Betty Pfefferbaum is a research psychiatrist and professor of Psychiatry and Behavioral Sciences at the University of Oklahoma. She is the first recipient of the ISTSS Frank Ochberg award for Research in Trauma and the Media. Her published research includes media effects after the Oklahoma City bombing and September 11, 2001 (citations). Here, she speaks of practical implications of her work in understanding effects of journalism coverage of trauma.

Q: In light of your research, what are your observations on the recent tsunami coverage?

Pfefferbaum: Media coverage has been instrumental in informing the world of what occurred and of the secondary consequences of this disaster.

My thoughts naturally turn to the impact of events like the tsunami, and media coverage of it, on children. Media coverage has been at times graphic and cause for concern. For example, extensive and explicit coverage should not occur in association with children’s programming. In these situations, where news becomes drama, we should consider limiting and monitoring children’s exposure, monitoring their reactions, and helping them process what they see and hear. We need to provide opportunities for them to discuss these events. Perhaps, this applies to adults as well.

Q: What led to your interest in the connection between media content and trauma reactions?

Pfefferbaum: Media coverage of the 1995 Oklahoma City bombing led to our interest. After the bombing, we recognized that the goals of terrorism were broad and extended beyond the death, injury, and individual experiences of those directly exposed. The goal of terrorism is to affect whole communities and our society at large. The media play a key role in realizing this goal. Thus, we became interested in examining the effects of terrorism on individuals whose only exposure was by virtue of their residence in the community. Given that the media is the source of information about these events, it was a natural area of study.

Q: You've studied media and trauma reactions after both the Oklahoma City bombing and 9-11. What does your research tell us about media effects on people who have victims of national trauma?

Pfefferbaum: For those individuals who are directly exposed to an incident, media reminders may trigger arousal associated with the event and reinforce the avoidance and numbing reactions that survivors and their loved ones experience.

Our research has not demonstrated a relationship between exposure to media coverage and posttraumatic outcome in individuals directly exposed to an incident, though we have looked for it in both Oklahoma City samples and samples of individuals exposed to the 1998 Embassy bombings in East Africa. That does not mean that there was no relationship — simply that we did not find one.

A September 11 study conducted by the New York Academy of Medicine found that, among individuals directly affected by the attacks, those who frequently watched coverage of people falling or jumping from the World Trade Center Towers were more likely to have posttraumatic stress disorder (PTSD) and depression than those who did not. For respondents who were not directly affected, the prevalence of PTSD and depression was not associated with viewing these images (for citations of this and other NY Academy of Medicine studies, click here).

The New York Academy of Medicine’s work and ours suggest that there may be differences in the effects of exposure to media coverage depending on the experiences and trauma exposure of those individuals being studied. Cultural and social factors may also be important. For example, our failure to find a relationship between media exposure and outcome in our East African samples may reflect the very different penetration of the media in that part of the world where television is less dominant.

Q: Do we need to be concerned about media reports causing emotional damage to people who haven't experienced trauma first hand?

Pfefferbaum: Our work speaks to the relationship between exposure to media coverage and posttraumatic outcome in individuals, children in our samples, who were only indirectly or remotely affected by the Oklahoma City bombing. We did find a small but significant relationship between exposure to media coverage and posttraumatic stress reactions in children residing in Oklahoma City and in children residing 100 miles away. I would note, however, that the effect was small indicating that other factors which we did not measure were more important correlates of the posttraumatic reactions we measured.

In the study of children living 100 miles away, we also examined the children’s exposure to print coverage and their reactions to media exposure. There was a relationship with print as well as broadcast coverage. The children’s reaction to the coverage was also important in outcome, so it is not simply the amount of exposure but children’s reactions to it that concern us.

While we think the relationship between media exposure and posttraumatic reactions is important from a public health perspective, we do not know what its clinical significance is. By that I mean, we do not think exposure to media coverage constitutes the type of trauma exposure necessary to qualify one for a diagnosis of PTSD. In fact, we think that equating exposure to media coverage with exposure experienced by individuals physically present at a site trivializes the horrifying experiences of those directly involved.

Studies related to September 11 have also identified exposure to television coverage as a correlate of posttraumatic reactions in national samples of individuals remotely affected by the attacks.

As our thoughts about the issue have evolved and as we have continued to examine our own work and that of others, we have become quite circumspect with respect to interpreting the results of these studies. For example, it is crucial that we not assume a cause-effect relationship in these findings. It may be that those who are most aroused or distressed turn to the media for information. It may also be that some other factor is responsible for both heightened reactions and for individual’s turning to the media.

Q: Have your findings changed your own perception of media responsibilities?

Pfefferbaum: Certainly, our work in this area has changed our perceptions of the media in the sense that we have a new appreciation of the importance of the media for both good and bad outcomes. While terrorists clearly use the media to their advantage, the media also serve the important purpose of informing the populace and may also be important in evoking the rage, intense patriotism, and support needed to combat the enemy.

Q: Your work is unusual, and especially relevant, because it takes a scientific approach to controversial topics that are usually argued through anecdotes and personal impressions. Could you comment on the importance of a scientific approach to journalism and trauma?

Pfefferbaum: A scientific approach is essential and it needs to be much more comprehensive than our own work. It should explore a variety of populations in terms of trauma exposure, developmental issues, and culture. It should explore various media forms. And it should examine a range of predictors and outcomes both positive and negative. To date, the research does little more than suggest the importance of exploring the issues.

While responsible reporting is crucial, too many are too quick in blaming the media. Surely, we do not want to be without media coverage. Rather, we should join hands in attempting to better understand the many issues involved in media coverage of terrorist incidents. We might do this through coalitions representing the multiple interests in the issue (the media, the public, mental health and public health, education, for example) to identify and explore the many questions and concerns. Clearly, more research is needed and educating the public about some of these issues would also be prudent.

Q: How might journalists use these research findings to assess and improve their own reporting on trauma?

Pfefferbaum: It is important that we not over read the results of the research because it really is in its infancy. But commenting as a clinician, I would urge journalists to approach individuals and topics mindful of the potential for generating traumatic reminders in the interview process
and in their coverage.This requires caution and balance in choosing stories and angles, in using dramatic and graphic images and text, and in timing the presentation of their work.

The area is far more complex than it might appear on first blush so teaming with mental health professionals in exploring the issues would be welcomed.