The Vegas Strong Resiliency Center offers counseling to those who experienced the attack, including police, at a time of year when losses feel particularly acute

A survivor of the Las Vegas mass shooting went Christmas shopping recently, hoping to forget – if just briefly – the night when bullets rained down on an outdoor concert, killing 58 in the crowd and injuring scores, including one who died next to her.

Shopping for presents made her feel worse, though.

“She felt guilty for pretending that everything was normal when it really wasn’t,” said Amy Ream, a counselor at the Vegas Strong Resiliency Center, which provides therapy and other services for people affected by the 1 October attack. “It’s survivor’s guilt: ‘How could I be celebrating when this person’s family is not?’”

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Las Vegas therapists are seeing a surge in new clients this season; many attendees and staff of the Route 91 country music festival, casino workers, first responders, and people who lost loved ones that night are seeking help for the first time.

Coming nine weeks after the deadliest mass shooting in modern US history, Christmas is coinciding for many of them with symptoms of pent-up trauma such as flashbacks, nightmares, anxiety and intense emotions.

The festive holiday mood is also making many survivors feel out of sync. “Some people feel lost, because they want to be there for the rest of their family yet are suffering inside,” said Ream. “I have some clients who don’t want to celebrate the holidays, period. They just want to forget this year.”

The Vegas Strong Resiliency Center is decorated with handmade cards sent by San Bernardino and Orlando shooting survivors – messages like “We are with you Las Vegas” – as well as photos of candlelight vigils. A Clark County government initiative, the center holds group therapy sessions and provides tips on social media for coping with the holidays.

To prepare for this season, national mental health organizations offered Las Vegas counselors free training in the nuances of trauma therapy.

Facebook Twitter Pinterest Amy Ream: ‘I have some clients who don’t want to celebrate the holidays, period.’ Photograph: Dan Hernandez

“We all knew the initial reaction was great, but we had to be prepared to support all these people that were going to come in in December, January and February,” said Dan Ficalora, of Bridge Counseling Associates. “Trauma takes one to two months to settle in and you have to handle these clients in a way that’s not hurtful, detaching the negative emotion from the experience so you can talk about it. This takes knowledge of how to de-escalate and train the client in relaxation.”

He recommends that people with post-traumatic stress remember that they’re safe now, that it’s OK to talk about what happened, and that getting through social outings 15 minutes at a time is an adequate goal. Avoiding the Las Vegas strip on New Year’s Eve, where fireworks will pop overhead, is also advised.

But for people who have lost someone, it’s holiday traditions that are painful, and Ficalora suggests that they plan something new that both respects the past and looks forward. That may be an act of homage to the person they lost; leaving an empty seat at the table can be cathartic, he said. Going out to do charity work or taking a trip are other possibilities.

Once the holidays are over, he and other Las Vegas counselors expect a spike in need regarding substance abuse. First responders, in particular, have been asked to look out for each other.

“In the past they’ve turned a blind eye to knocking back a couple extra beers,” said Las Vegas police chaplain Russ Goodrum. “Now they’re trying to bring pressure to care about one another’s struggles.”

The thought that at any given moment another act of violence could occur – and the fear that it’s impossible to protect yourself – was causing even cops to feel unsafe, Goodrum said. “These [attacks] keep rolling, whether it’s in America or Europe or other places, and now that they’re using trucks and weapons of various kinds, looking for crowds and people en masse, there really isn’t a place where you can relax.”

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There was also a sense among some in law enforcement, he said, that they had failed their neighbors.

“The vest will protect you from bullets,” Goodrum tells them, “but it’s the negative energy, it’s the fear, it’s the hostility, it’s the pent-up anger, it’s a lot of that out there that can bring you down.

“We’re trying to make ourselves available to them for support and to remind them that it’s a lifelong process of protecting themselves, their relationships, their mental processes.”

Some Route 91 shooting survivors have organized gatherings or charity events among themselves to counter these effects. “Finding that sense of belonging, and a sphere of influence to have an impact on after a trauma, can be really empowering to your recovery,” Ficalora said.

“Las Vegas gets flak both externally and internally that there’s no community here,” he added. “But if anything, what happened in October showed that there really is a deep core of community here … Sometimes it takes a very terrible event to brush off the dust and show that that’s there.”