kind to yourself.

Do something positive: Get involved in activities that encourage togetherness and reassurance. Contact community volunteer organizations to see how you can help. Give blood, prepare "care packages" for service men and women or write letters to people in the military. Support a friend or neighbor who is having a difficult time.

Seek Treatment: If you have strong feelings that won’t go away or you are troubled for more than four to six weeks, you may want to seek professional help. People who have had previous mental health problems and who have survived past trauma may also want to check in with a mental health care professional. Nearly every military installation has a Family Service Center, Family Support Center or Army Community Service Center (depending on the branch of service) where you can access information, referral, counseling, and crisis intervention services. In addition, all military families, including those of National Guard and Reserve members who are activated for more than 30 days, are eligible for medical and mental health care either at a Military Medical Treatment Facility or at a civilian facility through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).

With the war in Iraq and Afghanistan, and the ongoing threat of terrorist attacks, our world has changed drastically, and focusing on "business as usual" has become extremely difficult. But occupying our time with the routine of work is a necessary step in coping with crisis.

Each person reacts differently to a crisis and a range of responses can be expected. You must remember, however, that for some people the effects may not be felt immediately but, instead, arise months later.

As the war and the terrorist threat continue, you may begin to see evidence of the emotional impact on employees. This may play out in their performance and productivity in the following ways:

• Working slowly
• Appearing numb or emotionless
• Missing deadlines
• Withdrawal from work activity
• Absenteeism; calling in sick frequently
• Overworking
• Irritability and anger
• Forgetting directives, procedures and requests
• Difficulty concentrating and making decisions
• Difficulty with work transitions or changes in routines

To help your employees work through the emotional tolls of this crisis and reduce the impact on your organization’s productivity, the National Mental Health Association (NMHA) recommends the following actions:

Educate your supervisors and managers. Inform all supervisors and human resources professionals about the signs of emotional distress; all policy changes and actions being taken in response to the crisis; and available counseling resources so they, in turn, can inform their staffs. Direct them to encourage employees to seek counseling when necessary. Have them tell employees that your doors are open to them during this and other times of crisis. Designate a human resources or other manager as a contact person.

Provide educational resources. Your employee assistance program (EAP), human resources unit and/or local mental health center may have educational materials and information on covered treatment resources. Make sure to have up-to-date provider listings, as well as information about available benefits and the processes for accessing care. Tell employees whom they should contact if they have trouble accessing services or if they are unhappy with the quality of care they receive.

Facilitate communication among employees. Support from their colleagues can help people work through difficulties. Consider allowing people to break from work periodically to talk. Provide a comfortable environment where they can gather.

Consider bringing a professional counselor/facilitator on-site. A professional can conduct group meetings and provide individual counseling. This will help you identify and get help to those who need it most. This will help alleviate their immediate anxiety and reduce their need for services later on.

Consider temporary changes in your leave and travel policies. Allow people to take time off beyond the norm to donate blood, take part in community activities and to address personal needs. With regard to travel, reassure employees that you have their safety in mind, first and foremost. Tell them about any short-term travel policy changes, and let them know that policies will be revised as required by future events.

Promote tolerance. Warn employees that you will not tolerate hostility directed at members of specific ethnic or religious groups, in the workplace, among your customers or in the community. Supervisors will challenge discriminatory remarks or actions, or any form or harassment, and disciplinary action will be taken.

Organize community activities. Hold a blood drive, collect donations for "care packages" or encourage writing letters to people in the military. Show employees that your organization is committed to helping those in the workplace, and to supporting our service men and women. (Bear in mind that the military is overloaded with generic "care packages" that cannot be sent to anonymous military personnel. You’ll have to send a package to a specific soldier with lots of goodies that he or she can share.)

Plan for future emergencies. Create or review your organization’s emergency plan to address any situations that might arise from the current crisis. Involve all levels of staff in the planning. Remind employees of emergency procedures. Feeling prepared will help ease their anxiety.

Talk with your co-workers and listen patiently. If you feel grief, anxiety or anger, you are not alone. Talk with colleagues who are experiencing the same feelings. Be aware of the special needs of people who have loved ones in the military or living overseas. When listening, don’t try to "fix it" or offer false comfort, especially if somebody has lost a loved one. Instead, offer a simple expression of sorrow and take time to listen. Discourage damaging ways of coping, such as excessive drinking. Don’t hesitate to recommend professional help if needed.

Accept that life will go on. Acknowledge that everyday life will be subdued and, perhaps, different in some way, depending on your particular situation, but there will be continuity. Continuing everyday routines helps with healing.

Take care of yourself. Eat well, get plenty of rest and exercise, spend time with those closest to you, postpone major life decisions and other significant stressors if you can, and seek professional help when necessary.

Take care of your children. You may be concerned about the well being of your children. There are things you can do to help them handle the effects of this crisis:

• Turn off the TV news when children are in the room.
• Let children express their feelings and ask questions.
• Share your own coping strategies with them.
• Maintain a family routine.
• Reassure children that they are safe.

Faced with the war with Iraq and the threat of terrorist attacks at home, Americans of every religious and spiritual tradition are wondering how best to move forward with their lives. In times of crisis, people often look to their faith for support and guidance in coping with the emotional and spiritual impact.

Each person reacts differently in a crisis and a range of responses are to be expected. These responses can appear immediately or sometimes develop months later. Here is a list of common emotional and physical responses to a crisis:

• Disbelief and shock
• Disorientation; difficulty making decisions or concentrating
• Apathy and emotional numbing
• Sadness and depression
• Fear and anxiety about the future
• Intrusive thoughts; replaying events in our minds
• Excessive worry about safety and vulnerability; feeling powerless
• Irritability and anger
• Headaches and stomach problems
• Difficulty sleeping
• Extreme changes in eating patterns; loss of appetite or overeating
• Excessive use of alcohol or drugs

For many people, war not only challenges their emotional and physical sense of well being, but also their spirituality. As a result, many Americans will turn to their faith through prayer and meditation to try to cope with their feelings and seek support, reassurance and understanding in this time of crisis.

While some people find solace in their faith, others may be troubled by questions and doubts. They may have difficulty sorting out the ambiguities of life and faith. What is important to remember is that trust, hope and strength are the most essential elements of all faiths.

Here are some ways people can use their faith to cope with anxiety and uncertainty:

Reflect. Reflect on ways to achieve peace on earth, and to support our service men and women, and those with loved ones in the military.

Connect. Spend more time with family, friends, and members of your house of worship. Reach out to others for strength and support. Draw strength from your faith.

Talk. By talking with others, you’ll relieve anxiety and realize that others are having similar feelings and reactions. Talk with a friend, family member, doctor, religious or spiritual advisor, mental health professional, or anyone with whom you feel comfortable. Encourage those you care about, especially children, to do the same.

Act. Engage in positive activities for your spirit, mind and body. Candlelight vigils and prayer groups are good ways to encourage togetherness and reassurance. Consider doing things for others. Contact community volunteer organizations to see how you can help. You may want to organize activities, such as blood drives, creating "care packages" for service men and women or writing letters to people in the military. (Bear in mind that the military is overloaded with generic "care packages" that cannot be sent to anonymous military personnel. You’ll have to send a package to a specific soldier with lots of goodies that he or she can share.)

Get help. For most people, the fear and anxiety will end when peace is declared. But some people may have trouble getting back to their usual routines and normal feelings. Anyone who is troubled for longer than four to six weeks should seek professional help. People with existing mental health issues and those who have suffered past trauma may also want to check in with a mental healthcare provider.

The death of a loved one is always difficult. When the death results from a war or a disaster, it can be even more troubling given the sudden and potentially violent nature of the event. After the death of someone you love, you experience bereavement, which literally means, "to be deprived by death." You may experience a wide range of emotions, including:

• Denial
• Disbelief
• Confusion
• Shock
• Sadness
• Yearning
• Anger
• Humiliation
• Despair
• Guilt

These feelings are common reactions to loss. Many people also report physical symptoms of acute grief – stomach pain, loss of appetite, intestinal upsets, sleep disturbances or loss of energy. Of all life’s stresses, mourning can seriously test your natural defense systems. Existing illnesses can worsen or new conditions may develop. Profound emotional reactions can include anxiety attacks, chronic fatigue, depression and thoughts of suicide.

Mourning is the natural process through which a person accepts a major loss. Mourning may include military or religious traditions honoring the dead, or gathering with friends and family to share your loss. Mourning is personal and can last months or years. Grieving is the outward expression of your loss. Your grief is likely to be expressed both physically and psychologically. For example, crying is a physical expression, while depression is a psychological expression.

Be aware that the death may necessitate major life adjustments, such as parenting alone, adjusting to single life or returning to work. These challenges may intensify any anxiety and grief you are already experiencing. Allow yourself to express these feelings.

When a loved one dies, the best thing you can do is to allow yourself to grieve. There are many ways to cope effectively.

Seek out caring people. Find relatives and friends who understand your feelings. Tell them how you feel; it will help you to work through the grieving process. Join a support group with others who have experienced similar losses. Support groups exist at most military installations. If you feel overwhelmed, ask for help. It’s not a sign of weakness. Talk with a trusted relative, friend, family services staffer, minister or rabbi. Military chaplains can be helpful, as most receive training in pastoral counseling and crisis. Don’t let yourself become isolated.

Take care of your health. See your family physician. Eat properly, exercise and get plenty of rest. Be aware of the danger of using medication or alcohol to deal with your grief.

Be patient. It takes effort and time to absorb a major loss, accept your changed life, and begin to live again in the present and not dwell on the past.

Seek help. If your feelings become too much to bear, seek professional assistance to help work through your grief. It’s a sign of strength, not weakness, to seek help.

If someone you care about has lost a loved one, you can help him or her through the grieving process.

Listen. Encourage the person to talk about his or her feelings and to share memories of the deceased. Remember, it may take the person a long time to recover from the loss.

Don’t offer false comfort. It doesn’t help the grieving person to say, "It was for the best." or "You’ll get over it in time." Instead, offer a simple expression of sorrow and take time to listen.

Offer practical help. Baby-sitting, cooking and running errands are ways to help someone who is grieving.

Encourage professional help when needed. Don’t hesitate to recommend professional help when you feel someone is experiencing too much pain to cope alone.

Children grieve differently from adults. A parent’s death can be particularly difficult for small children, affecting their sense of security. Often, they are confused about the changes they see taking place, particularly if well-meaning adults try to protect them from the truth or from their surviving parent’s grief. Limited understanding and an inability to express feelings put very young children at a special risk. They may revert to earlier behaviors (such as bed-wetting), ask questions about the deceased that seem insensitive, invent games about dying or pretend that the death never happened.

Coping with a child’s grief puts added strain on a bereaved parent. However, angry outbursts or criticism only deepen a child’s anxiety and delays recovery. Instead, take extra time and talk honestly with children, in terms they can understand. Help them work through their feelings, and remember that they are looking to you for suitable behavior and coping skills.

The Army Family Assistance Hotline is 1-800-833-6622, and the Army Reservist Hotline is

Post-traumatic stress disorder (PTSD) is an extremely debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include military combat; violent personal assaults such as rape or mugging; natural or human-caused disasters such as the terrorist attacks of 9/11; or accidents.

People who develop PTSD include military troops involved in combat; rescue workers; survivors of accidents, rape, physical and sexual abuse, and other crimes; immigrants fleeing violence in their countries; survivors of natural disasters; and people who witness traumatic events. Families of victims can also develop the disorder.

Fortunately, through research supported by the National Institute of Mental Health (NIMH) and the Department of Veterans Affairs (VA), effective treatments have been developed to help people with PTSD. Research is also helping scientists better understand the condition and how it affects the brain and the rest of the body.

Particularly in a time of war, it is important for people to be aware of the causes and symptoms of post-traumatic stress disorder to ensure that they and their loved ones are getting counseling and support if needed.

Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms. People with PTSD also experience emotional numbness and sleep disturbances, depression, anxiety, and irritability or angry outbursts. Feelings of guilt are also common. Most people with PTSD try to avoid any reminders or thoughts of the ordeal. PTSD is diagnosed when symptoms last more than one month.

At least 3.6 percent of U.S. adults (5.2 million Americans) have PTSD during the course of a year. About 30 percent of the men and women who have spent time in war zones experience PTSD. One million war veterans developed PTSD after serving in Vietnam. PTSD has also been detected among veterans of the Persian Gulf War, with some estimates running as high as 8 percent.

PTSD can develop at any age, including in childhood. Symptoms typically begin within three months of a traumatic event, although occasionally they do not begin until years later. Once PTSD occurs, the severity and duration of the illness varies. Some people recover within six months, while others may not do so for much longer.

Research has demonstrated the effectiveness of cognitive-behavioral therapy, group therapy and exposure therapy, in which the patient repeatedly relives the frightening experience under controlled conditions to help him or her work through the trauma. Medications have also been shown to help ease the symptoms of depression and anxiety and help promote sleep. Scientists are attempting to determine which treatments work best for which type of trauma.

Depression, alcohol or other substance abuse, or anxiety disorders are not uncommon co-occurrences for people with PTSD. The likelihood of treatment success is increased when these other conditions are appropriately diagnosed and treated as well.

Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, or discomfort in other parts of the body are also common. Often, doctors treat the symptoms without being aware that they stem from PTSD. The National Institute of Mental Health (NIMH), encourages primary care providers to ask patients about experiences with violence, recent losses and traumatic events, especially if symptoms are recurring. When PTSD is diagnosed, referral to a mental health professional who has had experience treating people with the disorder is recommended.

People who have been abused as children or who have had other previous traumatic experiences are more likely to develop the disorder. Research is continuing to pinpoint other factors that may lead to PTSD.

NIMH and the Veterans Administration sponsor a wide range of basic, clinical and genetic studies of PTSD. In addition, NIMH has a special funding mechanism, called RAPID Grants, which allows researchers to immediately visit the scenes of disasters, such as plane crashes or floods and hurricanes, to study the acute effects of the event and the effectiveness of early intervention.

Research has shown that PTSD clearly alters a number of fundamental brain mechanisms. Because of this, abnormalities have been detected in brain chemicals that mediate coping behavior, learning and memory among people with the disorder. Recent brain imaging studies have detected altered metabolism and blood flow as well as anatomical changes in people with PTSD.

The following are also recent research findings:

• Some studies show that debriefing people very soon after a catastrophic event may reduce some of the symptoms of PTSD. A study of 12,000 schoolchildren who lived through a hurricane in Hawaii found that those who got counseling quickly were doing much better two years later than those who did not.
• People with PTSD tend to have abnormal levels of key hormones involved in response to stress. Cortisol levels are lower than normal, and epinephrine and norepinephrine are higher than normal. Scientists have also found that people with this condition have alterations in the function of the thyroid and in neurotransmitter activity involving serotonin and opiates.
• When people are in danger, they produce high levels of natural opiates, which can temporarily mask pain. Scientists have found that people with PTSD continue to produce those higher levels even after the danger has passed. This may lead to the blunted emotions associated with the condition.
• It used to be believed that people who tend to dissociate themselves from a trauma were showing a healthy response, but now some researchers suspect that people who experience dissociation may be more prone to PTSD.
• Animal studies show that the hippocampus -- a part of the brain critical to emotion-laden memories -- appears to be smaller in cases of PTSD. Brain imaging studies indicate similar findings in humans. Scientists are investigating whether this is related to short-term memory problems. Changes in the hippocampus are thought to be responsible for intrusive memories and flashbacks that occur in people with this disorder.
• Research to understand the neurotransmitter system involved in memories of emotionally charged events may lead to discovery of drugs that, if given early, could block the development of PTSD symptoms.
• Levels of CRF, or corticotropin releasing factor—the ignition switch in the human stress response—seem to be elevated in people with PTSD, which may account for the tendency to be easily startled. Because of this finding, scientists now want to determine whether drugs that reduce CRF activity are useful in treating the disorder.

Many college students, faced with the war in Iraq and the ongoing threat of terrorist attacks, not to mention the threat of campus violence, find that they now feel uncertain about a future for which they had just begun to plan. Some may be concerned about parents, relatives or friends in the military or who are living overseas. Others may wonder how they, themselves, may become directly involved in this crisis. No one is unaffected.

Whether you are directly or indirectly impacted, it is important to know that each person reacts differently to crisis, and it is common and expected to experience a range of responses. Emotional responses can appear immediately or sometimes develop months later. Students who live away from home may have a more difficult time coping without the reassurance of having family nearby.

Understanding how you feel and taking positive steps to address those feelings can help you cope. Remember that, while things may never be quite the same again, they will get better and you will feel better.

Disbelief and shock

Disorientation; difficulty making decisions or concentrating

Inability to focus on schoolwork and extracurricular activities

Apathy and emotional numbing

Sadness and depression

Fear and anxiety about the future

Intrusive thoughts; replaying events in our minds

Excessive worry about safety and vulnerability; feeling powerless

Crying for "no apparent reason"

Irritability and anger

Headaches and stomach problems

Difficulty sleeping

Extreme changes in eating patterns; loss of appetite or overeating

Excessive use of alcohol or drugs

Talk about it. Encourage others to share their perspectives. Sharing your feelings with friends, classmates, professors, advisors and family will help you work through your emotions. Talking with others will relieve stress and help you realize that you’re not alone with your feelings.

Take care of yourself. Get plenty of rest and exercise. Do things that you find relaxing and soothing. Remember to eat nutritious foods. Limit your exposure to media reports and images of the war. Avoid excessive drinking and risk-taking activities. Try to maintain your usual routines.

Stay connected. Maintain contact with friends and family. Make plans to visit family or others who can offer reassurance. If you can’t visit them in person, increase your contact through phone calls and e-mails.

Do something positive. Do something that will help you gain a greater sense of control (for example, give blood, take a First Aid class, collect donations for "care packages" for people in the military or write letters to service men and women). Whether you support or oppose the war, you can write letters to elected officials or get involved in campus activities, such as a candlelight vigil, benefit, discussion group or special lecture. (Bear in mind that the military is overloaded with generic "care packages" that cannot be sent to anonymous military personnel. You’ll have to send a package to a specific soldier with lots of goodies that he or she can share.)

Ask for help. If you feel overwhelmed by events, remember that it’s not a sign of weakness. Talk with a trusted friend, family member or spiritual advisor. Use on-campus resources, such as the college counseling center and health center, or reach out to community resources, such as faith leaders or the local mental health association.

If you have strong feelings that won’t go away, or if you’re troubled for longer than four to six weeks, you may want to seek professional help. Being unable to manage your responses to a crisis and to resume your regular activities may be a symptom of depression, anxiety or post-traumatic stress disorder. People who have existing mental health problems and those with a history of trauma may want to check in with a mental health care professional. Help is available. You don’t have to deal with this alone.

Anxiety Disorders Association of America – www.adaa.org

Facing a war on two fronts and the continuing terrorist threat, Americans are experiencing many powerful emotions. For most people, the intense feelings of anxiety, sadness, grief and anger are healthy and appropriate. But some people may have a more profound and debilitating reaction to the war.

It is important to remember that everyone reacts differently to trauma and each person has his or her own tolerance level for difficult feelings. To cope with these emotions, there are some things you can do for yourself and others. Experts say that remaining engaged in our world, staying connected with people, and being optimistic about the challenges ahead are key to riding through otherwise traumatic times. In fact, in times of turmoil, people can make changes that improve their lives and life satisfaction.

Knowing what is a normal response to an abnormal situation, and what signs might indicate you have a more serious problem, will help you determine if and when to seek help from a mental health professional.

It is common to have difficulty managing your feelings during times of war, threat of terrorism or traumatic events. Many people will experience such symptoms as:

• Disbelief and shock
• Fear and anxiety about the future
• Disorientation; difficulty making decisions or concentrating
• Inability to focus
• Apathy and emotional numbing
• Irritability and anger
• Sadness and depression
• Feeling powerless
• Extreme changes in eating patterns; loss of appetite or overeating
• Crying for "no apparent reason"
• Headaches and stomach problems
• Difficulty sleeping
• Excessive use of alcohol and drugs

When feelings do not go away or are so intense that they impair your ability to function in daily life, you may have a diagnosable disorder that requires mental healthcare. There are signs that can help you determine whether you are having a normal reaction to our nation’s crisis or if you’re experiencing a mental health problem. These signs include:

• Nightmares and reoccurring thoughts about war or a traumatic event
• Being unable to stop thinking about the war or a traumatic event
• Avoiding thoughts, feelings or conversations that remind you of a traumatic event
• Avoiding places or people that remind you of a traumatic event
• Having a sense of a foreshortened future
• Continued difficulty falling asleep or staying asleep
• Feeling jumpy or easily startled
• Being overly concerned about safety
• Feeling guilty, worthless or hopeless
• Not taking pleasure in activities once enjoyed
• Having thoughts of death or suicide

If you are experiencing these symptoms, talking with a mental health professional or taking a mental health screening test can help you understand how well you are coping. Take that step and get help.

Here are some tips for coping in these difficult times:

Talk about it. By talking with others, you can relieve stress and realize that others share your feelings.

Take care of yourself. Get plenty of rest and exercise, avoid excessive drinking and eat properly. Avoid foods that are high in calories and fat.

Limit exposure to images of the war. Especially avoid television news programs.

Do something positive. Give blood, prepare "care packages" for people in the military, write letters to service men and women. Whether you support or oppose the war, write letters to elected officials, take part in community meetings, etc. (Bear in mind that the military is overloaded with generic "care packages" that cannot be sent to anonymous military personnel. You’ll have to send a package to a specific soldier with lots of goodies that he or she can share.)

Ask for help. Asking for help is not a sign of weakness. Talk with a trusted relative, friend or spiritual advisor. If you want professional help, obtain a referral for services from your local Mental Health Association or Mental Health America at 800-969-NMHA (6642).

If you need a referral to a mental health professional, call the Mental Health Association of Greater St. Louis, a United Way agency, at 314-773-1399.

© 2003 National Mental Health Association