Treatment of acute stress disorder in adults
- Richard Bryant, PhD
Richard Bryant, PhD
- Professor of Psychology
- University of New South Wales
Acute stress disorder (ASD) is characterized by acute stress reactions that may occur in the initial month after a person is exposed to a traumatic event. The disorder includes symptoms of intrusion, dissociation, negative mood, avoidance, and arousal. Some patients who experience ASD go on to experience posttraumatic stress disorder (PTSD), which is diagnosed only after four weeks following exposure to trauma.
Treatment for ASD is aimed at curtailing symptoms of acute stress responses and preventing their development into PTSD.
The treatment of ASD is discussed here. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of ASD are discussed separately. The epidemiology, pathogenesis, clinical manifestations, course, diagnosis, and treatment of PTSD are also discussed separately. (See "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, and diagnosis" and "Pharmacotherapy for posttraumatic stress disorder in adults" and "Psychotherapy for posttraumatic stress disorder in adults".)
First-line treatment for acute stress disorder (ASD) is trauma-focused cognitive-behavioral therapy (CBT), which has been shown to reduce the likelihood of subsequently developing PTSD. Short-term use of a benzodiazepine may be useful for reducing acute arousal and sleep disturbance. Treatment of acute stress disorder is also addressed in trials of interventions to prevent PTSD. (See "Pharmacotherapy for posttraumatic stress disorder in adults" and "Psychotherapy for posttraumatic stress disorder in adults", section on 'Prevention'.)
A proportion of people with ASD will adapt without formal intervention (between one half to one quarter of people with ASD) .
- Bryant RA. Acute stress disorder as a predictor of posttraumatic stress disorder: a systematic review. J Clin Psychiatry 2011; 72:233.
- Bryant RA, Harvey AG, Dang ST, et al. Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol 1998; 66:862.
- Bryant RA, Sackville T, Dang ST, et al. Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. Am J Psychiatry 1999; 156:1780.
- Bryant RA, Moulds M, Guthrie R, Nixon RD. Treating acute stress disorder following mild traumatic brain injury. Am J Psychiatry 2003; 160:585.
- Bryant RA, Moulds ML, Nixon RD, et al. Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up. Behav Res Ther 2006; 44:1331.
- Kornør H, Winje D, Ekeberg Ø, et al. Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: a systematic review and meta-analysis. BMC Psychiatry 2008; 8:81.
- Bryant RA, Mastrodomenico J, Felmingham KL, et al. Treatment of acute stress disorder: a randomized controlled trial. Arch Gen Psychiatry 2008; 65:659.
- Mellman TA, Byers PM, Augenstein JS. Pilot evaluation of hypnotic medication during acute traumatic stress response. J Trauma Stress 1998; 11:563.
- Gelpin E, Bonne O, Peri T, et al. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry 1996; 57:390.
- Robert R, Blakeney PE, Villarreal C, et al. Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study. J Am Acad Child Adolesc Psychiatry 1999; 38:873.
- Robert R, Tcheung WJ, Rosenberg L, et al. Treating thermally injured children suffering symptoms of acute stress with imipramine and fluoxetine: a randomized, double-blind study. Burns 2008; 34:919.
- Vaiva G, Ducrocq F, Jezequel K, et al. Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma. Biol Psychiatry 2003; 54:947.
- Pitman RK, Sanders KM, Zusman RM, et al. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry 2002; 51:189.
- Stein MB, Kerridge C, Dimsdale JE, Hoyt DB. Pharmacotherapy to prevent PTSD: Results from a randomized controlled proof-of-concept trial in physically injured patients. J Trauma Stress 2007; 20:923.
- Norman SB, Stein MB, Dimsdale JE, Hoyt DB. Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder. Psychol Med 2008; 38:533.
- Holbrook TL, Galarneau MR, Dye JL, et al. Morphine use after combat injury in Iraq and post-traumatic stress disorder. N Engl J Med 2010; 362:110.
- Bryant RA, Creamer M, O'Donnell M, et al. A study of the protective function of acute morphine administration on subsequent posttraumatic stress disorder. Biol Psychiatry 2009; 65:438.
- Saxe G, Stoddard F, Courtney D, et al. Relationship between acute morphine and the course of PTSD in children with burns. J Am Acad Child Adolesc Psychiatry 2001; 40:915.