Bill Gentile and Patrick Hamilton made a decision in the 1980s that could have killed them. The photojournalists were covering the Contra war in isolated Nicaraguan mountains for Newsweek and the Associated Press, respectively, when they came upon a young man bleeding to death after being shot in a firefight. "The decision was either to continue on our way, or to take this kid where he could get real help," says Gentile, now an independent journalist and documentary filmmaker in Washington, D.C.

They chose to help, despite the risk that one of the soldier's opponents would kill them all if they were caught "aiding and abetting" on their way to the nearest hospital — a three-hour dirt road drive away, Gentile says. As a journalist whose professional role is to document, but not intervene, on such an assignment, "You really have to be [prepared] to accept the consequences of the decision, no matter what the consequences are," he says. Fortunately, in this case, the three made it to safety.

Most reporters don't confront such stark life-and-death situations. But many face ethical and professional decisions that have physical and mental health implications for both themselves and their subjects. For example, how should a journalist approach a survivor of a school shooting? Will news coverage of a crime victim help the family heal or deepen its pain? And, how will covering the aftermath of a natural disaster affect a reporter's own mental health?

Offering evidence-based guidance to answer such questions is the mission of the Dart Center for Journalism and Trauma, a project of Columbia University's Graduate School of Journalism that provides tip sheets, seminars and other resources to newsrooms and reporters. Its research program is run out of the University of Tulsa psychology department by psychology professor and trauma expert Elana Newman, PhD, who oversees research on audiences' responses to coverage of trauma, the occupational health of journalists and more.

Bruce Shapiro, the center's executive director and a longtime human rights reporter, says it's the authority of the Dart Center's research that makes it a trustworthy source among journalists — a notoriously skeptical audience.

"We can help journalists report more effectively on veterans because we can read the scientific papers on vets and know what they mean. We can help news organizations make better decisions when covering a crisis like Newtown because we understand the impact of traumatic events on children and families," he says. "News choices become informed by research, and that's an extraordinary thing."

Understanding victims

Fifteen years ago, most reporters who covered disasters and violent crimes knew little about psychological trauma. "It just wasn't on the radar," says Shapiro, a contributing editor at The Nation and U.S. correspondent for an Australian public radio show.

But then came the 9/11 terrorist attacks in 2001, Hurricane Katrina in 2005 and the ongoing wars in Iraq and Afghanistan. Launched in 1999 at the University of Washington as a loose network aimed at educating journalists, the Dart Center — named for its funder, the Dart Foundation — was poised to help. It set up a temporary site at ground zero in New York City in response to 9/11, established permanent outposts in Europe and Australia, and has since held programs in 25 nations. In 2009, the center moved to Columbia University. "We were well-positioned when these catastrophes transpired to be helpful to journalists who were looking for advice — both on how to cover great loss and great violence, and how to take care of themselves better," Shapiro says.

For example, one of the center's main goals is to help journalists better understand their subjects, says Newman, who has studied post-traumatic stress disorder, trauma and violence for nearly 20 years. "Many [journalists] are trained in techniques that are helpful to get information from people in power, but less in how to talk to people who have no power," she says.

To fill that gap, the center's resources advise journalists to build trust with their subjects and not to overwhelm them with the most difficult questions first. The center's guide to covering tragedy suggests reporters say, "I am sorry for your loss," rather than "I understand," since the latter is rarely true and can minimize the victim's suffering. And, Newman says, an interviewer should consider the power differential between a reporter and a trauma survivor, who might be experiencing symptoms of post-traumatic stress disorder, such as anxiety or a sense of loss of control.

The center also encourages journalists to rethink some standard journalism practices in some cases. For instance, news organizations rarely allow subjects to read articles before publication — a practice that makes sense when reporting on a politician's embezzlement, for example. But Newman suggests considering making exceptions when profiling a victim such as a rape survivor, whose feelings of helplessness might deepen if she hears about the story from a neighbor before reading it herself. "Telling a story can be helpful. It's not always bad, it can bring resources, it can make [subjects] feel valued," she says. "But journalistic practice should be trauma-informed."

For journalists, such knowledge can shape the way they approach a story. "Over the years, without even thinking about it, I covered a large number of tragic events," says Shapiro, whose first story as a student involved a young woman who was killed in her Chicago apartment. Today, he says, "I'm much more aware of the necessity of creating opportunities for my interview subjects to control their own narrative."

Media as first responders

The Dart Center, which maintains a database of research worldwide on the intersection of journalism and trauma, also aims to promote journalists' own mental health. Various studies, including those by Newman, have pinned rates of PTSD among journalists anywhere from less than 6 percent among photojournalists to more than 28.6 percent among war correspondents. Researchers now understand that journalists are vulnerable to the same "secondary trauma" once ascribed only to first responders and police officers, Newman says. Research has continued to show that that the more journalists are exposed to trauma on the job, the more likely they are to experience symptoms of PTSD. Guilt can weigh heavily on them, too, one study by Tess Browne, PhD, and colleagues at the University of London found (Journal of Traumatic Stress, 2012).

"One of the things we do when we train clinical psychology students, in order to be more objective, is teach them how to monitor and process their own emotions to set them aside," Newman says. "And until recently, journalists were told that the way to be objective was to ignore their emotions."

To help change that, the Dart Center partners with psychologists and other mental health experts who train reporters and editors in newsrooms and news associations around the world to confront tragedy — and to recover when they come home. Newman, for example, addresses PTSD, trauma literacy and some brain research in her workshops. The center's resources also encourage journalists to know their limits, take breaks and relieve stress in healthy ways such as by exercising, deep-breathing or spending time with friends and family. And, of course, seeing a therapist if necessary.

Gentile, the photojournalist, says he could have benefited from such training. "It would have been great if I had a bit more context to give me a broader understanding of what happens to people when they go into situations of profound violence," he says. "It probably would have helped me cope a little bit better."

Instead, Gentile learned on the job how to protect his emotional and psychological integrity by confiding in colleagues. "Like so many others, I just kind of made up the rules as I moved," he says. "That has changed now with organizations like the Dart Center."

The good news is that most journalists — and victims — come away from tough situations even stronger, Newman says. One survey of television newsroom employees led by Anke Weidmann, PhD, of Humboldt University of Berlin, for example, found that while 80 percent had recurring intrusive memories, their overall PTSD symptoms were low. It was those who experienced prior, non-work-related trauma, more general stress and more exposure to video footage of violent events who were most likely to show more severe symptoms (The Journal of Nervous and Mental Disease, 2010).

"PTSD is an occupational hazard [for journalists], but not much more than the average population," Newman says. "They may in fact be more resilient."

Visit the Dart Center's website.