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Nicole O'Neil was standing about 150 feet from where the second bomb detonated at last year's Boston Marathon. She wasn't physically injured, but, nearly one year later, the 34-year-old Charlestown photographer says she hasn't fully recovered.
Once-routine things still trigger anxiety attacks, flashbacks and waves of overwhelming emotion. At a Bon Jovi concert in July, O'Neil says she went into "full panic" when the Gillette Stadium crowd roared and the lights went out. Summoned for jury selection recently, she was overcome by an anxiety attack that left her shaking and crying on a courtroom bench before she was excused.
She's among hundreds of people who have taken advantage of a range of programs offered - free of charge - at Boston-area hospitals for those affected by last year's bombings, which killed three people and injured more than 260 on April 15, 2013.
"Sometimes it's just this feeling in my chest, where my heart is beating fast," she said. "But other times it's so intense it can feel like I'm dying. I can't catch my breath and my body goes numb and it's hard to pull out of it. It's completely exhausting."
It wasn't always this way. O'Neil says she wasn't much of a crier before. She never suffered from anxiety or panic attacks. She was comfortable in social situations. "I'm more afraid now than I ever was before," O'Neil says. "I was a completely different person a year ago."
O'Neil spent a few months in private counseling before finding the support groups, individual therapy and other mental health services at Beth Israel Deaconess Medical Center.
Some of those services were covered through an initiative funded in part by the state's Office for Victim Assistance. The city is also offering free counseling sessions, both in person and over the phone, to help residents cope with the anniversary.
Cynthia Kennedy, a clinician at Beth Israel, says the significant psychological trauma suffered by those in the vicinity of the twin blasts is too often overlooked. Part of the problem, mental health professionals suggest, is how the public and media interpret "Boston Strong," the phrase that became the city's rallying cry after the bombings.
"Some people are not feeling justified with their own struggles, or they are feeling guilty with their reaction," Kennedy said. "It leaves people feeling like, `What is wrong with me? Why can't I just get over it?"'
O'Neil says she started participating in programs at Beth Israel in August. But she became frustrated at what she felt was a lack of progress early on. Over the holidays, she took a break from the programs.
"It's isolating. Even the people closest to you don't understand it. That you don't really have control over it," O'Neil said.
Kennedy says O'Neil's experience is typical. Support group members at Beth Israel, who range from marathon runners to first responders, volunteers and bystanders, report having trouble adjusting to public settings, being in large crowds and riding public transit.
Kennedy says the support groups help people understand that these reactions are normal after traumatic events.
In February, O'Neil resumed her individual counseling sessions at the hospital and started taking part in a Buddhist meditation group, also provided by Beth Israel. She knows it will be a gradual process.
"Those of us there that day have a new reality," O'Neil says. "A year ago, if someone asked me what the chances were that I would witness a terrorist attack, I would have said the chance was slim. Now I've been that statistic."
As the bombing anniversary and next marathon near, mental health professionals say their programs have shifted focus to how people will handle those two critical milestones.
Kennedy says support group members are considering a variety of approaches. Some will attend the race. Others will be far away from Boston. Still others, she said, have talked about doing something locally as a group, like bowling.
O'Neil says her plans are still up in the air. She's determined to attend a public ceremony marking the bombing anniversary. The actual marathon on April 21 is another matter.
"I feel torn. I want so badly to be there. ... The marathon is an important day for me. I have always loved it," O'Neil says. "I worry the crowd and all of the aspects of the race could trigger anxiety and flashbacks that will make it difficult."
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