Incidents of violence against Black people have made it into the therapy sessions Charlotte Andrews holds in Elkins Park — no matter where they’d happened in the nation.

“I noticed that there’s a significant amount of anxiety, fear, anger,” said the therapist, recalling the emotions Black patients expressed after police killings, such as the murder of George Floyd in Minneapolis. “People bring it with them. People are carrying it with them.”

When an entire community is targeted, the fear and trauma mount.

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On Saturday, a white 18-year-old man entered a supermarket in Buffalo and opened fire, killing 10 people and wounding three. Eleven of the victims were Black. Authorities said Payton Gendron drove about 200 miles from his hometown of Conklin, N.Y., to target a Tops Friendly Markets in a predominantly Black neighborhood. He livestreamed the massacre and left behind a 180-page manifesto that includes references to Great Replacement Theory and other white-supremacist ideologies.

The FBI is investigating the mass shooting “as a hate crime and an act of racially-motivated violent extremism.”

“That’s the fear — that we are not done,” said Andrews, who is also the clinical coordinator and supervisor of Black Men Heal, a Philly-area mental health nonprofit providing services to men of color in eight states. “This can happen anywhere, and it can happen any time. That’s what I see showing up in therapy.”

Researchers have documented the impact of violent events on mental well-being of entire communities. A 2018 study in the Lancet found that a police killing of an unarmed Black person increases the number of days the mental health of Black people suffers across the state. White people did not report similar distress. A more recent study in the Proceedings of the National Academy of Sciences found that when there is more than one incident in a week that is perceived as anti-Black violence and garners national interest, Black Americans report a decline in mental health, while white Americans do not.

Alexander Tsai, psychiatrist at Boston’s Massachusetts General Hospital and an associate professor of psychiatry at the Harvard Medical School, coauthored the 2018 study on police shootings. He said there is a growing body of evidence that violent incidents harm the mental health of entire communities — and that the effect could be far reaching. “Whenever stories are covered much more widely, like in the case of this Buffalo shooting, I would imagine that the impact will also reverberate more widely,” he said.

The news of the Saturday shooting traveled far, as did the imagery.

Even though the shooter’s livestream was shut down within two minutes of the violence, according to the Amazon-owned streaming platform Twitch, clips from the event circulated online.

Bruce Nash, who is 38 and from North Philadelphia, saw video from the shooting and felt re-traumatized. “I seen a person laying on the ground, and it took me back to 2017, when I got shot eight times,” he recalled. “As I tried to run off, I ended up tripping over a bike, and I landed on the ground and the shooter stood over me and shot.”

» READ MORE: HEALING SCARS: After he was shot eight times, Bruce Nash fought for a second chance at life.

For Nash, like many of the thousands of other gun violence survivors in Philadelphia, the trauma is daily — but events like the mass shooting in Buffalo bring the injury to the front. The exposure to such violent racism also adds pain. “Ten Black people, you know, it’s hurtful,” Nash said referring to the number of deceased victims.

The day after the Buffalo mass shooting, a gunman opened fire in a Taiwanese congregation in Laguna Woods, Calif., killing one and wounding five in what the Orange County sheriff described as a politically motivated hate incident.

“Right now we are in a tailspin around traumatizing events,” said Brenda Shelton-Dunston, the executive director of Black Women’s Health Alliance, a nonprofit that provides health and wellness services to women of color.

Her organization has been expanding its mental health offerings in recent years. It is preparing to have conversations about the violent incidents in their programs and to support the women they serve. “We have to do what we can to provide nonjudgmental spaces,” Shelton-Dunston said.

Nash said that therapy helped him cope with his trauma — with the nightmares, the heart palpitations, the feeling that he could be shot again at any moment.

“At the end of the day, you can’t hide the feelings and the emotions and the trauma that your body and mind is going to face,” he said. “You gotta go to therapy because you’re gonna have to talk to somebody.”

Black Men Heal is preparing to provide mental health services to the family members of the victims from Buffalo, Andrews said. Here and across the country, she is concerned about the impact that blatant display of racism could have on the self-image of young Black boys and men.

“Where do you start that conversation of really being able to tell them that ‘you deserve to live and you shouldn’t be penalized for being Black’? I don’t have the answer, unfortunately,” she said. “I wish I did.”