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]

Overview

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.

Psychotherapy

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. 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