Individuals with ASD experience dissociative symptoms or feelings of detachment; this is what makes ASD different from PTSD.
People with ASD may feel emotionally detached from their lives and emotionally numb. The world may seem unreal. Dissociation can last a few seconds, hours, or even days. During the dissociation, the individual relives the event and may behave in a manner as if they were experiencing the event in that moment. Some patients also experience dissociative amnesia, which makes recalling precise details of the traumatic event difficult. Detachment has been described by some as akin to seeing oneself from the other side of the room or having a distorted view of their surroundings.
Anger, aggressive responses, and irritability can also be a common response. The individual may re-experience the traumatic event through intrusive spontaneous or recurring memories. The intrusive memories are often triggered by sensory, emotional, or physiological experiences which leads to avoidance of these triggering experiences. Distressing dreams related to the trauma are commonly experienced, as well as panic attacks, sleep difficulties, and impulsive behaviors.
Cognitive Behavioral Therapy for Acute Stress Disorder is a form of therapy used in the early stages of traumatic response. Cognitive-behavioral therapy helps people with acute stress disorder change their way of thinking about the traumatic event and alter their behaviors in anxiety-provoking situations. Like posttraumatic stress disorder (PTSD), acute stress disorder may develop in an individual who has experienced or witnessed a traumatic event. Unlike PTSD, however, the anxiety which accompanies acute stress disorder lasts for a minimum of 2 days and a maximum of 4 weeks. If symptoms persist for longer than 4 weeks, or begin more than a month after the trauma was initially experienced or witnessed, a diagnosis of PTSD may be appropriate.
Publicly available information indicates there is a manual that describes how to deliver this program, and there is some training available for this program. See contact info below.
Relevant Published, Peer-Reviewed Research
Child Welfare Outcome: Child/Family Well-Being
Bryant, R. A., Harvey, A. G., Dang, S. T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: A comparison of Cognitive-Behavioral Therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 66(5), 862–866. https://doi.org/10.1037/0022-006X.66.5.862
Type of Study: Randomized controlled trial
Number of Participants: 24
Population:
- Age — 18–60 years
- Race/Ethnicity — Not specified
- Gender — Not specified
- Status — Participants were civilians that suffer from PTSD who were in an inpatient hospital.
Location/Institution: Westmead Hospital, Sydney, New South Wales, Australia
Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the benefit of early provision of Cognitive Behavioral Therapy for Acute Stress Disorder (CBT for ASD) to trauma survivors with acute stress disorder. Participants were randomly assigned to either CBT for ASD or supportive counseling (SC). Measures utilized include the Acute Stress Disorder Interview (ASDI), Impact of Event Scale (IBS), and Beck Depression Inventory (BDI). Results indicate that fewer participants in CBT for ASD (8%) than in SC (83%) met criteria for PTSD at posttreatment. There were also fewer cases of PTSD in the CBT for ASD condition (17%) than in the SC condition (67%) six months post trauma. There were greater statistically and clinically significant reductions in intrusive, avoidance, and depressive symptomatology among the CBT for ASD participants than among the SC participants. Limitations included the small sample size.
Length of controlled postintervention follow-up: 6 months.
Bryant, R. A., Sackville, T., Dang, S. T., Moulds, M., & Guthrie, R. (1999). Treating acute stress disorder: An evaluation of Cognitive Behavior Therapy and supportive counseling techniques. American Journal of Psychiatry, 156(11), 1780–1786. https://doi.org/10.1176/ajp.156.11.1780
Type of Study: Randomized controlled trial
Number of Participants: 45
Population:
- Age — 18–60 years
- Race/Ethnicity — Not specified
- Gender — 23 Female and 22 Male
- Status — Participants were survivors of either motor vehicle accidents or nonsexual assault who were referred to an inpatient mental hospital.
Location/Institution: Westmead Hospital, Sydney, New South Wales, Australia
Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to prevent posttraumatic stress disorder (PTSD) by an early provision of Cognitive Behavioral Therapy for Acute Stress Disorder (CBT for ASD). Participants were randomly assigned to either CBT for ASD which included prolonged exposure and anxiety management, prolonged exposure (PE) on its own, or supportive counseling (SC). Measures utilized include the Clinician Administered PTSD Scale, the Acute Stress Disorder Interview (ASDI), the Impact of Event Scale (IES), the Beck Depression Inventory (BDI), and the State Trait Anxiety Inventory (STAI). Results indicate that fewer patients with CBT for ASD or PE than SC met the criteria for PTSD after treatment. Limitations include results are applicable only to motor vehicle accident and nonsexual assault victims and should not be generalized to other trauma populations, small sample size, and measures not utilized across all assessments.
Length of controlled postintervention follow-up: 6 months.
Bryant, R. A., Moulds, M. L., & Nixon, R. V. D. (2003). Cognitive Behaviour Therapy of acute stress disorder: A four-year follow-up. Behaviour Research & Therapy, 41(4), 489–494. https://doi.org/10.1016/S0005-7967(02)00179-1
Type of Study: Randomized controlled trial
Number of Participants: 80
Population:
- Age — 18–60 years
- Race/Ethnicity — Not specified
- Gender — Not specified
- Status — Participants were civilians that suffer from posttraumatic stress disorder (PTSD) who were in an inpatient hospital.
Location/Institution: Westmead Hospital, Sydney, New South Wales, Australia
Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Bryant, et al. (1998) and Bryant et al. (1999). The purpose of the study was to index the long-term benefits of early provision of Cognitive Behavioral Therapy for Acute Stress Disorder (CBT for ASD) to trauma survivors with acute stress disorder. Participants were randomly assigned to either CBT for ASD or supportive counseling (SC). Measures utilized include the Clinician Administered PTSD Scale, the Acute Stress Disorder Interview (ASDI), the Impact of Event Scale (IES), the Beck Depression Inventory (BDI), and the State Trait Anxiety Inventory (STAI). Results indicate that participants who received CBT for ASD reported less intense posttraumatic stress disorder (PTSD) symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. Limitations include that the retention rate at four years was only 64% of treatment completers and may not accurately reflect functioning of all patients who completed treatment, small sample size, and comparable measures were not conducted for each treatment study.
Length of controlled postintervention follow-up: 6 months and 4 years.
Bryant, R. A., Moulds, M. L., Guthrie, R. M., & Nixon, R. D. V. (2005). The additive benefit of hypnosis and Cognitive-Behavioral Therapy in treating acute stress disorder. Journal of Consulting and Clinical Psychology, 73(2), 334–340. https://doi.org/10.1037/0022-006X.73.2.334
Type of Study: Randomized controlled trial
Number of Participants: 87
Population:
- Age — CBT Group: Mean= 33.09 years; CBT-hypnosis Group: Mean=32.97 years; Supportive Counseling Group: Mean=35.00 years
- Race/Ethnicity — Not stated
- Gender — 53 Female and 34 Male
- Status — Participants were civilian trauma survivors who met criteria for acute stress disorder (ASD)
Location/Institution: Westmead Hospital PTSD Unit – Sydney, Australia
Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on the first controlled treatment study of hypnosis and cognitive–behavioral therapy (CBT) of acute stress disorder (ASD) [now called Cognitive Behavioral Therapy for Acute Stress Disorder (CBT for ASD)]. Participants were randomly assigned to 6 sessions of CBT, CBT combined with hypnosis (CBT–hypnosis), or supportive counseling (SC). Measures utilized include the Stanford Hypnotic Clinical Scale for Adults, the Acute Stress Disorder Interview (ASDI), the Impact of Event Scale (IES), the Beck Depression Inventory—2 (BDI-2), the Beck Anxiety Inventory (BAI), and the Clinician Administered PTSD Scale—2 (CAPS–2). Results indicate that in terms of treatment completers, fewer participants in the CBT and CBT–hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT–hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. Limitations include small sample size, the diagnosis of ASD has questionable validity, and did not include the CAPS-2 at the initial assessment.
Length of controlled postintervention follow-up: 6 months.
Cognitive Behavioral Therapy for Acute Stress Disorder (CBT for ASD)
Summary
This clinician’s resource comprises a treatment manual for Acute Stress Disorder (ASD).
This treatment manual presents a 6 session treatment for Acute Stress Disorder, which has demonstrated effectiveness in preventing the development of chronic PTSD at 6 months (Bryant et al., 1998) through to 4 years post trauma (Bryant et al., 2003). The treatment has been used with survivors of motor vehicle accidents, industrial accidents and nonsexual assaults.
Author/Publisher Details
Richard Bryant, University of New South Wales, Australia.
Description
Acute stress disorder describes post-traumatic stress reactions that are present after an event until 4 weeks post-trauma. Prospective studies (Bryant & Harvey 1998; Harvey & Bryant 1998) suggest that up to 80% of people with ASD will go on to suffer PTSD within 6 months. This early intervention treatment manual guides 6 sessions of structured Cognitive Behavioral Therapy sessions with prolonged exposure. Patients who receive CBT in the initial month after trauma present with less intense PTSD than those who received supportive counseling. See references for further details.
References
Bryant, R. A., Harvey, A. G., Dang, S. T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: A comparison of cognitive-behavioural therapy and supportive counselling. Journal of Consulting and Clinical Psychology, 66(5), 862-866.
Bryant, R. A., Moulds, M. L., & Nixon, R. V. D. (2003). Cognitive behaviour therapy of acute stress disorder: A four-year follow-up. Behaviour Research & Therapy, 41(4), 489-494.
Bryant, R. A., Sackville, T., Dang, S. T., Moulds, M., & Guthrie, R. (1999). Treating acute stress disorder: An evaluation of cognitive behavior therapy and supporting counselling techniques. American Journal of Psychiatry, 156(11), 1780-1786
Training Requirements
Note that only appropriately trained clinicians with experience in cognitive behavioral theory and therapy should attempt to use this treatment manual. Practitioners without this background are strongly advised to obtain training and supervision in general CBT approaches prior to implementing the approaches described in this manual.
This resource should be used in an ethical and responsible manner and should be used only for the purpose(s) for which it has demonstrable validity. Please observe copyright where indicated and reference it appropriately.
Manual Available Only to ISTSS Members
Manual
