Column: How to best care for survivors

• Our children look to us for courage and compassion. If we worry, they will worry.

Public shootings release powerful emotions, both for survivors and for the families of the victims. The same deep center of the brain that processes fear also handles courage and caring. We need to fill our brains with positive emotions for the sake of our health.

Hundreds of children successfully escaped Sandy Hook Elementary School in Newton, Conn., this past week, leaving behind 20 schoolmates who were not so fortunate.

But the survivors have also been wounded. The initial lifesaving response, fight or flight, which involves an outpouring of stress hormones triggered by the brain's fear center, gives way over the succeeding weeks to Post Traumatic Stress Disorder (PTSD). According to the National Center for PTSD, 77% of children who witness a school shooting and 35% of the kids who see violence in the area are affected.

These children are headed for a rocky course filled with anger and sadness at play, feelings of alienation and low self-esteem, repeating the tragedy, and feelings that they will see warning signs before future tragedies. Luckily, psychotherapy can help these children overcome their fears and anxieties and return to a normal life.

Previous experiences with school shootings predict that the long-term impact on survivors will depend on how close they were to the shootings and what their relationship was to the victims.

A 1984 sniper shooting at an elementary school in Los Angeles initially caused widespread PTSD, but by 14 months later, a study found that only the group at the playground where the shooting took place remained distressed.

The same long-term impact related to proximity to the shooting was found in a study of the 1998 Thurston High School shooting in Oregon. Retrospective studies on the infamous Columbine High School shooting in 1999 found that because of the intensive involvement of the news media, the impact went well beyond the town of Littleton, Colo., where the shootings occurred and impacted attitudes across the nation. Survivors of Columbine continue to experience flashbacks, though no formal study has yet been conducted.

What about the rest of us? Despite the fact that less than 1% of all homicides occur at schools, it is too easy for us to over-personalize the risk and believe that our own children could be next. We ask for heightened security around our own kids schools without considering the message that might be sending them.

Our children look to us for courage and compassion. If we worry, they will worry. If we obsess about their safety, they will be nervous and insecure.

What should we teach our children?

We should answer their questions and share the empathy and compassion we share for the victims. We should make sure our kids return to normal routines while limiting their exposure to disturbing news accounts that will populate cable TV stations for days.

Elizabeth Phelps, neuroscientist at New York University, has examined how our brains respond to threats we only imagine. Using highly sensitive MRI scans, she determined that the fear center (amygdala) in our brain responds to videos that show an attack as if it were actually happening to us at the time.

The acute stress response that occurs involves a production of hormones (adrenaline, noradrenaline, and cortisol) that causes our hearts to race our metabolism to rev up in anticipation of imminent danger. But over time, these hormones cause a cycle of worry which wears us down and puts us at risk for many diseases including heart attack, stroke and depression.

The accumulation of media-hyped events -- from Columbine to Virginia Tech to the Aurora, Colo., theater to the Oregon mall and now to Sandy Hook -- can have an effect on those of us who absorb these tragedies and refuse to let them go. Cable news addicts can become attached to these stories and over-personalize the risk. This response is not only unhealthy, it is also unfair to the memories of the victims and their families who are true sufferers.

As a society, we can either become callous to these shootings or we can become too sensitized, seeing shooters wherever we go. Either response is bad for our health. Better we focus on the victims and their courage, and show our children how to empathize without making their problems our own.

Marc Siegel is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He also is a member of USA TODAY's Board of Contributors.

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