Shots Fired, Lives Lost: Coping with Mass Shootings (featured article)


In the September 2019 issue of The Boss Mann Magazine, Dr. Nelson explores how mass shootings in America have soared to epidemic proportions. He also identifies ways you can respond and support in the wake of a mass shooting incident.

*The following manuscript is shared with expressed permission from BossMann Magazine.


Shots Fired, Lives Lost: Coping with Mass Shootings

By John A. Nelson, Clinical Psychologist

Violence is never easy to recover from, especially when it comes in the forms of senseless, random and unprovoked incidents that tragically shatter the lives of countless individuals within seconds to minutes. Violent encounters like these perfectly describe mass shootings in America. A mass shooting is generally defined by a domestic event where four or more victims are shot and/or killed. Over the past few decades the United States has seen an increase in mass shootings. Mass shootings range from small scale incidents that rarely make the news to high profile cases that consume mass media for days, if not weeks at a time.

According to, in 2019 alone there have been approximately 263 mass shootings to date. This stark statistic includes recent cases involving the nightclub shooting in Dayton, Ohio on August 4 (10 dead, 17 injured), the Walmart shooting in El Paso, Texas on August 3 (22 dead, 24 injured), the Garlic Festival shooting in Gilroy, California on July 28 (4 dead, 12 injured), the city public works building shooting in Virginia Beach, Virginia on May 31 (13 dead, 4 injured), and the workplace shooting in Aurora, Illinois on February 15 (6 dead, 6 injured). Unfortunately, these sentinel events seem to occur more frequently than statistical data can stand to keep up with. This public crisis demands increased attention from many sectors, including efforts from public health intervention, education and awareness. In turn, this article seeks to explore the psychological impact of mass shootings as well as identify helpful coping skills individuals may use in the event they unfortunately face such a crisis.

The Psyche of Mass Shooters:

Many discussions on mass shootings inevitably include a connection to mental health. While it is important to acknowledge the psychological impact mass shootings have on victim survivors, it is first necessary to address common misperceptions surrounding mental health and mass shooters. Following mass shooting incidents, suspects are oftentimes typecast as emotionally unstable or mentally ill. This characterization tends to suggest mental illness is automatically linked to violent and criminal behaviors. Far worse, this misconception gives the illusion that a mass shooter’s actions are explainable or even excusable due to an illness. Research does not support these notions, and neither does research support the idea that mentally ill individuals are more violent than non-mentally ill persons. While addressing this very topic in the aftermath of the recent El Paso, Texas shooting, Dr. Rosie Phillips Davis, president of the American Psychological Association, mentioned how attempts to blame mass shootings on mental illness are both stigmatizing and unfounded [1]. She challenged the public to consider how mental illness rates are similar around the world, yet mass shootings disproportionately impact the United States due to other variables, including access to, availability of, and types of firearms.

Mental Health in the Aftermath of Mass Shootings:

Undoubtedly, firearms access is a polarizing and hotly debated topic in many forums. Despite one’s personal, social or political leanings, it is evident that victim survivors, as well as their families and friends, face short-term and long-term emotional consequences following a mass shooting. Common mental health concerns in the wake of mass shooting incidents include post-traumatic stress disorder (PTSD), anxiety, depression and substance abuse. In the immediate aftermath of traumatic events, it is expected that survivors and those impacted by the incident will experience emotional maladjustment. In some cases, this maladjustment does not improve over time and develops into more serious mental health conditions that require professional intervention. The National Center for PTSD estimates that about 28% of people who witness a mass shooting will develop PTSD [2].

With this in mind, it is important to identify when reactions to mass shootings are situationally appropriate or more extreme in nature. In a 2017 research bulletin, the Substance Abuse and Mental Health Service Administration (SAMHSA) described three stages of healing following a mass shooting incident: acute phase, intermediate phase, and long term phase [3]. The acute phase happens immediately following a mass shooting incident and can last from hours to days. In this phase, victims and survivors are usually anxious, experience denial, shock, disbelief, fear, and helplessness. These reactions are considered normative and are generally expected to improve or go away within a relative short period of time. There are some cases, however, when victims and survivors do not improve over a relatively short period of time and ultimately enter into the intermediate phase of healing. This phase is characterized by intense anxiety, fear and anger that disrupts normal functioning, including causing regular attention and concentration problems, sleep problems, or even depression, for example. If these behaviors go unaddressed for too long then they can morph into more complicated problems characterized by the long-term phase. The long-term phase occurs several months after the event and is linked to more serious mental health concerns, including PTSD, self-medication, or substance use disorders.

Individuals at Risk for Emotional Problems:

Not everyone exposed to a mass shooting incident will experience long-term, negative emotional outcomes. Individuals most at risk for developing serious emotional problems include those who have prior mental health conditions, including exposure to prior traumas or PTSD, those directly involved in the shooting, as well as individuals who know someone involved in the shooting or live geographically close to the incident. Additional individuals most at risk for developing emotional problems following a mass shooting include first responders such as emergency medical services and law enforcement personnel, as well as the general population exposed to mass media coverage.

Coping Strategies Following a Mass Shooting:

In the face of helplessness, which is a feeling that tends to overcome survivors and others impacted by mass shootings, varying levels of support can be helpful during aftermath recovery.  Coping strategies are useful in assisting survivor victims, families and friends of survivors, as well as others impacted by mass shootings.

Social Support: Individuals who have the availability and support of family and friends tend to recover better compared to those who do not. Opportunities to reach out to, connect with, and even process thoughts and feelings with family and friends are a valuable part of the healing process.

Memorial Events: Memorial gatherings and memorial sites are common following a tragic event. These provide opportunities for survivors and those affected to reach out to the wider community to grieve, process, and heal together. Although there is a heavy sadness that accompany these events, there is healing value that allows participants to attempt to make meaning of what happened, as well as confront heavy emotions that can be buried and ignored during social isolation.

Obtaining Facts and Clarification: Feeling left in the dark, and having limited access to information, could worsen anxiety and reinforce fear. Factual information obtained about a mass shooting incident may ease the burden of not knowing, as well as assist with coming to terms with accepting the reality of the situation.

Mass Media Exposure:The impact of mass media exposure varies from individual to individual. There are pros and cons to mass media. Pros include obtaining easily accessible and updated information about the event, whereas cons might include exposure to repeated trauma and reinforcement of negative emotions. Individuals should monitor their reactions to media exposure, including limiting media exposure if they notice it triggers increased negative emotions.  Also, parents are encouraged to monitor their children’s exposure to mass media, including identifying how much their children can tolerate at any given time. This is especially important given children tend to be more impressionable and vulnerable toward emotional events compared to adults. Additional resources for parents are referenced below through NCTSN.

Structured Activities: Keeping busy with normal daily, personal, and family routines are a healthy way to prevent mental obsessions over the shooting incident. Constantly replaying tragic events in one’s head can reinforce emotions related to trauma and anxiety, and is not generally supportive of positive emotional health in the end. This is equally important for individuals not directly connected to the shooting incident, but affected nonetheless through media exposure. Being aware of your surroundings and mindful of safety are important. However, being hypervigilant and generally avoidant of certain places and routines are not necessarily helpful, and can lead to increased anxiety.

Anniversary Dates:  Tragic anniversaries tend to lead to the return or worsening of anxiety and depression. It is common to feel unusually sad during landmark dates surrounding the anniversary of a mass shooting. This is a great time to surround oneself with social support systems, including friends and family.

Ways You Can Help:

Although mass shootings represent a type of violence that is unpredictable and random, it is important to be aware that random violence rarely occurs and does not affect most neighborhoods. Being prepared to respond in the event of an actual tragedy is always best. There are several ways you and the larger community could assist in the event of a mass shooting incident if ever called upon. Examples include donating blood as well as volunteering with the Red Cross or local disaster response networks. If you are interested in learning more about ways to respond and offer support, the following free resources are available to you.



  1. Statement of APA President in Response to Mass Shootings in Texas, Ohio. (2019, August 4). Retrieved from
  2. Orcutt, H. K., Miron, L. R., & Seligowski, A. V. (2014). Impact of mass shootings on individual adjustment. PTSD Research Quarterly25(3), 1-9.
  3. (2017, September). Mass violence and behavioral health. Disaster Technical Assistance Center Supplemental Research Bulletin. Retrieved from

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