Recovering emotionally from tragic events like September 11th takes time, but mental health experts say that most people manage to feel better after some time.

"As people are getting over the shock of what has happened, they may now feel sad, anxious, angry, and even fearful," says Rachel Yehuda, PhD, Professor of Psychiatry and Director of the Traumatic Stress Studies Program at the Mount Sinai School of Medicine in New York City. "These feelings are part of the normal emotional response to trauma and are likely to be temporary. In the long run, most people will find ways to cope and eventually recover."

Helping Ourselves and Others
How can we help ourselves recover? Mental health professionals have identified several steps we can take to help us cope with trauma:

Talk about your feelings and allow others to express theirs. "Talking helps, but may not be easy for everyone. Being willing to listen is one of the best things we can do for one another," says Yehuda. Experience with trauma victims has shown than denying grief and bottling up emotions significantly interferes with recovery.

• Remind yourself of your own resources--emotional, spiritual, economic, and social. Remember that you have overcome adversity in the past: What did you do for yourself and others that helped? Share your own particular skills with others. Make use of your social networks--your church or synagogue, book club or your running partner---as a sounding board and for support. "I've come to appreciate that there is a broad range of responses to trauma and loss," says Yehuda. "People will find their own way to grieve. There are no 'shoulds' here."

• Be good to yourself. Jerilyn Ross, MA, LICSW, President and CEO of the Anxiety Disorders Association of America, suggests that it is important to take care of yourself physically; get enough sleep and exercise and go easy on the alcohol and caffeine. And be gentle with your psychological self: Expect some forgetfulness and concentration problems, even weepiness. Things will get better.

• Return to routines. Going back to work, getting neglected housework done, even planning a night out are ways people may get back to former routines and begin to make a transition. Children are particularly helped by a return to the household routine; parents should enforce their normal rules about homework, piano practicing, bedtimes, and so forth (see "Helping Children Cope" below).

If You're Not Feeling Better
Grieving takes time. But anger, anxiety, or depression that lasts for three or more months, or an inability to function at home or on the job, may be signs of clinical depression or posttraumatic stress disorder (PTSD). Rescue and medical personnel at the crash sites, people who escaped from the World Trade Center or Pentagon, and those who witnessed the attacks at close range are most at risk for developing PTSD. Symptoms include recurring images of the traumatic event, nightmares, tensions and anxiety, and a tendency to startle easily. They may begin immediately or not surface for six months or a year, or even longer. People with PTSD tend to withdraw from the world, becoming disinterested in people and activities that were once important to them. They may try to cope by abusing alcohol, drugs, or smoking. Guilt, depression, and sudden outbursts of aggressive behavior may also surface. Professional help may be needed for those whose symptoms persist.

Experience with natural disasters and other terrorist events reveal that about 10 to 25 percent of those who experience such events develop chronic PTSD. "We don't want to 'pathologize' what is a natural response to stress," says Yehuda, who warns against pushing a reluctant person into therapy. "People often find a way to use natural supports such as family and friends. This is positive in the early phases after trauma. We should not insist that people seek help if they do not feel up to it, but make it easily available. We also need to be sensitive to the fact that each individual has his or her own timetable for recovery," she says.

The challenge will be moving forward without suppressing the emotions that are apt to surface over the next months. Continuing to talk about feelings and seeking social contact and support will give people the strength to go on. "The good in people is coming out now," says Yehuda, who lives in New York and says everyone is pulling together and showing acts of great kindness and generosity. "I think people have decided that what we have here is worth fighting for together."

Helping Children Cope
Following a catastrophic event, children may be fearful, sad, or apprehensive. But most recover from their feelings of fear in a short time.

A key element in recovery is the support children receive from parents, teachers, and other adults. "In assisting children in coping with trauma, assume that every child will have some level of reaction, although most will be relatively mild," says Andrew L. Berger, PhD, ABPP, Director of Psychological Services for the State University of New York (Farmingdale), and a psychologist in private practice in Commack, New York. "All children will benefit from active involvement and awareness of a concerned adult, instead of a more passive approach which delays action until significant problems are observed."

According to Berger, children may be particularly vulnerable because they have limited coping and communication skills to counteract the powerful influence of television and other media exposure. And often there is insufficient attention focused on early identification and intervention for children affected by traumatic events. To help deal with kids' feelings after a traumatic event, Berger makes these recommendations to parents:

• Anticipate needs. Take the initiative: Approach children to chat; try to talk about their feelings and concerns about a traumatic or scary event before they bring it up. It is easier for children if adults open the lines of communication, particularly during difficult times. This also sends the message that a topic is OK to talk about with adults.

Berger also recommends looking at these discussions as a process. "Use brief, frequent chats, rather than a single all-inclusive presentation as a way of exploring feelings and thoughts. Such chats are more natural and allow for observation and interaction and are less likely to be overwhelming or 'preachy' to children."

• Use candor, but with discretion. This should be the theme of all adult-to-child communication about traumatic incidents. Be honest, but give details and explanations at a level appropriate to a child's cognitive and emotional capacity. It is healthy to begin with more limited sharing, which provides a foundation for future elaboration. "We can do much to assist children in dealing with reality but cannot and should not attempt to rewrite reality for children," says Berger.

• Let kids know how you feel. While adults dealing with children in distress should maintain a moderate level of composure, it is often helpful to let children know that they experience upsetting feelings, too. Children need to know that adults are sometimes scared and seek support from those around them and that it is OK to hurt, but that the pain does get better with time

Most children and teenagers will recover from their fears. If after a month a child is still showing signs of distress, seek the assistance of a school counselor or other mental health professional. Signs of distress include not sleeping or eating; excessive clinging; re-experiencing the event through nightmares, recollections, or play; emotional numbing; or persistent fears about disaster.