On July 22,  2011, a car bomb went off near government buildings in the city of Oslo, Norway.  The massive explosion could be heard more than four miles away and created a shock wave that started fires and filled nearby streets with glass and debris.  Eight people were killed outright in the blast and 209 others were injured, some seriously.  Witnesses reported that the driver of the van in which the bomb had been placed had been dressed as a policeman and had a gun in his hand. Though several people called the police and reported this suspicious behaviour, the driver was still free to leave the van unattended and walk several blocks to where he had a second car parked.  But that bomb blast was only the beginning.

Two hours later, as police were still cordoning off the site of the Oslo blast, the driver of the van, a 32-year old right-wing extremist named Anders Breivik, boarded a ferry to Utoya Island not far from Oslo.  Breivik was still dressed as a police officer and carryied official identification giving his name as "Martin Nilsen" of the Oslo Police Department.  At the time, the island was the site of the annual youth camp hosted by the Norwegian Labour Party's Worker's Youth League.   About 600 teenagers were attending and nobody had any idea about the horror that was about to strike.  

When Breivik arrived, he claimed to be a police officer conducting a security check following the Oslo bombing.   After staff members became suspicious, Breivik shot them to death and then asked people to gather around him before pulling weapons out of his bag and firing indiscriminately into the crowd.   Survivors later described what followed as a scene of terror as Breivik shot anyone he could find and then shot at people in the lake trying to swim for safety. The mass shooting lasted for 90 minutes before Breivik calmly surrendered to a police task force that had arrived on the scene. In all, 68 people were killed outright (one died later of his injuries) while another 110 people were wounded. Most of the victims were teenagers with the youngest being fourteen years of age. It was the deadliest attack in Norway since the end of World War 2.

Breivik later told police that the purpose of his attacks was to save Norway from a Muslim takeover.  His long and rambling manifesto had been released to the Internet that same morning. Breivik targeted the youth camp because Norway's Prime Minister had been making a speech there that same day.  Fortunately, she had already left by the time he managed to reach the island..  

Breivik's killing rampage, both the bombing and the mass shooting, sparked a media firestorm that lasted for weeks.  Along with calls for tighter security, the families of the victims found themselves under intense public scrutiny as they grieved their losses.  

Though everybody who has suffered a traumatic loss will experience extreme grief as they try to movie on with their lives, losing a loved one to a terrorist attack can be especially devastating.  The very purpose of atrocities such as the Utoya massacre is to cause maximum loss of life and inspire fear in the name of a specific cause.   It's hardly surprising that research studies have shown that grief caused by terrorism seems especially likely to lead to mental health problems such as posttraumatic stress disorder (PTSD) and major depression disorder (MDD).  

Another mental health problem linked to traumatic loss is  prolonged grief (also known as complicated grief).  Prolonged grief is characterized by symptoms such as intense separation  distress,  yearning and longing for the deceased, frequent thoughts and memories of the deceased, ruminations about the circumstances of the death, and  difficulties accepting that the death actually happened.    Though similar to normal or uncomplicated grief, it is usually much more extreme and can lead to impaired social or occupational functioning persisting six months or longer after the loss.  While prolonged grief is considered to be different than PTSD or MDD, there can still be considerable overlap in terms of symptoms.  

For survivors and family members of victims of a terrorist attack, coping with the avalanche of news coverage that often follows can be an added source of trauma, especially if the news coverage is too graphic or detailed.   Since many of these news stories can feature survivors or family members describing how they were affected,  survivors are often besieged by emotional reminders that can retraumatize them.   

Even after the initial media storm dies down, there are other reminders that can frequently surface.  In the case of Anders Breivik, his trial added to the trauma of his victims and their families by providing him with a soapbox to share his beliefs and self-justifications for his actions.  

And then there were the inevitable retrospectives of the Utoya massacre on the first anniversary and after fresh attacks in other countries. As you might expect, research studies consistently show a strong correlation between media exposure to terror attacks and psychological problems such as posttraumatic stress.   Long after the 9/11 attacks for example, research showed that media coverage often produced posttraumatic symptoms, both for survivors and for the general public.    But can this apply to prolonged grief as well?

To examine the role that media can have in prolonged grief, a new study conducted by a team of Norwegian researchers interviewed parents and siblings of many of the victims of the 2011 attack. The study, which was recently published in the journal Psychological Trauma, showed what was learned from the 103 parents and siblings of Utoya victims who agreed to take part in the research.    According to lead researcher Pal Kristensen and his co-authors, the aim of the study was to examine prolonged grief experienced by surviving family members eighteen months after the attack and to determine how media exposure can contribute to the long-term psychological problems that often develop.

As expected, almost 80 percent of parents or siblings of victims reported symptoms of prolonged grief eighteen months after the attack.  This prevalence in prolonged grief is much higher than what was reported for family members dealing with the loss of a loved one from suicide, accidents, or natural disasters (but similar to the grief reported by family members dealing with a murdered relative).  Overall, prolonged grief was highest in female family members (regardless of being a parent or sibling), in family members reporting spending four hours or more a day watching news coverage in the first month after the attack, and those family members who had actually been in phone contact with a victim during the attack.  

As Pal Kristensen and his co-authors point in in their conclusions, people who are directly affected by terrorism remain particularly vulnerable to the graphic news coverage often seen in the days or weeks following an attack.  After the 2011 Utoya massacre, photographs and videos of Anders Breivik could be found just about everywhere on television and the Internet.  And even after the initial news storm died down, his later trial,which was attended by many of the family members of his victims, likely traumatized bereaved relatives even further. 

While more research is needed, this study highlights how the steady stream of news reports following a terrorist attack can prolong the traumatic grief many relatives of victims must endure.   Although news coverage is essential in keeping the general public informed about terrorist attacks, news agencies need to be more sensitive about the effect over overly graphic or sensational images or videos can have on the families of victims.  

As more terrorist attacks occur, the lessons learned from the Utoya massacre can guide mental health professionals dealing with family members dealing with loss.   Recognizing how obsessive media watching can lead to prolonged grief may help with the lengthy recovery family members many family members face.

References

Kristensen, P., Dyregrov, K., Dyregrov, A., & Heir, T. (2016). Media exposure and prolonged grief: A study of bereaved parents and siblings after the 2011 Utøya Island terror attack. Psychological Trauma: Theory, Research, Practice, and Policy, 8(6), 661-667.

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