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Evidence-Based Management for Acute Stress Disorder (ASD)

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Evidence-Based Management for Acute Stress Disorder (ASD) Center for the Study of Traumatic Stress Understanding the Effects of Trauma and Traumatic Events to Help Prevent, Mitigate and Foster Recovery for Individuals, Organizations and Communities A Program of Uniformed Services University, Our Nation’s Federal Medical School, Bethesda, Maryland • www. usuhs.mil/csts/ Evidence-Based Management for Acute Stress Disorder (ASD) Acute Stress Disorder (ASD) is characterized by dissociative ongoing assessment of safety and psychiatric status, symptoms (e.g. detachment, derealization, or amnesia) addressing co-morbid disorders, and increasing the during or after exposure to a traumatic event followed patient’s understanding of and coping with the effects of promptly by symptoms of re-experiencing, avoidance/ exposure to traumatic events through specific treatment numbing, and hyperarousal from two days to a maximum strategies (e.g. psycho-education, psychotherapy and/or of four weeks after the traumatic exposure. While not the pharmacotherapy) for ASD. only disorder seen acutely after exposure to traumatic events, ASD is quite common. The American Psychiatric PSYCHOTHERAPY—Early supportive psycho-education Association and the U.S. Department of Veterans Affairs and case management facilitate entry into other evidence- Office of Quality and Performance have published Practice based treatments. Cognitive Behavior Therapy (CBT) Guidelines for the treatment of ASD. For details see: may be helpful relatively acutely after traumatic exposure although heightened arousal and anxiety states may http://www.psych.org/psych_pract/treatg/pg/PTSD-PG- preclude some patients from absorbing information or PartsA-B-C-New.pdf and acquiring new coping skills in the immediate aftermath http://www.oqp.med.va.gov/cpg/PTSD/PTSD_cpg/ of trauma. Psychological debriefing was developed as frameset.htm. an intervention to prevent the development of negative emotional consequences of trauma including ASD, but Practice Guidelines do not define the standard of care. well controlled studies using single-session individual or However their synthesis of research and expert consensus group debriefings have not demonstrated efficacy. Some augments clinical experience in treating patients, educating studies have indicated that persons experience these session the public, guiding research, and establishing credibility for as helpful. However, if conducted for heterogenous groups medical care delivery. Essential recommendations of the some individuals will increase their traumatic exposure above noted guidelines for ASD are outlined below. through participation. ASSESSMENT—Psychological effects of trauma PHARMACOLOGIC TREATMENT—Potential benefits may result from physical injury so detailed diagnostic of selective serotonin reuptake inhibitors and other evaluation should be continued only after a physically and antidepressants are supported by limited study in ASD psychologically safe environment has been established, the and considerable evidence of their efficacy in PTSD. individual’s medical condition has been stabilized, and Benzodiazapines reduce anxiety and improve sleep but psychological reassurance has been provided. Diagnostic potential for dependence, withdrawal symptoms, and small evaluation may be accomplished through individual or studies indicating greater incidence of PTSD after early group interviews or consultation. Surveillance instruments treatment with this medication class suggest only transient or screening symptom checklists may aid the process and use in acutely distressed individuals. may also be helpful in identifying at-risk individuals for Combination psychotherapy/pharmacotherapy although follow-up evaluation when large populations are exposed to not well studied, should also be considered if initial trauma (e.g. natural disaster or terrorist event). medication therapy or psychotherapy is ineffective. MANAGEMENT—Objectives for patients with ASD include establishment of a therapeutic alliance, providing Disaster Response Education and Training Project, Center for the Study of Traumatic Stress For more information see www.usuhs.mil/csts/.
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