Digital Terror: Its Striking Impact on Public Mental Health

As technology advances and is assimilated into daily life, it presents both new opportunities and challenges for fostering public mental health, often in ways that are not predictable. Recently, a new type of challenge arose. During conflicts in the Middle East, digital media was used to spread violent images of acts of terror intended to inflict severe physical and social harm. The use of digital media represents a new form of previously unimaginable “digital terror,” affecting public mental health. Of note, this column was written by Israeli scientists. We acknowledge the suffering of innocent citizens during this war, including of the Palestinians in Gaza.

Digital terror refers to the use of digital technology—most commonly computers, smartphones, and cameras—to rapidly and widely disseminate images of acts of terror. Such terror aims to spread fear and to intimidate, coerce, humiliate, or manipulate the public for political or ideological purposes. Although the purposeful spreading of terror via digital means may have been first used by ISIS (the Islamic State of Iraq and Syria) and related groups, which, for example, posted videos of beheadings, the October 7, 2023, attack on Israel by the Hamas organization differed in scope and in the rapid and broad dissemination of videos with violent content through social media.

Shocking images, videos, and text exchanges captured by smartphones and video devices (e.g., dashcams and GoPro cameras) served as a significant source of publicly available information on the October 7 atrocities. These atrocities were recorded by the attackers and included images of civilians being massacred in their homes, attackers exulting as they killed unarmed individuals, beheadings, and bodies showing signs of rape or other sexual assaults (1–3). The online footage showed traumatic events as they unfolded in real time and, to our knowledge, represents the most extensively documented massacre in history (4).

We note that any armed conflict can evoke feelings of vulnerability and traumatization among victims of aggression and violence. The focus of this column is not on this known effect of war and violence but rather on the deliberate documentation and sharing of premeditated assaults on vulnerable individuals with the goal of public intimidation and humiliation. Because the phenomenon of digital terror is likely to recur, in this column, we attempt to understand this new form of terror, to consider what is unique about it, and to explore the nosological as well as public health implications.

What Makes Digital Terror Emotionally Devastating and Often Traumatic?

The effects of digital terror appear to stem from a confluence of factors. The first is the graphic nature of the documented violence. Studies of the effects of fictional imagery on individuals suggest that graphic images are more likely than nongraphic images to capture viewers’ attention, evoke more negative emotions, and produce greater physiological arousal. The vividness of these images may rely on including graphic sensory details such as blood and gore (5). Given that such graphic images may persist in a person’s mind in ways that are more disturbing and harder to eradicate than written descriptions of similar levels of violence, exposure to such images may lead to chronic and intense emotional distress. Viewing potentially traumatizing images can engender intrusive memories and flashbacks through the activation of areas of the brain linked to fear, visual imagery, and threat processing (6, 7).

Second, the rawness of the events that took place on October 7—and were documented in real time—violated the sense of safety that many Israeli civilians had previously felt, leading to persistent fear, anxiety, and hypervigilance. The lack of an apparent purpose by the attackers other than inflicting pain, suffering, and humiliation may present additional challenges to the processing and development of an understanding of what happened. Civilians, including women, children, infants, and elderly people, were not collateral damage in an armed conflict but rather the direct targets of brutality and torture. Documenting such acts of violence amplified feelings of vulnerability. The helplessness and loss of basic dignity resulting from experiences of violence and torture, including sexual assault, further contributed to the devastating impact of these acts of terror.

We note that the dissemination of images documenting incidents of intentional humiliation was not limited to one side of the conflict. Images were leaked to social media that grossly disrespected the dignity of presumed perpetrators (8), and Israel Defense Force soldiers shared photos and videos they had recorded of themselves “toying with lingerie found in Palestinian homes” (9). Regardless of any side in a conflict, the more such documentation is focused on direct aggression toward civilians for the purpose of inflicting pain, and the more such documentation vividly presents these acts being perpetrated against civilians in their homes (and sometimes even in their pajamas), the greater the potency of the traumatizing experience.

Finally, in the past, terrorists struck fear in the hearts of people primarily by committing destructive acts that became known to the public by word of mouth or through news outlets. In contrast, the October 7 attacks were intentionally recorded and then spread through social media as graphic imagery not typically shown in traditional news media. This broad dissemination was facilitated by the global use of smartphones and social media, such that many people were exposed to these images when communicating with friends and family. Often, these horrified and terrified individuals—as they grappled with the significance and meaning of the unfolding events—shared these images with others they knew, which, in turn, had a similarly distressing effect on those individuals. The high accessibility of information created a situation in which many people witnessed horrendous atrocities broadcast in real time. For many, viewing these images was a choice influenced by a perceived duty to understand what happened to their countrymen and -women, to bear witness, or as part of their duties in the army or health-related settings. Many others, however, viewed the images involuntarily through their normal ways of communicating with friends and families. This sudden, unexpected exposure to distress and violence could be even more traumatizing.

The digital dissemination of these terrorist acts was also carried out by the victims of the attacks (or by members of the society to which they belonged). In other words, digital terror may spread not only via its perpetrators but also via its victims. For terrorists, engaging in digital terror creates a win-win situation: they initially instill terror through their acts, and they then benefit further as these acts are also disseminated and amplified by the victims within the echo chamber of social media.

The sharing of such videos by the victims may have been driven by a desire to elicit support from others, to evoke similar feelings among others, to foster a sense of community united by a common grievance (“look what they did to us”), or to let others know what happened to a friend or loved one. However, this activity, while possibly accomplishing some of the victims’ goals, had the side effect of provoking feelings of horror, helplessness, and fear among viewers, some of whom may have been already vulnerable to feelings of distress and traumatization. In addition, some individuals are generally more susceptible to anxiety or depression, and some individuals, including children as well as those who are developmentally and cognitively challenged, inevitably struggle to process such distressing images.

Implications for Public Mental Health

The emergence of digital terror poses several mental health challenges that need to be identified and addressed. First, it has been acknowledged that individuals can be traumatized by indirect exposure to violent or disturbing events, that is, even without witnessing or experiencing them firsthand. However, the manifestations and extent of traumatic symptoms in the population exposed to violent imagery are not well understood, although some studies have reported a link between media exposure and trauma (7, 10). Moreover, in the face of digital terror, societies now confront the challenge of providing mental health support and services to a vast number of people who were exposed to horrific and painful graphic imagery. It is crucial to screen for various forms of distress in the population exposed to graphic violence on social media, which may lead to substance use (11), depression and anxiety (12), and posttraumatic stress disorder (PTSD).

Second, digital terror amplifies emotional harm when it is spread, thereby extending the impact of terror attacks. The dissemination of terror via digital technology not only causes psychological damage, including feelings of dread, helplessness, and vulnerability, but also humiliates the victims. Societies may counteract this scenario by preventing the spread of such information and protecting vulnerable populations from exposure. This task could be accomplished via psychoeducation of the public regarding the negative impact of digital terror and how to reduce it. Special emphasis should be given to parents, and safeguards to shield children from violent and emotionally upsetting images should be implemented. Soldiers should also be made aware that they may be exposed to potentially traumatic events. It is crucial to ensure that both active duty personnel and veterans are receiving guidance on how to seek support from families, friends, and mental health services.

Third, researchers and clinicians should evaluate interventions for individuals affected by exposure to digital terror and who experience distress or PTSD symptoms; such interventions could include cognitive-behavioral therapy and its variants (e.g., cognitive restructuring, cognitive processing, and exposure and prolonged exposure therapy), all of which aim to mitigate the impact of trauma. Identifying the most traumatizing aspects of images depicting terror acts and posted on social media and recognizing their impact on core beliefs about oneself, others, and the future are essential to prevent or alleviate the effects of trauma. Furthermore, clinicians need to help individuals who experience emotional distress after exposure to traumatic events to process, identify, and challenge exaggerated responses and construct personal narratives that can accommodate the realities of hatred and violence.

Finally, clinicians and researchers need to find ways to assist those most affected by digital terror in maintaining their faith in humanity. During the October 7 disaster, numerous acts of bravery and altruism also occurred. Highlighting these positive actions may help counterbalance the negative impacts of this new form of terror.

Conclusions

Incidents of modern-day collective trauma are increasing and complex because social media exposes many people to graphic information depicting war and conflict involving death, bodily injury, and loss of dignity. Exposure to graphic imagery is becoming an important aspect of modern warfare, which calls attention to the need for efforts to minimize exposure to such images and footage, primarily among vulnerable populations (e.g., children). Research addressing the impact of such exposure on public health has just begun (8). Understanding the mechanisms of vulnerability and resilience in light of the public health impact of violent imagery disseminated via social media will assist in developing timely, efficient, and accessible interventions.