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A Psychological Price

After 9/11, several studies aimed to capture the psychological footprint of the attacks that killed nearly 3,000 people. A landmark study conducted by the New York Academy of Medicine in 2004, Redefining Readiness: Terrorism Planning Through the Eyes of the Public, put the importance of anticipating behavioral response plainly: “Research shows that even if the nation gets all of the [logistics, equipment, and preparation] right, the plans that are being developed now are destined to fail because they are missing an important piece of the puzzle: how the American public would react to these kinds of emergency situations.” 

Research shows elevated levels of post-traumatic stress disorder (PTSD) in those living in New York City and the surrounding area months after the 9/11 attacks; an article in the Journal of Nervous & Mental Disease revealed that Americans exposed to television coverage and images of the terrorist attack also suffered symptoms of PTSD. 

More recent terror attacks have resulted in similar behavioral responses. Following the Pulse Nightclub shooting in Orlando, Florida, in June 2016 that left 49 people dead, several first responders reported suffering from symptoms of PTSD. Months after the attack, many responding law enforcement officers had yet to return to work because of the severity of their symptoms, The New York Times reported in October 2016. 

When properly diagnosed, these victims can receive help from their organizations, communities, and medical professionals. Last year, for example, approximately 400 victims and first responders affected by the 2015 Paris terror attacks were given the opportunity to participate in a clinical trial aimed at curtailing their PTSD symptoms, The International Business Times reported in April 2016. 

Understanding key human factors will create a solid foundation for organizational counterterrorism planning. These concepts can help security practitioners mature and validate their plans against the behavioral impact of terrorist attacks, enhancing plans, procedures, and exercises. ​


There cannot be a one-size-fits-all approach to anticipating behavioral reactions to a crisis. The psychological response to fires, floods, and other natural disasters is radically different from that experienced after an active shooter incident or disease outbreak. 

Anticipating the response to an anthrax scare in an organization’s mailroom based upon how employees react to an armed intruder alert will lead to a grossly ineffective security response. Security professionals must understand the different types of behavioral reactions associated with various types of emergencies to properly plan for and respond to these events. 

PTSD is a possible psychological consequence of any traumatic event, but the likelihood of this condition varies. Active shooter and other purposefully violent events result in mental health diagnoses at a level almost three times higher than the diagnoses after natural disasters. That’s according to a study that appeared in the publication Psychiatry in which approximately 60,000 disaster victims were interviewed in 2002. 

Mental health diagnoses in victims of purposefully violent attacks ranged from 10 percent to 36 percent; in natural disasters, those same types of diagnoses ranged from 11 percent to 15 percent, according to the study. 

Tactics. Distinguishing conventional from unconventional terrorism will help emergency management experts plan for various types of events, because tactics and the types of violence employed in a terrorist attack affect victims differently. Conventional terrorism is the use of shooting, bombing, kidnapping, and hostage-taking. Recent vehicular attacks in Paris, Berlin, Stockholm, and London, while less common, also fall within this category. 

Unconventional terrorism involves more exotic weapons, such as chemical, biological, radiological, and nuclear (CBRN) materials. There are critical differences in the behavioral response to conventional versus unconventional terrorism, as discussed throughout this article, and failure to appreciate these differences can lead to fatal flaws in plans, exercises, and response.  

The timeline of an attack, and the amount of time that has passed since the incident took place, also play a crucial role in shaping the response. Responders and security personnel can expect extreme stress reactions (ESRs) in the first minutes to hours after a terror attack. 

The characteristics of ESRs include: frantic, unfocused behavior; difficulty following directions; deterioration of fine motor skills and problem-solving ability; freezing up; and autopilot behaviors, where the victim seems to be relying on primitive, perfunctory responses. 

Panic. Panic is an inevitable response to terrorism, and is driven by two factors: perception of limited opportunity for escape and perception of limited critical supplies. 

Consider the stampede of travelers running for their lives in active shooter scares at international airports, stadiums, or other crowded venues. 

Attacks that disrupt the supply chain can cause people to fend for food, water, and other basic necessities. Unconventional terrorism can lead to higher levels of panic, because fear of illness drives people to compete for medications or to escape from potentially contaminated areas. 

Bystanders. Planners and first responders rely on some level of bystander intervention in certain attack scenarios, such as active shooter incidents. This may include distracting, disrupting, or disarming the shooter, or rendering basic first aid to the wounded. 

But ESRs may cause people to become part of the problem, rather than the solution. There may be a significant delay in psychological symptoms as victims and witnesses cycle through the stages of disbelief, denial, indecision, and action. Anticipating a slowness in bystander response will help inform emergency plans and procedures. ​


Acts of conventional terrorism tend to have clear stages—those affected can observe and recall when the attack began and ended and if they were in or out of the threat environment during each phase. 

Unconventional terrorism employs CBRN hazards, which often cannot be detected by the senses. These acts frequently produce a set of behavioral responses that do not resemble the traumatic stress reactions seen following acts of conventional terrorism.

The invisibility of the threat drives the powerful behavioral reaction to CBRN scenarios. The hazards may be odorless, colorless, tasteless, or silent. The effects of CBRN terrorism come from the action of the substance on the brain and body, and the psycholog­ical implications of the terrorist act. CBRN incidents are unique in their psychological power due to public’s intense fear and limited knowledge of these hazards.

Acts of unconventional terrorism produce a unique cluster of psychosocial reactions that manifest as physical signs and symptoms. These effects can confound response and recovery efforts. 

Concern about long-term or delayed health effects of exposure to CBRN materials can result in a chronic stress response, unlike responses to attacks that have clear bookends. Some segments of the exposed population will have additional health concerns; for example, pregnant women may fear damage to the fetus. There may be multiple casualties, limited availability of treatments, and uncertainty about effectiveness of treatments, all of which can complicate and confuse response and recovery efforts. 

These symptoms cannot be explained through contemporary medical, anatomic, physiological, or scientific methods. The individual’s signs and symptoms may be consistent with those related to exposure or contamination, reinforcing people’s beliefs that they are, in fact, injured or ill and require medical attention.

Sociogenic illness. Sometimes referred to as epidemic hysteria, sociogenic illness is the social phenomenon of experiencing a cluster of symptoms for which there is no apparent medical cause. This is a type of social suggestion that can trigger psychosomatic reactions throughout a community or workforce, resulting in significant disruption and overwhelming the local healthcare system. 

The advent of social media and the ubiquity of mobile communications are important factors in the potential for sociogenic illness. Social media can further the dissemination of misinformation and rumors. It is important for leaders and decision makers to realize the difficulty of calming people once frightening information begins to move through the population.

Misattribution of fear. The misattribution of fear is the misinterpretation of normal physiological arousal as serious illness. Individuals who are frightened by a threatening incident are likely to experience elevated heart rates, blood pressure, respiration, and other uncomfortable sensations related to the fight or flight response. 

Unfortunately, some people having these physiological reactions are likely to misinterpret them and believe they are proof that they have been exposed or contaminated, further driving the surge in demand for emergency medical services.     

Distrust. Distrust is another atypical response to terrorism. The advent of “fake news” only further complicates this type of reaction. The public often believes that government or community leaders may downplay the seriousness of a health risk to prevent panic. Conspiracy theories only cause further confusion when the public is seeking clarity. ​


Terrorism has a profound impact on the community in which it occurs, and three types of community response to emergencies should guide plans, procedures, and exercises related to disaster response. 

Neighbor helps neighbor. This altruistic response to a threating event is the most common, and the one that planners typically count on. While it is human nature to reach out to help others in distress, that response is not always feasible when fear enters the equation.

Having several employees trained in psychological first aid will help reduce fear and arousal in the immediate response to a violent or traumatic event. 

For example, in active shooter plans and exercises, students and workers may be trained in lock-down or shelter-in-place tactics. It is essential that they know how to calm and soothe a seriously distressed coworker who is frantic to the point of giving away the group’s secure location to the attacker. 

Neighbor fears neighbor. If a person is injured in a violent attack, coworkers or bystanders will likely rally around to try to find ways to help. But if that person or coworker may be infected with a highly contagious disease, or was exposed to a hazardous substance in an attack, most people would have an understandable hesitation in providing aid for fear of becoming exposed or infected. 

This type of response is more likely in unconventional terrorism scenarios and can seriously erode community or workplace cohesion. It can also result in stigma that hinders resilience and recovery efforts.

Neighbor competes with neighbor. Acute fear can trigger panic and competition to flee a threat or grab up the last of essential supplies. Looting is a possibility in the wake of certain acts of mass violence; some of these incidents are crimes of opportunity, while others are acts of survival. It is important for leaders to understand this behavioral risk and work to keep group cohesion intact in emergencies and violent attacks.   

Understanding human factors in critical incidents can help explain why people behave in a certain way in disasters, emergencies, and violent incidents, and should inform every aspect of the planning, response, and recovery phases of the event.

Terror is fear, and fear is one of the most powerful forces affecting human behavior. An act of terror, or the belief that a terror attack is imminent, creates changes in the character of people and nations in a way that plays to the terrorist’s narrative. Understanding and counteracting fear is just as important as physical security measures when it comes to defeating the terrorists. 

The question is not if a terror attack will occur, but when. Getting the behavioral piece of the response and recovery puzzle is critical. Applying these human factor concepts can help security practitioners validate and mature their plans and procedures, and should inform exercise design, facilitation, and evaluation.  

Steven Crimando is the principal of Behavioral Science Applications, a training and consulting firm focused on human factors in crisis prevention and response. He is a Board Certified Expert in Traumatic Stress (BCETS). He is a consultant and trainer for multinational corporations, government agencies, major city police departments, and military programs. ​