How to help yourself and others when acute anxiety hits during rocket attacks

As calls for emotional support spike, mental health professionals say it’s normal to be highly stressed when the country is under attack on multiple fronts, as it was in past week

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Illustrative: People take cover during a rocket warning siren in Sderot, southern Israel, November 12, 2019. (AP Photo/ Tsafrir Abayov)
Illustrative: People take cover during a rocket warning siren in Sderot, southern Israel, November 12, 2019. (AP Photo/ Tsafrir Abayov)

As a teacher, Lisa Biton was trained how to respond when incoming rocket sirens blared. Fortunately, the Kiryat Gat resident knew how to act when she was recently at a large family holiday gathering in Sderot, near the Gaza border, and the red alert system sounded. There were only 15 seconds to get to the bomb shelter, but Biton’s in-laws froze. She touched them on the shoulder, gently yet firmly got their attention, and shepherded them quickly to safety.

“I got them to stay in the moment. I reassured them that they were with me, and that we were going to be okay,” Biton said.

Biton’s in-laws’ reaction was a common manifestation of acute stress and anxiety (harada in Hebrew) that can be expected in response to recent events in Israel, including rocket attacks from Lebanon, Syria, and Gaza, and an uptick in terror attacks on both sides of the Green Line.

The societal rifts resulting from the government’s contentious judicial overhaul plan are also taking a toll on Israelis’ ability to cope.

According to mental health experts, the physical, emotional, behavioral, and cognitive symptoms that many people experience are normal. The key is to know what to do when anxiety-provoking events occur and to recognize when symptoms do not resolve easily or in a reasonable amount of time. Emotional trauma can develop and worsen, leading to post-traumatic stress disorder even a month after the precipitating event.

According to Israel Trauma Coalition executive director Talia Levanon, for 80 percent of those shaken up, the feeling will quickly pass and they will be able to return to their normal routines. For the remaining 20%, the symptoms continue beyond a few minutes or hours and require professional intervention.

Israel Trauma Coalition executive director Talia Levanon. (Yoel Ben Ari)

“One of the ways to understand whether you’re suffering from something that will only be short-term is to see whether it’s becoming easier over days. For those who do not have the [natural] coping mechanism and do not receive care immediately, they will have symptoms of trauma that will not alleviate over time,” she said.

However, initial feelings of acute stress in a period in which Israel currently finds itself can be natural for anyone. These feelings must be legitimized and people allowed to express their emotions without judgment.

“The acute anxiety people feel is a result of the threat we feel to our physical and mental well-being. It’s a normal reaction to an abnormal situation,” said Dr. Shiri Daniels, executive director of counseling at ERAN, Israel’s emotional first aid service.

Daniels noted that people should be aware of how they might react when a siren goes off, hear a loud boom, or even overexpose themselves to distressing radio or television news reports.

Physical symptoms can include nausea and vomiting, difficulty breathing, headaches and fatigue. Cognitive symptoms can entail poor attention, decision-making, and concentration. There can also be memory problems and a tendency to catastrophize. Emotional challenges could involve feelings of guilt, loss of control, fear of uncertainty, and depression. One may also have difficulty with sleep or with eating.

Both Daniels and Levanon give similar tips for acting quickly to help people who freeze or panic when a rocket siren goes off. The key is to be calmly assertive with them.

The scene of a deadly terrorist shooting attack in the West Bank, near the settlement of Hamra, April 7, 2023. (Courtesy; used in accordance with Clause 27a of the Copyright Law)

“You should reach out to that person and state your name and say you are here to help them, and that you need them to help you too. Ask them their name. Of course, there is a real danger and you may not have time to have a real conversation before getting to a shelter,” Levanon said.

“In general, what you need to do is make them conscious of their surroundings, assure them they are not alone, and get them to follow orders,” she said.

According to Daniels, once both of you are safely in the shelter, it is important to create a sense of flow of events because the traumatic event can disrupt one’s reality and sense of continuity.

“‘You say something like: ‘There was a siren now, so we went into the nearest shelter, and now we are safe,” Daniel advised.

Another helpful tip is to activate the person and give them a task. They could count the other people entering the shelter or direct them through the door.

“Research shows that it’s quite calming because we all need our roles,” Daniels said.

ERAN executive director of counseling Dr. Shiri Daniels (Courtesy)

Ra’anana resident Elana Horwitz believes she kept functioning when a siren when off as she was shopping in a supermarket because she gave herself a task.

“I guess I was so traumatized that it felt like I had an out-of-body experience. But somehow I knew that the way to keep myself calm was to approach other people in the aisle and encourage them to get to the safe room,” she said.

Levanon emphasized that for the most part, individuals who show extreme anxiety during the moment do not require medical intervention. Giving a person some water to drink and helping them steady their breathing is usually all that is needed.

Daniels explained that when Israelis hear on the news about people who have been taken to the hospital with acute anxiety after a bombardment or terror attack, these are usually cases of panic attacks that need further investigation.

“If a person experiences a panic attack, it could feel like a heart attack. So it’s always better to seek help and then know that it’s not anything physical,” she said.

Children are especially sensitive to stressful events. Parents, grandparents, and caregivers must serve as role models and do everything in their power to keep their feelings in check in front of youngsters.

In certain areas of the country, children themselves are taught about how their body and mind react when the siren goes off.

“In our work, we train people from a very young age, especially in the Gaza-area communities. We train them to understand their bodily response and emotional response. This is part of what we call ‘creating resilience,'” Levanon said.

Helping children cope is not only relevant on the borders. Eli from Ra’anana told The Times of Israel that his 14-year-old daughter suffers as a result of sirens she was first exposed to two years ago.

“She had her first panic attack last August, when rockets were falling on Tel Aviv. Now she has really high anxiety triggered even by news about rockets,” Eli said.

The current terror wave has made things difficult for his daughter, and she is using various techniques to try to stay calm, including drinking water, breathing, literally grounding herself with her feet on the ground, listening to a favorite song on repeat, and visualizing herself in her happy place — the beach.

“She realizes her fear is not rational from the point of view that the chances of her or her family and friends being hit are so minimal. It’s the idea that someone who doesn’t know her is trying to hurt her or her family that she can’t cope with,” Eli said.

Illustrative: A woman comforts a child as they take cover after rocket warning sirens sound on a road between Ashkelon and Sderot in southern Israel, on May 19, 2021. (Olivier Fitoussi/Flash90)

Daniels reported a 30% rise in calls to ERAN first aid centers over the first days of Passover, which has been a highly distressing time for the country. This follows a significant increase reported earlier due to the political turmoil.

“We have 1,600 volunteers and 13 centers in Israel, five in the US and one in Australia — all serving Israelis. We usually have 16 volunteers working per shift in a crisis, but over the last few days we have had to increase that number to 40,” she said.

For Levanon, it is clear that the political situation has worn people down and is not helping. But she finds now — as always — that when the security situation is rough, Israelis are resilient and supportive of one another.

“I think one of the reasons is that Israelis understand that they’re vulnerable. If you think you are Superman and something happens, you probably will react much worse than if you know that sometimes dangerous things happen, but you’re not alone and you can cope. That’s the secret,” she said.

Help is available from ERAN, NATAL, Bituach Leumi, and local resilience centers, among others.

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