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How to cope with war anxiety over Iran

Updated 7:13 PM ET, Sun January 12, 2020

Editor's Note: Joan Cook is an associate professor at Yale University and the 2016 president of the American Psychological Association's Division of Trauma Psychology. The opinions expressed in this commentary are her own. View more opinion on CNN.

(CNN) - Recent tensions between the United States and Iran and the underlying threat of war have many Americans on edge. After a US air strike in Baghdad on January 3 killed Gen. Qasem Soleimani, Iran's influential military commander and a power broker of terror in the Middle East, the Iranians vowed harsh revenge. They kept their promise by bombing US military bases in Iraq holding US troops.

As a trauma psychologist, I can very well understand public fear and anxiety resulting from this military escalation and the uncertainty it has generated about the future. An important study last year indicated that Americans were already suffering from a rising anxiety epidemic, particularly about health, safety and finances, and these new events will surely get people even more jacked up when our health can least afford it.

Concerns of going to war understandably bring increased tension and fear, whether by awakening past traumas or inviting worry about new trauma, such as concerns of being attacked on our own soil, loss of lives or the reverberating effects that could bring about World War III. Today's onslaught of video imagery brings war powerfully home, giving an up close feel of the danger and anguish. But there's something we can all do to cope.

For individuals who have experienced traumatic events, such as combat, sexual assault or natural disasters, fears of future war can act as triggers and negatively mix with or amplify unresolved psychological wounds. Many trauma survivors have reactions to reminders of their traumas. Some of the combat veterans I've worked with over the past 20 years will hear a noise, like fireworks, or even a car backfiring, and nearly jump out of their skin. Within a split second, they'll think they are under attack or that war has broken out in their back yard.

This is not just something we see in clinical settings. Research has documented this phenomenon. For example, in a sample of survivors of the 2011 mass shooting massacre on Utoya Island, Norway, survivors frequently found auditory reminders, such as sudden and sharp noises, as incredibly distressing. Furthermore, studies show that those survivors who had a higher frequency of exposure to such trauma reminders were even more emotionally distressed.

Trauma triggers can also affect survivors' psychological health by getting under the skin, impacting their bodies and brains. For example, research shows that survivors of war and torture experience a significant increase in cortisol when reminded of their traumatic events.

In a sample of relocated Hurricane Katrina survivors, exposure to trauma reminders resulted in an increased heart rate. In one study, a sample of survivors of recent road traffic accidents underwent functional MRI scans to examine brain activity patterns in response to trauma reminders. These patients showed increased activity in visual-, sensory-, memory- and attention-related areas of the brain in response to trauma-specific stimuli.

But you don't have to be a trauma survivor to strongly feel the threat of war. Given the rise of social media, the speeding up of the news cycle and the use of Twitter by world leaders (the back and forth of the American and Iranian flags after airstrikes alone, for example), regular folks have more access to information about the possibility of war and violence than they ever did before.

In the case of potential war with Iran, this climate of fear and for many, full-on anxiety, can intrude wherever and whenever there is a screen available. These images make people feel tense, worried about what this may mean for our troops and citizens stationed abroad and leave them wondering if there will be a 9/11 style attack stateside. Some individuals may even feel physical changes such as increased blood pressure.

In situations of heightened tension and fear, people in their everyday lives will feel the stress of our nation's pain and anxiety. Following the terrorist attacks of 9/11, many among the public experienced a heightened perception of threat. This perception also included feelings of animosity toward our threatening enemy and an increased desire for retaliation. In a longitudinal investigation of the public psyche post 9/11, people's heightened anxiety regarding potential threats was felt especially keenly during anniversary periods.

This cycle of fear and anxiety in response to a war or terror threat is not unique to our times. Actual or threatened bioterrorism attacks impacted people's fears in previous eras as well. In fact one study developed and tested a measure of nuclear war anxiety. The authors demonstrated how nuclear war anxiety was primarily made up of feelings of depression, despair and fear of what the future might bring. They talked about the importance of adopting realistic attitudes towards avoiding or preventing war, particularly regarding the tension between US and the then Soviet Union, to reduce stress levels.

It may provide some reassurance to realize that anxiety is normal under these roller-coaster conditions, and that human beings have been experiencing this kind of fear for a long time. A range of other strategies can be helpful in managing the anxiety from war or terror attacks.

One technique we use when working with trauma survivors is to try to limit their exposure to potential trauma triggers. This does not mean you should stay uninformed about world events but making sure our eyes do not stay fixated on a screen or that we don't instinctively swipe the Twitter feed to help minimize hyperarousal.

I often suggest to veterans with PTSD that they only take in strategic doses of news every day -- that they limit exposure to one to two times a day for short periods and that they will be better off reading the news rather than experiencing video depictions of it.

In addition, it is incredibly important that we do not let excessive fears impact our daily lives. A good way to do this is to maintain daily routines and engage in pleasurable, safe activities. One of the most effective strategies to deal with any type of stress is to cultivate and lean on strong social support.

The relations between the US and Iran are indeed concerning. The play-by-play coverage of events in the fast-paced, ever-present media outlets can be a trauma trigger for some. This onslaught of stress-inducing information can open old wounds and create new ones. For trauma survivors, it's important to recognize and manage reminders of their trauma. For the rest of us, we can use some of these same techniques to reduce stress and anxiety and help us lead happy, healthy daily lives.


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