Acute stress disorder psychotherapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]


The optimal therapy for acute stress disorder includes cognitive-behavioral therapy and pharmacotherapy. The mainstay of therapy for acute stress disorder is cognitive-behavioral therapy.[1][2][3][4][5][6]


Research has found that, whereas approximately 70% of those receiving no therapy or supportive therapy after a traumatic event develop PTSD, only 10-20% of those who receive cognitive-behavioral therapy (CBT) shortly after such an event develop PTSD. Patients who receive CBT with or without hypnosis report fewer avoidance and less reexperiencing symptoms than patients who receive supportive counseling. According to the current data, it is suggested that if the resources are available, a course of CBT should be offered to those at high risk for developing PTSD.[1][2][3][4][5][6] The steps taken in cognitive-behavioral therapy are shown below in a tabular form:

Steps taken in Cognitive-behavioral therapy to help patients with ASD Features
Step 1

Seeing that people are concerned about them

Step 2

Learning about the range of normal responses to trauma and hearing that their emotional reactions are normal responses to an abnormal event

Step 3

Being reminded to take care of concrete needs such as food, fluids, and rest

Step 4

Cognitive restructuring (eg, changing destructive schema to more constructive ones)

Step 5

Learning relaxation techniques

Step 6

Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo

Step 7

Desensitization to painful memories via repeated controlled exposures and systematic desensitization

  • For children having acute stress disorder, brief school intervention is given. A brief school intervention lasts approximately 1-2 hours and uses 4 therapists per class. Parents are informed of the intervention, and a teacher is present.

The steps taken in cognitive-behavioral therapy are shown below in a tabular form:

Steps taken in brief school intervention Features
Step 1

Introduce the therapists, and ask students to guess why they have come to the classroom

Step 2

Explain that therapists have come to talk about the disaster, and encourage students to share what they know for 10-30 minutes; validate correct information, and be calm

Step 3

Have children draw while therapists circulate, and ask students to tell them about their drawings

Step 4

Reassure students that their symptoms are normal and will ease; that people have different symptoms; that disasters are rare; and that teachers, parents, and counselors are available to help them

Step 5

Having students do a second drawing in which they depict a future and a positive state of the world is very important; the first picture is likely to focus on the trauma, their loss, and its effect on them; ideally, the second picture should show healing and restoration of normal life

Step 6

Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo

Step 7

Thank the students and the teachers, and redirect their attention to learning


  1. 1.0 1.1 Bryant RA, Harvey AG, Dang ST, Sackville T, Basten C (1998). "Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling". J Consult Clin Psychol. 66 (5): 862–6. PMID 9803707.
  2. 2.0 2.1 Bryant RA, Moulds ML, Guthrie RM, Nixon RD (2005). "The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder". J Consult Clin Psychol. 73 (2): 334–40. doi:10.1037/0022-006X.73.2.334. PMID 15796641. Review in: Evid Based Ment Health. 2005 Nov;8(4):109
  3. 3.0 3.1 Bryant RA, Moulds ML, Nixon RD, Mastrodomenico J, Felmingham K, Hopwood S (2006). "Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up". Behav Res Ther. 44 (9): 1331–5. doi:10.1016/j.brat.2005.04.007. PMID 16368074.
  4. 4.0 4.1 Bryant RA, Moulds ML, Nixon RV (2003). "Cognitive behaviour therapy of acute stress disorder: a four-year follow-up". Behav Res Ther. 41 (4): 489–94. PMID 12643970.
  5. 5.0 5.1 Foa EB, Hearst-Ikeda D, Perry KJ (1995). "Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims". J Consult Clin Psychol. 63 (6): 948–55. PMID 8543717.
  6. 6.0 6.1 Scheeringa MS (2007). "CBT treatment of PTSD within the first month". Am J Psychiatry. 164 (8): 1267, author reply 1267-8. doi:10.1176/appi.ajp.2007.07030406r. PMID 17671292.