For some of the students who lived through the Virginia Tech tragedy, the fact that they survived the attack by fellow student Cho Seung-Hui could haunt them as much as the sickening sounds of gunfire and chaos that gripped the Blacksburg campus Monday morning. Mental-health counselors who are helping students, faculty and families deal with the trauma of the worst shooting spree in U.S. history said the fear and underlying guilt about the killings are just a couple of the issues they expect to see in the days and weeks ahead.

"We've had a number of calls from people who have survivor's remorse, where they feel guilty for having lived through this and have so many not live through it," said Leigh Frazier, the director of clinical services for Virginia's Lewis-Gale Center for Behavioral Health, which has set up a hotline for victims and other students who need counseling. "You also have students not knowing what's going to happen next. You're two weeks from the end of the session, so they are worried about graduation, or even their professors who were killed and how will their classes end?"

(Read [article id="1557356"]"On Virginia Tech Campus: 'I Can't Believe This Happened Here' "[/article], [article id="1557266"]"Virtual Memorial, MySpace Pages Help VT Mourners Cope Online"[/article] and [article id="1557235"]"Gunshots 'Sounded Like A Hammer': Virginia Tech Students Speak About Shootings"[/article] for student reactions, reports and more.)

Frazier said the center has also gotten calls from students who are now afraid that something like this could happen anywhere, or who've suffered previous traumas that they are reliving as a result of the shock of Monday's shootings (see [article id="1557332"]"Virginia Tech Gunman Was 23-Year-Old Student"[/article]). "One person who called was an EMT who responded to the scene who was also in Hurricane Katrina and he said this was much worse," Frazier said. "Because this was not an act of nature, it was another person who did this to human beings."

In general, Frazier said callers are talking about being frightened, anxious or nervous about their personal safety, with the mental-health professionals taking the calls focusing on assessing how those feelings are impacting that person now. For those who are having a hard time with their daily routine, the specialists are suggesting the callers get additional in-person counseling and, if they have one, go see their therapist. "We just try to tell them that these feelings are normal, but to be proactive and address them now in the midst of the crisis," she said. "Because you want to deal with this now, not in six months when you might get more depressed about it."

On a series of eight boards erected on the campus' Drillfield for a candlelight vigil to be held Tuesday night (April 17), students have been scrolling messages in black marker to their fallen friends. "We will overcome evil with good," reads one message. "We will prevail."

"Though I never met you, I feel that I knew you and will never forget you," reads another. "You are in Hokie heaven."

But as they grieve, many students -- like sophomore Sarah McAlum -- are also angered by the media's portrayal of the college. Several news reports have suggested students don't feel safe at Virginia Tech or intend to leave the school, but the majority of students MTV News spoke with said that simply wasn't the case.

"The media's angling to get students to say they don't feel safe, but everyone is standing behind the school," said McAlum, a 20-year-old finance major. "I'm so sick of seeing reporters on TV, swaying their stories like that."

For McAlum, the horror of Monday's events hasn't fully sunken in yet -- but that, she said, will all change once "the list comes out of all the students who were killed. When we see their faces, and hear their stories, their majors, it will be a lot harder to deal with. You'll feel a connection with them, and feel their loss."

One of McAlum's friends, she said, was expected in class in Norris Hall on Monday morning, in one of the classrooms targeted by Cho. The friend chose to sleep in instead, only to realize later that he might have been among the victims had he gone to class. "He sat next to these people who died, and that freaked him out a bit," she said.

With state police stationed across campus, one student, named Joe, froze at the sound of a police siren, as the patrol car raced passed. He was stunned and shaken for a minute. "You know, I've just stopped watching the news," he said. "You have to, if you want to stay sane."

The killings reverberated across the nation, as students at universities as far away as California sought counseling and their anxious parents looked for reassurance that their children's campuses were safe from this kind of horror. The Los Angeles Times reported that students from the University of California, Santa Barbara, to Georgetown University in Washington, D.C., gathered Monday evening for candlelight vigils and prayer services.

Parents called their children to say they loved them, but they also called school administrators in the UC system to ask officials about security measures on campuses and they called each other to share their emotions. "There's outrage, there's fear, there's concern by most of the people I've communicated with that this has happened," Brian Forb, the father of a freshman at New York University, told the Times. Forb shared his concerns via e-mail with about a half-dozen friends who also have children at college. He described the running theme as "a feeling of not being safe, and that children are not safe, and that people have access to these kinds of weapons."

Officials at George Washington University in D.C. attempted to reassure students as well, sending out an e-mail informing them that "GW's University Police Department is on heightened alert. Students, faculty, and staff are asked to exercise appropriate caution and report any suspicious action to University Police."

The most difficult issues survivors and families of the slain will likely have to navigate are the problems of trauma, bereavement and fear, according to David Schonfeld, a pediatrician and director of the National Center for School Crisis and Bereavement in Cincinnati.

"There is the trauma of the actual event, then there is the anxiety about it possibly happening again and the loss of those they care about," Schonfeld said. "You could have individuals walking somewhere and they see someone out of the corner of their eye and they are suddenly concerned about that, or they're startled by loud noises, have trouble sleeping or concentrating. And because of the number of people who died, people who lost someone they care about will have bereavement issues, even if they were out of the country or not on campus at the time."

Schonfeld said that support for bereavement is different from that for trauma, with trauma support focused on trying to help a victim deal with what just happened, while bereavement treatment aims to help deal with living the rest of your life without the person you care about. He said a lesson he learned while helping schoolchildren deal with the loss of a parent following 9/11 is that both kinds of support are equally important.

"The fact that the shootings occurred on a college campus also complicates things emotionally," Schonfeld said. "You have young adults embarking on their first taste of real independence and separated from their parents and close friends they had through childhood, and while they form strong ties with some individuals in college, it may be difficult to find that long-term support system. The strength is that they have a common shared experience and they will be surrounded by other young adults who understand and appreciate the loss on a personal level."

The same goes for the surrounding city of Blacksburg, where thousands of citizens will likely have to confront memories of the shootings on a daily basis for years to come, if not for the rest of their lives.

With the shootings coming near the end of the school year, Schonfeld said, students leaving campus for the summer might also face an uncomfortable notoriety when they go home, where they might not have a network of people around them who understand the experience.

The best thing friends and family can do to assist all these potential issues is to simply to re-establish open communication and let the victims know that you know what happened to them and that you're available and interested in helping them. "You have to invite them to talk about it," Schonfeld said. "But you have to realize that it is an invitation and then wait for that invitation to be accepted. Be there to listen and let them know you care."

Schonfeld encouraged those affected by the shootings to visit his organization's Web site for a primer on dealing with bereavement.

Just hours after the shootings, a variety of services were made available to victims, students and families affected by the incident. In the Blacksburg area around the university, they include:

· A public convocation for the Virginia Tech community at Cassell Coliseum on campus at 2 p.m. Tuesday featuring a speech by President George Bush

· A candlelight vigil at 8 p.m. Tuesday on the Virginia Tech campus that is expected to draw up to 40,000 people

· A support group for families who have lost a child, Compassionate Friends of Roanoke Valley, is offering counseling services. Call (540) 231-8639 during the day or (540) 387-3081 at night, or visit TheCompassionateFriends.org.

· Grief counseling for students, faculty and staff at the Inn at Virginia Tech: (540) 231-8000 or (877) 200-3360

· A toll-free information hotline for parents and family has been set up by the university: (800) 533-1144

· The American Psychological Society (APA.org) has tips on talking to children about school shootings, as well as managing stress after trauma and a link to more resources

· Grief counseling for Virginia Tech students by phone at Cook Counseling Center: (540) 231-6557 or (540) 231-6444

· New River Valley Community Services Board emergency hotline: (540) 961-8400

· Lewis-Gale Center for Behavioral Health/RESPOND crisis hotline: (540) 776-1100 or (800) 541-9992

· CrisisLink: (703) 527-4077 or (800) 273-8255

· Fairfax/Falls Church Community Services Board, Woodburn Mental Health Center: (703) 573-5679

· Action in the Community Through Service Helpline: (703) 368-4141

· National Suicide Prevention Hotline: (800) 784-2433

· Parents are advised to call (540) 231-3787 for additional assistance

Around 81 percent of school attackers tell someone of their plans beforehand. If someone mentions or threatens to use violence against you or anyone else, don't be afraid to speak up. You can contact a parent, school administrator or law-enforcement agent for advice, or if you would like to take action anonymously, you can call Speak Up at (866) SPEAK-UP (866-773-2587). Speak Up is a national toll-free hotline for students to report threats of violence at school and feature both English- and Spanish-speaking operators. After talking with you, they can work with your school and local officials to evaluate the situation and act accordingly on the potential threat. Go here for more information on this service.

When faced with such a tragic and inexplicable situation like this, often times the best thing to do is to talk it over with friends and mentors. We've all spent many years of our life in schools which is why the horrible events at Virginia Tech can really strike a nerve. Remember, you are not alone in any concerns you might have. Contact your guidance counselor, teacher or school principal if you feel like talking about how the incident has affected you and your school. You may also want to find out what your school has in place if something like this were to happen in your community. If there isn't a plan in place, then you can help them develop one. Pax (PaxUSA.org) is a national organization that helps set up these programs in schools and works with students, administrators and local law enforcement. They can assist you develop a plan on your school's campus.

[This story was originally published at 2:31 p.m. ET on 04.17.2007.]

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