psychiatric disorders
Acute Stress Disorder (ASD)
Treatment of Acute Stress Disorder
Safety and self-care Psychotherapy Limited role of pharmacotherapy Safety and self-care are important for successful recovery from acute stress disorder (ASD). It can be difficult to overcome ASD if the traumatic experience is recurring and the surrounding conditions remain unsafe. Attention to physical needs and sufficient sleep are helpful. In addition, psychotherapy focused on working through the emotional aftermath of the trauma may be effective. The adverse effects of sudden traumatic experience can include shame and inappropriate guilt, which can be modulated by emotional protection and support. Self-care is crucial during and after a crisis or trauma. Self-care can be divided into 3 components: Personal safety Physical health and practical support Mindfulness Personal safetyis fundamental. After a traumatic episode, people are better able to process the experience when they know that they and their loved ones are safe. It can be difficult, however, to gain complete safety during ongoing crises such as domestic abuse, war, or an infectious pandemic. During such ongoing difficulties, people should seek the guidance of experts on how they and their loved ones can be as safe as possible. Physical healthcan be put at risk during and after traumatic experiences. As much as possible, the at-risk person should try to maintain a healthy schedule of eating, sleeping, and exercise. Medications and substances that sedate (eg, benzodiazepines) and intoxicate (eg, alcohol) should be used sparingly, if at all. Practical support includes assistance with housing, legal support, insurance, and other issues that need to be addressed but can be overwhelming. A mindful approach to self-care aims to reduce the stress, boredom, anger, sadness, and isolation that traumatized people normally experience. If circumstances allow, at-risk individuals should make and follow a normal daily schedule. Community involvement can be crucial, even if maintenance of human connection is difficult during a crisis. It is useful to practice familiar hobbies as well as activities that sound fun and distracting: draw a picture, watch a movie, cook. Stretching and exercise are beneficial, but self-soothing techniques such as counting one's own breaths, meditating, or self-hypnosis can also be helpful. Social connection with family and friends is also encouraged. Under stress, people can become short-tempered, even with those they care about. Friends and family can be expecially helpful in reaching out and providing expressions of concern and comfort. Sending a nice note, making someone cookies, and offering up a smile may not only be a nice surprise for the recipient, but such actions can reduce the hopelessness and shame that tend to be part of the experience of trauma. is a time-limited CBT treatment that has the most robust evidence base for treatment of ASD and prevention of PTSD ( Treatment references ). This psychotherapy consists of 3 parts: Patient educationis an important initial step. Normalization and explanation of the stress response is often helpful, as is a reminder that symptoms should improve. Cognitive restructuringhelps correct maladaptive thoughts the patient might have about the trauma or personal response to the trauma. Exposureto traumatic memories or safe reminders of traumatic experiences is an important—if difficult—part of the psychotherapy. Through re-experiencing, the patient is better able to emotionally process material that had previously been experienced as overwhelming. Trauma-focused CBT is generally delayed for at least 2 weeks following the trauma. This time period allows most situations to calm down and gives patients some distance from acute issues related to such complications as danger, pain, surgery, and geographical relocation. Since trauma-focused CBT can itself be stressful, therapy may be deferred for months while the clinician identifies factors that might complicate treatment. These complicating factors include clinically significant suicidality, dissociation, grief, anger, psychosis, or PTSD symptoms from an earlier trauma. Debriefing is a form of psychotherapy that is discouraged because it has not proven to be effective; however, it remains widely practiced. For this intervention, the patient is asked to provide a detailed description of the trauma within the first 72 hours. There are no medications that are supported by sufficient evidence to recommend routine use for reducing the symptoms of ASD or preventing the development of PTSD ( Treatment references ). in the acute aftermath of serious physical trauma reduced the risk of the subsequent development of PTSD ( Treatment references ); this approach has not been otherwise studied. 1.Carpenter JK, Andrews LA, Witcraft SM, et al: Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials.Depress Anxiety35(6):502-514, 2018. doi: 10.1002/da.22728 2.Wright LA, Sijbrandij M, Sinnerton R, et al: Pharmacological prevention and early treatment of post-traumatic stress disorder and acute stress disorder: a systematic review and meta-analysis.Transl Psychiatry9(1):334, 2019. doi: 10.1038/s41398-019-0673-5 3.Holbrook TL, Galarneau MR, Dye JL, et al:Morphineuse after combat injury in Iraq and post-traumatic stress disorderN Engl J Med362(2):110-117, 2010. doi: 10.1056/NEJMoa0903326. 