Oslo Bombing Research Articles

“I could have been dead”: Counterfactual thinking and posttraumatic stress disorder in individuals directly exposed to the 2011 Oslo bombing.

“I could have been dead”: Counterfactual thinking and posttraumatic stress disorder in individuals directly exposed to the 2011 Oslo bombing.

The Politics of aMemory Wound: Norwegian Exceptionalism and the Trauma of July 22, 2011

Following the July 22, 2011, Oslo bombing and shootings at the Utøya youth camp Norway became embroiled in a conflict over commemorative ethics. The memorial initially selected in an international contest, Memory Wound by Jonas Dahlgren, drew opposition from victims’ families and local residents for its severe impact on the natural landscape. Plans for installation were cancelled in 2017. This controversy, we submit, must be contextualized in relation to the Norwegian justice system’s handling of Anders Breivik, the perpetrator whose criminal proceedings were kept relatively secluded. We demonstrate how the design of Memory Wound and the suppression of Breivik’s publicity reflect a symbolic logic traceable to a national imaginary of Norwegian exceptionalism. By interpretively aligning the use of negative space in Memory Wound with the muting of Breivik as a media event, we investigate the prescriptive force of symbols to inculcate world views. Specifically, we attend to the foreclosure of “prosthetic memory,” which through media circulation allows people to engage with memory that is not primarily theirs. We acknowledge the possibility of empathy across difference that Landsberg ascribes to prosthetic memory; however, we insist that the circumstances under which solidarity might be rejected must be considered. With a dual case study, we offer a perspective on enduring assumptions about cultural identity and the rise of rightwing extremism in Northern Europe.

The Role of Workplace on Work Participation and Sick Leave after a Terrorist Attack: A Qualitative Study.

Returning to work after large-scale traumatic events is desirable for employees, their organization, and society. The aim of the present study was to identify work-related factors that are perceived as important for work participation versus sick leave after a terrorist attack. We conducted in-depth interviews of 98 employees in the Norwegian governmental ministries that were the target of the 2011 Oslo bombing. Participants were randomly selected from 2519 employees who had responded to a web-based survey. We used a stratified sampling procedure to ensure inclusion of a wide range of experiences in terms of exposure and stress reactions. Participants were asked what, if any, factors contributed to work participation or sick leave, and which factors made a difference in how quickly people on sick leave returned to work. Thematic analyses provided three themes that stimulate work participation and prevent sick leave: supportive management, the ability of a leader to accept individual needs and help people cope with stress; sense of cohesion, feelings of being close, caring for each other, and working well together; and working as a coping strategy, basic assumptions that it is best to stick to work and familiar routines, or a strong belief in one’s ability to master. A fourth theme, high demands and lack of acceptance, included experiences that promoted an absence from work, such as too much business as usual, management’s lack of priorities for which tasks could be left out, or a lack of recognition of individual needs. The findings point to key factors that workers perceive as important for work participation in the aftermath of a disaster. We suggest that health and productivity benefits can be achieved by organizing work and the work environment in line with these experiences.

Gender Differences in Posttraumatic Stress Symptoms after a Terrorist Attack: A Network Approach.

Background: Posttraumatic stress symptoms are more prevalent in women than in men. To improve our understanding of gender differences in PTSD, detailed knowledge about the underlying symptom networks and gender specific symptom profiles is needed.Objective: We aimed to describe the gender differences in levels of individual posttraumatic stress symptoms after a terrorist attack, as well as identify possible gender differences in associations between posttraumatic stress symptoms.Method: This study used survey data from ministerial employees directly (n = 190) and indirectly (n = 1,615) exposed to the 2011 Oslo bombing. Data was collected approximately 10 months after the event. In order to investigate gender differences in levels of symptoms, we used bootstrapped means and standard deviations. Network analyses were conducted to identify gender differences in the associations between posttraumatic stress symptoms.Results: Women reported higher levels of all symptoms, and the strongest effect sizes were found for symptoms of re-experiencing, and anxious and dysphoric arousal. Among individuals with considerable levels of posttraumatic stress symptoms, women reported higher levels of physiological cue activity and exaggerated startle response. No significant gender differences in the networks of posttraumatic stress were found.Conclusions: The present results find no indication that the gender difference in prevalence of PTSD can be explained by differences in associations between symptoms. In order to determine if this finding can be applied to other participants and circumstances, future studies should seek to replicate this study in both community and clinical samples.

Does optimism act as a buffer against posttraumatic stress over time? A longitudinal study of the protective role of optimism after the 2011 Oslo bombing.

Cross-sectional studies have revealed that high levels of optimism can protect against high levels of posttraumatic stress after exposure to trauma. However, this is the first study to explore (a) the protective role of optimism in a longitudinal perspective and (b) optimism's protective effects on specific symptom clusters within the posttraumatic stress symptomatology. This study used prospective survey data from ministerial employees (n = 256) collected approximately 1, 2, and 3 years after the 2011 Oslo bombing. To examine relationships between optimism and development of posttraumatic stress, we applied a series of latent growth curve analyses of both overall posttraumatic stress and the 5 clusters within the posttraumatic stress symptomatology (intrusions, avoidance, numbing, dysphoric arousal, and anxious arousal) with predictors and interaction terms. The results showed that levels of exposure and optimism had main effects on starting levels of all clusters of posttraumatic stress. In addition, optimism had a protective-stabilizing effect on starting levels of avoidance, numbing, and dysphoric arousal. No associations between optimism and rate of change in symptoms clusters were found. These results suggest that optimism may help to neutralize the effects of high exposure on levels of symptoms of avoidance, numbing, and dysphoric arousal but not on the symptoms of intrusions and anxious arousal. Thus, individuals high in optimism still experience intrusions and anxious arousal after trauma, but may be better equipped to cope with these so they do not develop into avoidance, numbing and dyshorical arousal. (PsycINFO Database Record

For Whom Does Time Heal Wounds? Individual Differences in Stability and Change in Posttraumatic Stress After the 2011 Oslo Bombing.

Prospective studies describing and predicting individual differences in the course of posttraumatic stress symptoms (PTSS) after disasters are scarce. The present study aimed to describe and predict individual differences in both the level and the rate of change in PTSS after the 2011 Oslo bombing, a terrorist attack directed at the Norwegian government. Survey data from ministerial employees (N = 256) were collected 10, 22, and 34 months after the bombing. We used latent growth modeling to examine the development of PTSS, and to identify the strength of predictor variables. High exposure, female sex, and high levels of neuroticism were associated with higher levels of PTSS 10 months after the traumatic event (β ranged from .25 to .30, p < .001), whereas social support was associated with lower levels of PTSS (β = -.30, p < .001). The combination of being female and high in neuroticism was associated with a faster decline in PTSS (β range: -.20 to -.39, p = .010 < .05). High exposure seemed to have a lasting influence by maintaining high levels of PTSS. Our findings suggested that being female, being highly exposed, and having low levels of social support were risk markers for enduring PTSS.

Thinking About What Might Have Happened: Counterfactual Thinking and Post‐traumatic Stress in Individuals Directly and Indirectly Exposed to the 2011 Oslo Bombing

SummaryCounterfactual thinking (CFT), that is thinking about what might have happened, is linked to post‐traumatic stress. We studied the relationship between type and frequency of CFT and post‐traumatic stress in a sample of directly (n = 50) and indirectly exposed (n = 50) ministerial employees 4 years after the 2011 Oslo bombing. The results showed that frequency of CFT was associated with levels of post‐traumatic stress, among both directly and indirectly exposed participants. In the directly exposed group, self‐reported frequencies of downward counterfactuals were associated with post‐traumatic stress. A similar trend was found for upward counterfactuals. In the indirectly exposed group, self‐reported frequencies of both upward and downward counterfactuals were associated with higher levels of post‐traumatic stress. These results point to the intriguing possibility that people may not only develop post‐traumatic stress disorder as a result of actual experiences, but also via mental simulations of traumatic events that could have happened. Copyright © 2016 John Wiley &amp; Sons, Ltd.

Thinking that one's life was in danger: perceived life threat in individuals directly or indirectly exposed to terror.

Perceived life threat is associated with post-traumatic stress disorder (PTSD). Still, it is not known whether perceived threat may be important for PTSD in people indirectly exposed to trauma. To examine the prevalence of perceived life threat and the association with PTSD in individuals directly or indirectly exposed to terror. Data are cross-sectional from a survey 10 months after the 2011 Oslo bombing. Perceived life threat was measured by the question: 'How great do you think the danger was that you would die?' scored on a five-point scale. PTSD was measured with the PTSD Checklist (PCL). The retrospective belief that one's life was in great or overwhelming danger was reported by 65% and 22% of employees who had been present or not present, respectively, at the site of the bomb explosion (n = 1923). A high perceived life threat was associated with PTSD among those present (odds ratio (OR) = 5.7, 95% CI 1.9-16.9) and not present (OR = 5.2. 95% CI 3.0-9.0), even after adjusting for objective exposure, demographics and neuroticism. Perceived life threat may play a central role in the development and maintenance of PTSD in people directly as well as indirectly exposed to terror. Moderating perceptions of having been in serious danger may be an appropriate approach to the prevention and treatment of PTSD.

Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing.

Our understanding of the dynamics of post-traumatic stress symptomatology and its link to functional impairment over time is limited. Post-traumatic stress symptomatology (Post-traumatic Checklist, PCL) was assessed three times in 1-year increments (T1, T2, T3) following the Oslo bombing of 22 July, 2011, in directly (n = 257) and indirectly exposed (n = 2223) government employees, together with demographics, measures of exposure and work and social adjustment. The dynamics of post-traumatic stress disorder symptom cluster interplay were examined within a structural equation modelling framework using a cross-lagged autoregressive panel model. Intrusions at T1 played a prominent role in predicting all symptom clusters at T2 for the directly exposed group, exhibiting especially strong cross-lagged relationships with avoidance and anxious arousal. For the indirectly exposed group, dysphoric arousal at T1 played the most prominent role in predicting all symptom clusters at T2, exhibiting a strong relationship with emotional numbing. Emotional numbing seemed to be the main driver behind prolonged stress at T3 for both groups. Functional impairment was predominately associated with dysphoric arousal and emotional numbing in both groups. For directly exposed individuals, memories of the traumatic incident and the following intrusions seem to drive their post-traumatic stress symptomatology. However, as these memories lose their potency over time, a sequela of dysphoric arousal and emotional numbing similar to the one reported by the indirectly exposed individuals seems to be the main driver for prolonged post-traumatic stress and functional impairment. Findings are discussed using contemporary models within an exposure-dependent perspective of post-traumatic stress.

Posttraumatic Growth—An Antecedent and Outcome of Posttraumatic Stress

There is a gap in the literature concerning the temporal course, and the bidirectional nature, of the relationship between posttraumatic growth (PTG) and posttraumatic stress symptoms. This longitudinal study investigated PTG and posttraumatic stress in individuals directly exposed to the 2011 Oslo bombing ( N = 240). To investigate the relationships between PTG and posttraumatic stress 10 (T1) and 22 (T2) months after the bombing, a cross-lagged autoregressive model was applied. High levels of PTG at T1 were associated with high levels of posttraumatic stress at T2. Furthermore, high levels of posttraumatic stress at T1 were associated with high levels of PTG at T2. The association between PTG and stress declined from 10 to 22 months and was not significant after 22 months. These findings indicate that PTG may be both a consequence and antecedent of posttraumatic stress.

Long-term relationships between perceived social support and posttraumatic stress after the 2011 Oslo bombing: A three-year longitudinal study

BackgroundAfter traumatic events, social support and posttraumatic stress are interrelated, but little is known about the underlying dynamics behind this association. Levels of social support and posttraumatic stress may change and affect each other over time, but there are also stable time-invariant individual differences in both constructs. The present study aimed to determine the amount of variance explained by stable individual differences in levels of social support and posttraumatic stress across three years, and to determine whether and to what extent social support and posttraumatic stress may affect one another when these stable individual differences are controlled for. MethodsWe used data from ministerial employees present in the Governmental district during the 2011 Oslo bombing attack (N=255). Data was collected ten months, two years, and three years after the terror attack. Using a random intercept cross lagged panel model (RI-CLPM), we tested the possible directional effects between social support and posttraumatic stress within persons when variance between persons was taken into account. ResultsThe intraclass correlations of the three measures of posttraumatic stress and social support were.83 and.74, respectively. The remaining variation within persons could not be explained by change in either of these constructs. LimitationWe have no information on the processes that might have occurred before 10 months after the incident. ConclusionsOur findings indicate that the long-term longitudinal linkage between social support and posttraumatic stress may be best explained by stable individual differences rather than causal processes operating within persons.

The Launching and Ensnaring Effects of Construing a Traumatic Event as Central to One's Identity and Life Story

SummaryConstruing a traumatic event as central to one's life story and identity is associated with posttraumatic stress. The longitudinal relationship between centrality of event and trajectories of posttraumatic stress was examined. Data from ministerial employees were collected 10 months, 2 years, and 3 years after the 2011 Oslo bombing (N = 259). Using structural equation modeling, the launch and the snare hypotheses were tested. Support for the launch hypothesis was found; higher levels of event centrality 10 months after the attack were associated with higher levels of posttraumatic stress across time. Support for the snare hypothesis was also found; higher levels of centrality 10 months and 2 years after the bombing were related to higher levels of posttraumatic stress, beyond what could be anticipated based on the individual's general trajectory. This suggests that event centrality can influence the overall trajectory, and may also have additional time‐specific effects on posttraumatic stress.Copyright © 2016 John Wiley &amp; Sons, Ltd.

The aftermath of terrorism: posttraumatic stress and functional impairment after the 2011 Oslo bombing.

Objective: In the present study we wanted to investigate the link between exposure, posttraumatic stress symptomatology, and functional impairment in the aftermath of terrorism.Method: Posttraumatic stress symptomatology and functional impairment related to the Oslo bombing 22nd of July, 2011, in directly and indirectly exposed individuals (N = 1927) were assessed together with demographics, exposure, peri-traumatic reactions, and event centrality approximately 1 year after the attack.Results: Directly and indirectly exposed individuals qualifying for posttraumatic stress disorder (PTSD) reported similar peri-traumatic reactions, event centrality, and functional impairment. However, clusters within the PTSD symptomatology were differentially associated with impairment as a function of their exposure. In the directly exposed group, all clusters within the PTSD symptomatology were associated with impairment in function, while only emotional numbing was associated with impairment within the indirectly exposed group.Conclusion: Considering that terror attacks frequently involve directly exposed individuals and a larger population of indirectly exposed individuals, this finding is of importance, especially in the design of intervention programs and the development of treatment policies.

A retrospective observational study of medical incident command and decision-making in the 2011 Oslo bombing.

BackgroundA core task for commanders in charge of an emergency response operation is to make decisions. The purposes of the study were to describe what critical decisions the ambulance commander and the medical commander make in a mass casualty incident response and to explore what the underlying conditions affecting decision-making are. The study was conducted in the context of the 2011 government district terrorist bombing in Norway.MethodsThe study was a retrospective, descriptive observational study collecting data through participating observation, semi-structured interviews, and recordings of emergency medical services’ radio communications. Analysis was conducted using systematic text condensation. The ambulance commander was interviewed using the critical decision method.ResultsThe medical emergency response lasted 6.5 h, with little clinical activity after 2 h. Most critical decisions were made within the first 30 min, with the ambulance commander making the bulk of decisions. Situation assessment and underlying uncertainties strongly affected decision-making, but there was a mutual interaction between these three factors that developed throughout the different stages of the operation. Knowledge and experience were major determinants of how easily commanders picked up sensory cues and translated them into situation assessments. The number and magnitude of uncertainties were largest in the development stage, after most of the critical decisions had been made.ConclusionsIn the studied mass casualty incident, the commanders made most critical decisions in the early stages of the emergency response when resources did not meet demand. Decisions were made under significant uncertainty and time pressure. Ambulance and medical commanders should be prepared to make situation assessments and decisions early and be ready to adjust as uncertainties are reduced.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-015-0052-9) contains supplementary material, which is available to authorized users.

Perception of threat and safety at work among employees in the Norwegian ministries after the 2011 Oslo bombing

Background and objectives: Terrorism can heighten fears and undermine the feeling of safety. Little is known, however, about the factors that influence threat and safety perception after terrorism. The aim of the present study was to explore how proximity to terror and posttraumatic stress reactions are associated with perceived threat and safety after a workplace terrorist attack. Design and methods: A cross-sectional questionnaire survey was administered to employees in 14 of 17 Norwegian ministries 9–10 months after the 2011 bombing of the government headquarters in Oslo (n = 3520). Results: About 198 of 1881 employees completing the survey were at work when the bomb exploded. Regression analysis showed that this high-exposed group had elevated perceived threat (β = 0.36; 95% CI = 0.19 to 0.53) and reduced perceived safety (β = −0.42; 95% CI = −0.62 to −0.23) compared to a reference group of employees not at work. After adjusting for posttraumatic stress reactions, however, proximity to the explosion no longer mattered, whereas posttraumatic stress was associated with both high perceived threat (β = 0.55; 95% CI = 0.48 to 0.63) and low perceived safety (β = −0.71; 95% CI, −0.80 to −0.63). Conclusion: Terror-exposed employees feel more threatened and less safe after a workplace terrorist attack, and this is closely linked to elevated levels of posttraumatic stress reactions.

Posttraumatic growth and centrality of event: A longitudinal study in the aftermath of the 2011 Oslo bombing.

Previous studies have reported that construing a traumatic event as central to one's life story and identity are associated with posttraumatic growth (PTG). Due to cross-sectional designs, these studies provide only weak evidence of a causal relationship between event centrality and PTG. The main aim in the present study is to examine the longitudinal associations and directionality between centrality of event and PTG in ministerial employees who were present at work during the 2011 Oslo bombing attack (N = 229). By applying a cross-lagged autoregressive model, the present study investigates both stability across time, possible time-lagged effects, and the relationship between centrality of event and PTG at 1 and 2 years after the bombing. The results showed that levels of centrality of event and PTG were stable across time. There was a significant association between centrality of event and PTG both 1 and 2 years after the bombing; however, this relationship attenuated over time. No time-lagged effects in either direction were found. The present findings are in line with previous findings indicating that centrality of a traumatic event is related to PTG. However, the present longitudinal data do not support a hypothesis about a long-term causal effect of event centrality on PTG. Rather, the relationship between centrality of event and PTG are concurrent, and attenuates with time.

The case of Anders Behring Breivik - language of a lone terrorist.

Anders Behring Breivik carried out a massacre in Norway on July 22, 2011, killing a total 77 persons and leaving 42 others severely wounded. He detonated a bomb in Oslo and then drove to the island of Utøya, where he shot and killed youngsters gathered at a youth camp. The authors performed an analysis of Breivik's writing style in his extensive manifesto which he published hours before the attacks, and also referred to the two psychiatrists' reports. The first report concluded that he suffered from paranoid schizophrenia. The authors concurred with the second report. Breivik seemed to be a person with narcissistic personality disorder, whose grandiosity might have caused him to be regarded initially as mentally deranged; however, closer examination revealed his deliberate attempt to methodically indoctrinate and deceive potential readers, to alarm potential targets and to terrorize a nation.

Centrality of Event and Symptoms of Posttraumatic Stress Disorder After the 2011 Oslo Bombing Attack

SummaryIt has been proposed that a highly integrated trauma leads to more accessible and vivid memories of the traumatic event, in turn heightening symptoms of posttraumatic stress disorder. The relationship between the centrality of a traumatic event and symptoms of posttraumatic stress disorder after the 2011 Oslo bombing attack was investigated in the present study. A high degree of perceived centrality was associated with higher symptom levels of posttraumatic stress as shown in the results. This association was found after controlling for gender, age and educational background. The relationship between types and level of trauma exposure, peritraumatic reactions and centrality of event was also investigated in the present study. Higher levels of trauma exposure and peritraumatic reactions were associated with higher levels of centrality of event as shown in the results. When a traumatic event becomes a reference point in the individual's life story and central to their identity, this is associated with an increased risk of symptomatology as suggested in the findings. Copyright © 2013 John Wiley &amp; Sons, Ltd.

Anders Breivik and the Death of Free Speech in Norway

On July 22, 2011, Anders Breivik detonated a bomb in Oslo and massacred dozens of teenagers at a Labour Party Youth camp on the island of Utoya. Nearly all the media coverage of Breivik focused on the conservative political views outlined in his Manifesto. The week of the massacre, The New York Times ran a series of editorials which identified Breivik as a part of the counterjihad movement represented by Pete King, Bruce Bawer, Geert Wilders, Newt Gingrich, and Robert Spencer. In Norway, the Norwegian media was quick to blame Siv Jensen of the conservative Progress Party for creating the “climate of hate” which produced Breivik. In the wake of the murders, prominent Norwegian intellectuals began calling for a rejection of American “free speech absolutism” in favor of vigorously enforcing an “anti-racism” clause in Norway’s penal code which criminalizes threatening or insulting speech, or speech that incites contempt for anyone because of his or her skin color, religion, or sexual orientation. However, this would contribute little to public safety in Norway; instead it would stifle the kind of vigorous debate about social issues that one would expect to find in an open society. It would also demoralize moderate Muslims who are working to promote free speech and democratic pluralism in Muslim-majority countries.

Peripheral Response

This paper presents a case study of microblogging during the Norway attacks on 22 July, 2011, during which a single person first detonated a bomb in Oslo, killing eight people, and then shot 69 young people on the island of Utøya. It proposes a novel way of conceptualizing the public contribution to mobilization of resources through microblogging, particularly tweeting, as a form of ‘peripheral response’. By examining the distributed efforts of responding to the crisis in relation to emergent forms of agile and dialogic emergency response, the paper also revisits the concept of situation awareness and reflects upon the dynamic and constantly changing environment that social media and crises inhabit together.