By now everyone knows of the horrible series of events that happened in New York and Washington. We know this is a moment of great uncertainty and tension. We would like to address the needs of staff and clients and their family members in any way that would be helpful. We would like to share some information on how to provide support for them over the next few days. This kind of support is known as psychological first aid and will be described below.

When events of this magnitude occur a person's response goes in one of two directions: they experience either a great deal of distress and arousal, or extensive denial and numbing. Some people fluctuate between those two extremes, and don't understand what's happening to them. Those people who are experiencing the arousal and distress will often show physical signs. This reaction is normal and happens to people who don't have any preexisting psychological difficulties. People usually need a mixture of supportive help, nonjudgmental general conversation, and attention to their immediate signs of physical and psychological distress. Below is a series of things that anyone can do to become a source of mutual support.

• Take an inventory of your own reactions and find a way to be sure that you are calm and able to focus on other people. If you are not it is understandable.
• Ask people how they are doing and what would be most immediately helpful to them.
• Help people set useful limits in gathering information about the tragedy. The goal is to get information but not get overly aroused and stuck in the repetitive details of the tragedy. People can be re-traumatized by excessively over-viewing the events. If you notice someone getting progressively more upset by continuous attention to the news try to help them recognize that they need to limit the amount of their exposure, and try to help them shift their focus to calming themselves down.
• Ask people to describe their immediate physical reactions, such as rapid breathing or racing heartbeat, this can be a useful way of helping people to start to talk about the impact of the events upon them.
• Intervention should be focused on helping to mobilize the person's preexisting coping resources (i.e. talking with them about the things that have helped them to calm down in other situations of great distress), and reassuring them that the current arousal and distress will be time limited.
• People need to anticipate that over the next few days they may have difficulty sleeping, nightmares, stomach aches, or find themselves forgetful or inattentive. This is the usual way that the mind and body tries to integrate overwhelming, irreconcilable information. Good self-care is paramount, such as practicing calming methods, i.e. deep breathing, meditation, etc., making sure to eat regularly, not drinking alcohol, and getting regular exercise.
• People need to know that they will not be functioning at their usual levels but it will be helpful to try to maintain as much continuity and normality as is realistically possible.
• Parents should expect that their children will be seeking very close proximity to them. Although this may seem like clinginess or reverting to younger-type behavior, it should be allowed. This will include needing more reassurance before falling asleep and being very concerned about the whereabouts of their parents. Specific information and availability is most important. Facts should be given to children on an age appropriate basis. While the impulse to offer blanket reassurance to children is understandable parents should first attempt to find the nature of their children's worries and fears before trying to reassure them.
• As you interact with people who have been directly exposed, please pay attention to whether or not you are picking up indications of shame, blame, or helplessness, as these are indications of more complicated reactions.