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]

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:

Steps taken to help grieved persons	Features
Step 1	Take action Call Send a card Give hugs Help with practical matters
Step 2	Be available after others get back to their own lives
Step 3	Do not be afraid to talk about the loss
Step 4	Be a good listener, but do not give advice
Step 5	Do not minimize the loss; avoid clichés and easy answers
Step 6	Encourage bereaved individuals to care for themselves
Step 7	Be patient with the bereaved; there are no shortcuts
Step 8	Remember significant days and memories
Step 9	Do not try to distract the bereaved from grief through forced cheerfulness
Step 10	Remember significant days and memories

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:

If serious signs appear and last more than a couple of weeks, help should be sought. Signs that help is needed include the following:

Steps taken to help grieving or traumatized children	Features
Step 1	Be emotionally available to children despite personal loss (or fears)
Step 2	Encourage them to share their feelings, to talk at weekly family meetings, and to use drawings and puppets to express their feelings
Step 3	Give children more time than usual
Step 4	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
Step 5	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
Step 6	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
Step 7	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
Step 8	In discussing traumatic events with children, share only the details they can deal with; be honest, but do not overload them with facts
Step 9	Understand that regression, fear, sleep problems, and anger toward remaining family members are common after a loss or trauma
Step 10	Encourage action, such as sending letters to victims, to keep them from feeling helpless
Step 11	Do not force children to go to the funeral if they do not want to, but help them create a ritual
Step 12	Maintain as normal a schedule as possible
Step 13	Encourage patients to eat balanced meals on time and drink fluids; to get enough sleep, relaxation, and exercise; and to avoid alcohol and caffeine

Extended depression and loss of interest in activities and events Inability to sleep, loss of appetite, or prolonged fear of being alone Extended period of marked regression Excessive imitation of the deceased or repeated statements about wanting to join the deceased Withdrawal from friends Serious drop in school performance or refusal to go to school Persistent fears Persistent irritability and being easily startled Behavior problems Physical complaints 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:

Encourage staying in touch with family and friends Be sure that rescue workers get rest, food, exercise, and relaxation Encourage understanding of survival guilt Explain how chaos and confusion inevitably lead to upset between individuals and groups that are participating in the rescue effort Develop a buddy system, and encourage support of coworkers Encourage workers to defuse after troubling incidents and after each shift After the rescue operation, encourage workers to take a few days to decompress and attend a debriefing Do not overwhelm children with talk of experiences as a rescue worker; ask about their activities

Individuals are aided by the following:

Seeing that people are concerned about them Learning about the range of normal responses to trauma and hearing that their emotional reactions are normal responses to an abnormal event (rather than a sign of weakness or pathology) Being reminded to take care of concrete needs (eg, food, fluids, and rest) Cognitive restructuring (changing destructive schema to more constructive ones [see the Table below]) Learning relaxation techniques Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo Desensitization to painful memories via repeated controlled exposures and systematic desensitization

Number of steps	Steps taken in Cognitive-behavioral therapy to help patients with ASD
Step 1	Seeing that peole 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