Acute Stress Reaction

• transient condition that develops in response to a traumatic event.
• Individual vulnerability and coping style may affect the severity and occurrence 
• begin within minutes of the traumatic event and disappear within days (even hours). Symptoms include a varying mixture of:
  • An initial state of `daze’ · Narrowing of attention
  • Reduced levels of consciousness · Disorientation
  • Agitation or overactivity · Depression
  • Withdrawal · Amnesia
  • Anxiety symptoms (e.g., sweating, increased heart rate, flushing)
• The traumatic events that can lead to an acute stress reaction are of similar severity to those involved in post-traumatic stress disorder

• Diagnosis(see ICD-10)
  • The individual has been exposed to a traumatic event.
  • Symptoms begin within 1 hour of the traumatic experience.
  • Symptoms begin to diminish within 2 days.
  • The reaction occurs in the absence of any other mental or behavioural disorder.

• Note: The diagnostic criteria for this condition as outlined in DSM-IV (acute stress disorder) differ quite markedly from those required by ICD-10. F
• or example, according to DSM-IV:
  • The disturbance occurs within 4 weeks of the traumatic event and lasts anywhere from 2 days to 4 weeks.
  • The individual experiences distress on exposure to reminders of the trauma, or the event is re-experienced through dreams, imagery, illusions, or flashbacks.
  • There is a marked avoidance of stimuli that trigger memories of the trauma (e.g., people, places, thoughts).

• Differential diagnosis
  • Adjustment disorder involves a short term anxiety reaction to a life stressor, however, in adjustment disorder the stressor (e.g., such as loss of a job, a relationship break-up) is usually less traumatic than in acute stress reaction.
  • Acute stress reaction should not be diagnosed if the symptoms are simply an exacerbation of existing symptoms of another psychiatric disorder (with the exception of personality disorders)

Management 

• Help with the removal of any ongoing traumatic event.
  • For example, practical assistance with finding safe accommodation if necessary or protecting against further loss (possessions, job)
  Discussion about what happened during the traumatic event:
  • e.g., what was seen, how the individual acted or felt, or what he or she thought at the time)Discussion may help the individual reduce any negative appraisals of his or her reaction during the experience. For example, some individuals may feel guilty about their sense of helplessness during the trauma (e.g., that they did not do anything to stop the trauma). These negative appraisals are a common reaction to a traumatic event. In most cases it is highly unlikely that, when faced with such a trauma, the individual could have acted in any other way.
  Encourage the individual to confront the trauma by talking about the experience to family and friends.Time. Reassure the individual that the acute stress reaction is likely to pass in a short period of time.Social support and facilitate support from others (e.g., partners, family, friends, work colleagues, and work supervisors).

Psychoeducation:

• Provide information about the nature of acute stress reactions.
• Educate individuals about the mind-body connection and how stress affects both mental and physical well-being.

Cognitive Restructuring:

• Identify and challenge negative thought patterns related to the stressful event.
• Help individuals recognize and change irrational or unhelpful thoughts contributing to their stress.

Mindfulness and Relaxation Techniques:

• Teach mindfulness exercises to help individuals stay present and focused.
• Guide in relaxation techniques such as deep breathing, progressive muscle relaxation, or guided imagery to manage physiological arousal.

Behavioral Activation:

• Encourage individuals to engage in positive and enjoyable activities to counteract the impact of stress.
• Create a structured daily routine to provide a sense of stability and control.

Problem-Solving Skills:

• Assist in breaking down larger problems into smaller, more manageable parts.
• Help individuals generate and evaluate potential solutions to the issues contributing to stress.

Graded Exposure:

• Gradually expose individuals to stressors in a controlled manner to reduce avoidance behavior and desensitize them to anxiety-provoking situations.

Social Support Enhancement:

• Identify and encourage the use of social support networks.
• Work on communication skills to express needs and concerns effectively.

Behavioral Experiments:

• Collaboratively design experiments to test the accuracy of certain beliefs and assumptions related to the stressor.
• Use the results to modify cognitive patterns.

Journaling:

• Encourage individuals to keep a journal to track thoughts, emotions, and behaviors related to the stressor.
• Analyze patterns and identify areas for intervention.

Self-Compassion Training:

• Foster self-compassion by helping individuals develop a kind and understanding attitude toward themselves.
• Challenge self-critical thoughts and promote self-care.

Goal Setting:

• Collaboratively set realistic and achievable short-term goals to regain a sense of control and accomplishment.

Persistent symptoms may require more specialised treatment and a revised diagnosis of Post-Traumatic Stress Disorder and/or depression