How to Treat Acute Stress Disorder

Acute Stress Disorder (ASD) is a severe mental collapse that occurs within one month after a traumatic event. If untreated, ASD can evolve into Post-Traumatic Stress Disorder (PTSD), a more persistent mental health issue. Fortunately, acute stress disorder is a treatable condition. While it requires substantial effort and the intervention of mental health professionals, with the appropriate treatment methods, you can continue to live a normal life like anyone else.

Consider whether you or someone you know has experienced a traumatic event in the past month. A key condition for diagnosing ASD is that the patient must undergo intense emotional stress within a month before symptoms appear. Traumatic events can include death, fear of death, or physical and emotional harm. Knowing whether you or someone you know has encountered such trauma makes it easier to determine if ASD is causing the symptoms. The most common causes of this type of trauma include:

• Traumatic incidents such as assault, rape, or witnessing a shooting
• Being a victim of crime, such as robbery
• Car accidents
• Mild brain injuries
• Workplace accidents
• Natural disasters

Understand the symptoms of ASD. Acute Stress Disorder is characterized by a number of symptoms. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – a guide for mental health conditions – an individual may be diagnosed with ASD if the following symptoms appear after a traumatic event. To qualify as ASD, the symptoms must last more than two days but less than four weeks.

Look for dissociative symptoms. Dissociation occurs when a person seems to withdraw from the real world. It is a common coping mechanism for those who have just experienced a major trauma. Patients may dissociate in several ways. A person may have ASD if three or more of the following symptoms are present:

• Feelings of numbness, detachment, or lack of emotional response
• Decreased awareness of the surrounding environment
• Distorted reality perception (derealization), or the feeling that the outside world is unreal
• Depersonalization. This occurs when a person feels that their feelings and experiences are not their own. Trauma victims may convince themselves that the event was experienced by someone else, not by them.
• Dissociative amnesia. The person may block out memories or forget the traumatic event or parts of the event.

Determine if the person is reliving the traumatic event. Some people with ASD will relive the traumatic event in various ways. If you or someone you know is reliving the traumatic incident with one or more of the following signs, it may be an indication of ASD:

• Frequent images or thoughts about the traumatic event
• Dreams, nightmares, or night terrors related to the traumatic event
• Detailed flashbacks of the traumatic event. These could be brief images or highly detailed recollections, where the person feels as though they are actually reliving the event.

Observe for avoidance behaviors. The person may experience distress when exposed to reminders of the traumatic event. They often avoid situations or places that bring the memory of the event. If you notice that the person deliberately avoids certain situations or locations related to the trauma, this is another sign of ASD.

• Victims often experience anxiety, tension, agitation, or heightened alertness when confronted with reminders of the trauma.

Determine if the symptoms are causing significant problems in daily life. Another criterion for diagnosing ASD is that the symptoms cause substantial disruption in the person’s daily life. Consider your own or someone else’s daily life to see if these symptoms are causing major issues.

• Consider the impact on work. Are you able to concentrate and complete tasks, or is concentration impossible for you? Do you often think about the traumatic event and find it difficult to continue working?
• Think about your social life. Does the idea of going out make you anxious? Have you completely stopped socializing? Are you avoiding reminders of the trauma, and consequently avoiding certain social situations?

Seek professional help. If you or someone you know exhibits symptoms that match the diagnostic criteria for ASD, professional help is necessary. Fortunately, ASD is treatable, but early action is critical. A healthcare provider will assess the condition and recommend appropriate treatments.

• If the situation involves severe distress, suicidal or homicidal thoughts, or violent behavior, immediately call 113 (the emergency police) or 1800 1567 (the child counseling and support hotline provided by the Department of Child Protection and Care and supported by Plan International in Vietnam) for assistance. Once the crisis has passed, you can seek ongoing psychological support.
• If suicidal thoughts are present, please call 1800 1567 immediately.
• If neither you nor the person you care about is in immediate crisis, you can schedule an appointment with a therapist or mental health professional.

Try Cognitive Behavioral Therapy (CBT). Currently, CBT is considered the most effective treatment for ASD. Research also indicates that early treatment with CBT can prevent ASD from developing into PTSD, a similar but more long-lasting condition.

• CBT for ASD focuses on changing the way you perceive the danger associated with the traumatic event you experienced, aiming to process the trauma and help desensitize you to the triggers surrounding it.
• The therapist will explain your physical, emotional, and psychological reactions to the trauma to help you recognize the triggers and your responses. They will also explain how and why this process is important for your desensitization.
• You will also learn relaxation exercises to use in anxiety-provoking situations, both outside the clinic and during the therapy sessions where you process the trauma through verbal description or by imagining the traumatic event.
• The therapist will also use CBT to help you adjust your experience and overcome any survivor guilt if needed. For example, in the case of ASD, if a patient has survived a fatal car accident, they may now fear getting into a car because they feel it will lead to death. The therapist will try to help them think differently. For instance, if the patient is 25 years old, the therapist may point out that they have been driving for 25 years without dying, statistically supporting their safety.

Consider psychological counseling immediately after the trauma. Psychological counseling involves urgent mental health intervention right after a trauma, ideally before symptoms develop into ASD. The patient will attend an enhanced therapy session to recount the entire traumatic event to a professional. The downside of this approach is that it needs to happen immediately after the trauma to be effective.

• The effectiveness of psychological counseling remains debated. Some studies suggest that it does not offer long-term benefits for trauma victims. However, you should not hesitate to seek help from a psychologist, as this simply means that the professional may resort to other treatment methods if counseling proves ineffective.

Join an anxiety support group. In addition to one-on-one therapy sessions, group therapy can also benefit ASD patients. These group sessions are typically supervised by a mental health professional. The professional guides discussions and ensures that each group member has a positive experience. The support group can help alleviate feelings of isolation because you are surrounded by others who have had similar experiences.

• Like psychological counseling, the effectiveness of group therapy in treating ASD is debated, although participants may enjoy close friendships that develop during the group sessions.

Try Exposure Therapy. ASD often causes individuals to fear certain places or situations that remind them of traumatic events. This can be a major challenge in their lives, as they may have to stop communicating or avoid going out to prevent encountering triggers. If left untreated, these fears can evolve into PTSD.

• Through exposure therapy, patients are gradually exposed to anxiety-provoking stimuli. The hope is that repeated exposure will help desensitize the patient, enabling them to face these triggers without fear in daily life.
• This treatment typically begins with an imagined exposure to the stressor, as detailed as possible. Therapy sessions progressively increase in intensity until the therapist and the patient confront the trigger in real-life situations.
• For example, if a patient witnessed a shooting at a library, they may develop a fear of entering any library. The therapist might start by having the patient imagine being in the library, describing their feelings. Next, the therapist might simulate the library environment in their office so the patient can experience it in a controlled setting. Finally, both the therapist and the patient will visit the actual library.

Consult a doctor before taking any medication. Like any prescribed drug, medication for ASD can carry the risk of dependence. Therefore, these medications are often illegally sold on the streets. You should never take medication that was not prescribed by a doctor. If misused, ASD medications can exacerbate symptoms and even be fatal.

Take Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are considered the primary medication for treating ASD. These drugs alter serotonin levels in the brain, which helps improve mood and reduce anxiety. SSRIs are still the most commonly used medication for treating various mental health disorders.

• Common SSRIs include sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

Take Tricyclic Antidepressants. Amitriptyline and imipramine have been proven effective in treating ASD. Tricyclic antidepressants work by increasing the levels of norepinephrine and serotonin available in the brain.

Consider trying benzodiazepines. Benzodiazepines are frequently prescribed by doctors to help manage anxiety, which can be beneficial for individuals with ASD. These medications also assist with sleep disturbances, commonly experienced alongside ASD.

• The benzodiazepine family includes clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan).

Reduce stress with relaxation techniques. Relaxation exercises have proven to be effective in enhancing overall mental well-being. They help alleviate stress symptoms and reduce the likelihood of ASD relapse. Practicing relaxation also addresses secondary mental health concerns such as insomnia, fatigue, and high blood pressure.

• If you consult a mental health specialist for ASD treatment, they may introduce you to various relaxation techniques, often part of cognitive-behavioral therapy.

Practice deep breathing exercises. A well-known and effective method for reducing stress is deep breathing. When performed properly, deep breathing can significantly lower stress levels and prevent future complications.

• Focus on breathing deeply from your abdomen rather than your chest. This allows for more oxygen intake and promotes relaxation. Place your hand on your stomach to ensure it rises and falls with each breath. If it doesn't, your breathing may not be deep enough.
• Sit upright or lie flat on the floor.
• Breathe in through your nose and exhale through your mouth. Inhale as much air as possible, then exhale completely until your lungs are fully emptied.

Engage in meditation. Similar to deep breathing, meditation helps reduce stress and fosters relaxation. Regular meditation can improve both mental and physical health by reducing stress and anxiety.

• During meditation, one shifts into a calm state, concentrating on a sound, allowing the mind to escape daily worries and distractions.
• Choose a quiet place, sit comfortably, clear your thoughts, and focus your imagination on a candle or a word like 'relax.' Practice for 15-30 minutes each day.

Build a support network. People with strong support networks are generally less likely to experience episodes or relapses of mental health conditions. In addition to family and friends, you can also turn to support groups to receive help and foster connections.

• Share your concerns with loved ones. Don't keep your emotions bottled up. Talking to family and friends is crucial in building a support system. They can't help you if they don't know what's going on.
• You can also look for a local support group that specializes in your condition. A quick online search may help you find a group near you.

Keep a journal. Writing in a journal has been shown to reduce stress and anxiety. It provides a space to release your emotions, and many mental health treatment programs include journaling as a component. Committing to a few minutes of journaling each day can benefit your mental well-being.

• When journaling, try to reflect on what is troubling you. Start by writing about the stressor, then note your response. How do you feel and what are your thoughts when you start to feel stressed?
• Analyze your interpretations of the event. Identify whether you may be falling into negative thought patterns. Then, try to reframe your perspective in a more positive light, avoiding catastrophizing the situation.