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==Overview==
==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.<ref name="pmid9803707">{{cite journal| author=Bryant RA, Harvey AG, Dang ST, Sackville T, Basten C| title=Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. | journal=J Consult Clin Psychol | year= 1998 | volume= 66 | issue= 5 | pages= 862-6 | pmid=9803707 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9803707  }} </ref><ref name="pmid15796641">{{cite journal| author=Bryant RA, Moulds ML, Guthrie RM, Nixon RD| title=The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. | journal=J Consult Clin Psychol | year= 2005 | volume= 73 | issue= 2 | pages= 334-40 | pmid=15796641 | doi=10.1037/0022-006X.73.2.334 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15796641  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16246885 Review in: Evid Based Ment Health. 2005 Nov;8(4):109] </ref><ref name="pmid16368074">{{cite journal| author=Bryant RA, Moulds ML, Nixon RD, Mastrodomenico J, Felmingham K, Hopwood S| title=Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up. | journal=Behav Res Ther | year= 2006 | volume= 44 | issue= 9 | pages= 1331-5 | pmid=16368074 | doi=10.1016/j.brat.2005.04.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16368074  }} </ref><ref name="pmid12643970">{{cite journal| author=Bryant RA, Moulds ML, Nixon RV| title=Cognitive behaviour therapy of acute stress disorder: a four-year follow-up. | journal=Behav Res Ther | year= 2003 | volume= 41 | issue= 4 | pages= 489-94 | pmid=12643970 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12643970  }} </ref><ref name="pmid8543717">{{cite journal| author=Foa EB, Hearst-Ikeda D, Perry KJ| title=Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. | journal=J Consult Clin Psychol | year= 1995 | volume= 63 | issue= 6 | pages= 948-55 | pmid=8543717 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8543717  }} </ref><ref name="pmid17671292">{{cite journal| author=Scheeringa MS| title=CBT treatment of PTSD within the first month. | journal=Am J Psychiatry | year= 2007 | volume= 164 | issue= 8 | pages= 1267; author reply 1267-8 | pmid=17671292 | doi=10.1176/appi.ajp.2007.07030406r | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17671292  }} </ref>
==Psychotherapy==
==Psychotherapy==
It is essential for caregivers to remain available and not to allow a grieving person to become isolated. The following are helpful for adults who are grieving:
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]].<ref name="pmid9803707">{{cite journal| author=Bryant RA, Harvey AG, Dang ST, Sackville T, Basten C| title=Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. | journal=J Consult Clin Psychol | year= 1998 | volume= 66 | issue= 5 | pages= 862-6 | pmid=9803707 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9803707  }} </ref><ref name="pmid15796641">{{cite journal| author=Bryant RA, Moulds ML, Guthrie RM, Nixon RD| title=The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. | journal=J Consult Clin Psychol | year= 2005 | volume= 73 | issue= 2 | pages= 334-40 | pmid=15796641 | doi=10.1037/0022-006X.73.2.334 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15796641  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16246885 Review in: Evid Based Ment Health. 2005 Nov;8(4):109] </ref><ref name="pmid16368074">{{cite journal| author=Bryant RA, Moulds ML, Nixon RD, Mastrodomenico J, Felmingham K, Hopwood S| title=Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up. | journal=Behav Res Ther | year= 2006 | volume= 44 | issue= 9 | pages= 1331-5 | pmid=16368074 | doi=10.1016/j.brat.2005.04.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16368074  }} </ref><ref name="pmid12643970">{{cite journal| author=Bryant RA, Moulds ML, Nixon RV| title=Cognitive behaviour therapy of acute stress disorder: a four-year follow-up. | journal=Behav Res Ther | year= 2003 | volume= 41 | issue= 4 | pages= 489-94 | pmid=12643970 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12643970  }} </ref><ref name="pmid8543717">{{cite journal| author=Foa EB, Hearst-Ikeda D, Perry KJ| title=Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. | journal=J Consult Clin Psychol | year= 1995 | volume= 63 | issue= 6 | pages= 948-55 | pmid=8543717 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8543717  }} </ref><ref name="pmid17671292">{{cite journal| author=Scheeringa MS| title=CBT treatment of PTSD within the first month. | journal=Am J Psychiatry | year= 2007 | volume= 164 | issue= 8 | pages= 1267; author reply 1267-8 | pmid=17671292 | doi=10.1176/appi.ajp.2007.07030406r | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17671292  }} </ref>
The steps taken in cognitive-behavioral therapy are shown below in a tabular form:
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Steps taken in Cognitive-behavioral therapy to help patients with ASD}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Step 1
| style="padding: 5px 5px; background: #F5F5F5;" |
Seeing that people are concerned about them
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Step 2
| style="padding: 5px 5px; background: #F5F5F5;" |
Learning about the range of normal responses to trauma and hearing that their emotional reactions are normal responses to an abnormal event
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Step 3
| style="padding: 5px 5px; background: #F5F5F5;" |
Being reminded to take care of concrete needs such as food, fluids, and rest
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Step 4
| style="padding: 5px 5px; background: #F5F5F5;" |
Cognitive restructuring (eg, changing destructive schema to more constructive ones)
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Step 5
| style="padding: 5px 5px; background: #F5F5F5;" |
Learning relaxation techniques
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Step 6
| style="padding: 5px 5px; background: #F5F5F5;" |
Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Step 7
| style="padding: 5px 5px; background: #F5F5F5;" |
Desensitization to painful memories via repeated controlled exposures and systematic desensitization
|-
|}


Take action (eg, call, send a card, give hugs, or help with practical matters)
*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.
Be available after others get back to their own lives
Be a good listener, but do not give advice
Do not be afraid to talk about the loss
Talk about the person who died by name
Do not minimize the loss; avoid clichés and easy answers
Be patient with the bereaved; there are no shortcuts
Encourage bereaved individuals to care for themselves
Remember significant days and memories
Do not try to distract the bereaved from grief through forced cheerfulness
When dealing with children who are grieving or traumatized, it is particularly important to offer reassurance regarding their own safety and the safety of their loved ones (insofar as is possible). It should be emphasized to these children that such devastating events are very rare, that people are there to take care of them, and that they will always be loved. The following are helpful for grieving or traumatized children:


Be emotionally available to children despite personal loss (or fears)
The steps taken in cognitive-behavioral therapy are shown below in a tabular form:
Give children more time than usual
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
Encourage them to share their feelings, to talk at weekly family meetings, and to use drawings and puppets to express their feelings
|valign=top|
Let them know it is all right to talk about unpleasant feelings (including sadness and anger) and listen to them; sharing personal feelings of sadness with them is all right as well
|+
Check to see if children feel that they somehow caused the death or disaster or if they have other misunderstandings, and take pains to reassure them or correct any misunderstanding; do not assume children are fine just because they are not saying anything
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Steps taken in brief school intervention}}
Understand that children probably know more than you think they do; make sure to ask what the child knows and what questions he or she has
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}}
Monitor and limit television watching after a disaster, lest this flood them or desensitize them to violence; when they do watch, watch it with them and discuss the events
|-
In discussing traumatic events with children, share only the details they can deal with; be honest, but do not overload them with facts
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
Encourage action, such as sending letters to victims, to keep them from feeling helpless
:Step 1
Understand that regression, fear, sleep problems, and anger toward remaining family members are common after a loss or trauma
| style="padding: 5px 5px; background: #F5F5F5;" |
Do not force children to go to the funeral if they do not want to, but help them create a ritual
Introduce the therapists, and ask students to guess why they have come to the classroom
Maintain as normal a schedule as possible
|-
Encourage patients to eat balanced meals on time and drink fluids; to get enough sleep, relaxation, and exercise; and to avoid alcohol and caffeine
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
If serious signs appear and last more than a couple of weeks, help should be sought. Signs that help is needed include the following:
:Step 2
 
| style="padding: 5px 5px; background: #F5F5F5;" |
Extended depression and loss of interest in activities and events
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
Inability to sleep, loss of appetite, or prolonged fear of being alone
|-
Extended period of marked regression
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Excessive imitation of the deceased or repeated statements about wanting to join the deceased
:Step 3
Withdrawal from friends
| style="padding: 5px 5px; background: #F5F5F5;" |
Serious drop in school performance or refusal to go to school
Have children draw while therapists circulate, and ask students to tell them about their drawings
Persistent fears
|-
Persistent irritability and being easily startled
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Behavior problems
:Step 4
Physical complaints
| style="padding: 5px 5px; background: #F5F5F5;" |
Rescue workers may develop the same symptoms as victims, including those of acute stress disorder (ASD) or posttraumatic stress disorder (PTSD). As many as 1 in 3 rescue workers develop PTSD. Measures for helping rescue workers deal with stress after traumatic events include the following:
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
 
|-
Encourage staying in touch with family and friends
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
Be sure that rescue workers get rest, food, exercise, and relaxation
:Step 5
Encourage understanding of survival guilt
| style="padding: 5px 5px; background: #F5F5F5;" |
Explain how chaos and confusion inevitably lead to upset between individuals and groups that are participating in the rescue effort
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
Develop a buddy system, and encourage support of coworkers
|-
Encourage workers to defuse after troubling incidents and after each shift
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
After the rescue operation, encourage workers to take a few days to decompress and attend a debriefing
:Step 6
Do not overwhelm children with talk of experiences as a rescue worker; ask about their activities
| style="padding: 5px 5px; background: #F5F5F5;" |
Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Step 7
| style="padding: 5px 5px; background: #F5F5F5;" |
Thank the students and the teachers, and redirect their attention to learning
|-
|}
==References==
{{reflist|2}}
[[Category:Abnormal psychology]]
[[Category:Psychological stress]]
[[Category:Psychiatry]]
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Latest revision as of 19:08, 16 February 2016

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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.[1][2][3][4][5][6]

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.[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

References

  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.

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