1. Terror and disasters impacting young people Siri Thoresen ISTSS/ESTSS conference, 23 September 2013

2. The bombing at the Governmental Quarter The shooting at Utøya Island 22. July

3. This is our country

4. Most young people facing trauma: Interpersonal violence, accidents, sexual abuse, traumatic loss, violent crime… and more

5. So why focus on terror and disasters?

6. First response to trauma: Evidence-informed strategies (some examples) Intervention principles 1) a sense of safety, 2) calming, 3) a sense of self– and community efficacy, 4) connectedness, and 5) hope. (Hobfoll et al, 2007) Psychological First Aid (National Child Traumatic Stress Network and National Center for PTSD, Brymer et al, 2006) Skills for Psychological Recovery (Berkowitz et al, 2010) European consensus report (TENTS; Bisson et al, 2010) NICE guidelines (British National Institute for Clinical Excellence, 2005)

7. First response to trauma: Evidence-informed strategies The challenge is: A need for more evidence, but also – making use of existing knowledge?

8. Mass trauma: Some additional challenges (examples) Public events Media attention Organizing nationwide interventions

9. Where were you when you found out about 22. July?

10. Reactions in the Norwegian population: 22-24 juli Percent reporting «quite a bit» or «extremely» % Approximately 50% cried that weekend Thoresen, Aakvaag, Wentzel-Larsen, Dyb & Hjemdal, 2012

11. % ** p < 0.001 ** Reactions in the Norwegian population: Young people Percent reporting «quite a bit» or «extremely»

12. Mass trauma: Some additional challenges (examples) Public events Media attention Organizing nationwide interventions

13. Media experiences in Utøya survivors Figure in prep deleted

14. Mass trauma: Some additional challenges (examples) Public events Media attention Organizing nationwide interventions

15. Treating traumatized individuals -Evidence-based treatment strategies The challenge is: Making use of existing evidence-based treatements?

16. Bonanno, 2004 Who do well and who do not so well?

17. Utøya: Changes from T1 til T2 : Anxiety/depression Figure in prep deleted

18. Perceived social support - One of the most important predictor of health development following trauma (Brewin et al, 2000; Ozer et al, 2003) -Negative social support /feeling let-down maybe even more important (Brewin and Holmes, 2003) Figure in prep deleted

19. Oklahoma City bombing 9/11 An international research community The Kauhajoki school shootings The London bombings Utøya

20. Thank you for your attention!