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Exposure Therapy for Acute Stress Disorder

By John M. Grohol, Psy.D. on June 24th, 2008

Before someone is diagnosed with posttraumatic stress disorder (PTSD), they are often diagnosed with a disorder called acute stress disorder. Why? Because PTSD is considered more of a longer-term, even chronic, disorder, while acute stress disorder occurs more immediately and generally doesn’t last as long, especially if it’s treated. Left untreated, acute stress disorder often turns into posttraumatic stress disorder.
So what kinds of treatments are most helpful with acute stress disorder (ASD)?
There are no medications approved for the treatment of ASD (although a medication may be prescribed for associated anxiety or depressive symptoms). So treatment usually is a type of psychotherapy.
Two types of psychotherapy often prescribed for ASD are either exposure therapy or trauma-focused cognitive restructuring. In the former, patients are taught and practice clinical relaxation and imagery techniques and, when mastered, gradually “exposed” to components related to the original trauma. This exposure is done either for real (in vivo) or via imagery techniques, depending upon the level of trauma and, in consultation with the patient, the therapist’s experience and preference. Cognitive restructuring, on the other hand, doesn’t expose people to the original trauma, but instead helps the person examine and deconstruct their negative, irrational thoughts surrounding the trauma. These thoughts often lead to negative emotions, such as anxiety, so the thinking goes that by dealing with them, one can deal with the anxiety and traumatic feelings.
Recent research has looked into which of these two techniques results in better outcomes for people. A randomized controlled clinical trial of people (non-military) who experienced trauma and who met the diagnostic criteria for ASD (N = 90) were seen at an outpatient clinic. Patients were randomly assigned to receive 5 weekly 90-minute sessions of either imaginal …
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