Irene S. Levine, Ph.D.
Research Scientist and Liaison to Families, Nathan Kline Institute
Clinical Professor of Psychiatry, New York University School of Medicine

ACCENTUATE THE POSITIVE
Remember that most persons with serious mental illness cope fairly well during times of crisis and that their reactions are more similar, rather than different, from others in the community.

Identify your family member's individual strengths and let them know that they are truly appreciated.
Support their sense of mastery.

Recognize that each individual react to crises in different ways and assume that your family member's concerns are likely to be normal. Allow them sufficient time to heal; everyone recovers at their own pace.

Convey your own sense of confidence that things will improve and your belief that this may be an opportunity for positive life changes.

Emphasize patriotism, unity, and the heroism of the rescuers.

COMMUNICATE
Make time to listen to what your family members is thinking or feeling. Talking about the event together and sharing feelings can help relieve stress.

Talk about other times when you or your relative was stressed and how you overcame them.

Provide your family member with honest and accurate information about what happened. Find opportunities to talk about "normal" responses to this set of abnormal events.

Rather than saying that "Everything will be okay,"---discuss concrete steps being taken by the government to protect our safety, to assure that this doesn't happen again, and to bring the perpetrators to justice.

Make sure that your family member isn't watching TV continuously or listening to the news on the radio excessively. Too much news can make you feel "wired". Taking stock of the news several times a day is enough to keep you well informed.

REMAIN CONNECTED
Because natural support systems are as crucial as ever, encourage contacts with peers and friends.

If your family member has few friends or outside contacts, you may want to increase the frequency of visits and phone calls for a period of time.

Because anyone can inadvertently alienate themselves from others when they feel irritable tense, anxious, worried, or act demanding, provide reassurance that you are there for your family member when they feel "out of sorts".

Be aware of your own emotional reactions and of how they may be affecting others.

MAINTAIN ROUTINES
Encourage everyone to resume normal family, community, school, volunteer or work roles. Try to see that your family member keeps appointments and honors program commitments. At the same time, allow some flexibility when necessary.

Make sure everyone in your family gets rest, exercises, and eats well.

Set small goals and take one day at a time.

SEIZE THE DAY
Encourage your family member to do things that he/she enjoys.

Suggest mini-escapes in the form of a movie, a novel, soothing music, a walk in the woods, or a warm bath.

Share rituals such as eating together and enjoying comfort foods. like meat loaf and apple pie. Make a point of celebrating holidays and remembering special occasions.

Whenever possible, laugh and use humor to lighten things up.

GIVE BACK
People feel good when they can help others so encourage your family member to serve the larger community. Opportunities abound to donate food, clothing, or blood; take advantage of them.

Suggest to your family member that the time may be right to take a first-aid or CPR class.

STAY ALERT
Be alert to new symptoms or changes in severity of old ones. Differentiate normal from prolonged responses lasting more than 4-6 weeks.

Remember that is "normal" to react to extreme stress with symptoms of depression, anxiety, changes in eating patterns, sleep disturbances, difficulties concentrating, and irritability.

If these symptoms of stress are exaggerated or if they persist over time, you may want to want to seek out professional help. If symptoms do not abate, encourage your family member to talk to their clinician for careful assessment---possible screening for PTSD---or to evaluate exacerbations of an existing illness. This may entail a review of medications. Even in the absence of severe or lasting symptoms, individuals with a history of mental health problems may want to simply "touch base" with their clinician if they haven't done so for a while.

Remind your family member that now is not the time to forget to take medicine that is already being taken. Going off meds, against medical advice, can only make things worse.

Monitor the inappropriate use of alcohol or drugs to self-medicate.

Pay attention to physical problems as well.

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