Acute Stress Disorder

Acute Stress Disorder

Introduction

            The rate of clinical cases of certain disorders and conditions facing patients has increased.  These human conditions are often described or grouped as stress, trauma or crisis. Kaplan and Sadock did a research in which some people initially reported that they work best while under stressful conditions and are able to meet deadlines. Others in the same study nonetheless reported that they find it difficult to balance life activities and events especially of being responsible parents to their children and at the same time required to meet tight professional goals in their careers and work places, taking care of their parents who are getting old and need help among other demanding responsibilities that if not well managed, may bring about emotional breakdowns (Yeager & Roberts, 2003). Bryant et al continues to note that the term crisis has often been overused such that anyone who has had a nasty or bad day at the work place will end up saying that they have had a crisis. Trauma on the other hand occurs due to random events whose effects are massive and affects the victim in an adverse way.  They further define stress as any situation, condition, stimulus, or an individual’s internal state of coping with some different situations in the surroundings of an individual.  It involves the extent to which an individual reacts to situations by arousals that happen physiologically or the under arousal that causes an outcome of stress that is very bad. The factors that makes people stressed, often referred to as stressors range from home issues, matters pertaining to one’s job, marital or relational conflicts, tight academic schedules and goals to be met, accidents among others (Yeager & Roberts, 2003).

Bryant and other psychological experts have since defined Acute Stress Disorder as the actual symptoms which are always visible or manifested within the first two days to about four weeks of a traumatic event encountered by the victim. This is different from PTSD which is only detected after the four weeks have elapsed, probably beyond three months duration.

Another difference is experienced at the dissociation level where certain factors must be considered including; a sense of numbing that is subjective in nature, less surroundings awareness by the individual, depersonalization and derealization. PSTD needs symptoms of three cases of avoidance related to numbing but ASD only needs avoidance that is marked. This means one can have the ASD symptoms but may not be exposed to PSTD due to lack of manifested symptoms that meet the required clusters (Bryant et al, 2011).

            A working group on Acute Stress Disorder (ASD) and the Post Traumatic Stress Disorder (PTSD) commissioned by the American Psychology Association in 2010 established that the modern life events have become more stressful and made people to be more stressed in both their behaviors and emotional conditions. The group found out that despite a population of between 50-90% undergoing stressful events on a daily basis, majority of the people does not end up developing acute stress disorder. For this reasons, the ASD had been left out of the DSM analysis for many years until in 1995 when it was added as part of the DSM-IV so as to enable the differentiation between ASD patients and those with PTSD (Work Group on ASD and PTSD, 2010).This is supported by the views of Bryant and Harvey that the main reason that triggered the inclusion of ASD into the DSM was to enable the smooth characterization of the people in the population that are traumatically affected with the disorder by describing the initial symptoms so they can be avoided before developing to the next level of PTSD (Bryant & Harvey, 1997). The National Center for PSTD also agrees that two major reasons prompted ASD to be included into the DSM-IV including; the need to describe and define the reactions of ASD among individuals in the first month after a traumatizing event, which could not be satisfactorily defined as PTSD that may be diagnosed a month after the event. Secondly, it was introduced to identify those who portrayed the possibilities of further developing the PTSD rather than experience another reaction of stress (National Center for PTSD, 2013). The common perception has been that acute stress disorder is mainly dominant in the adult populations. Nonetheless, recent research and studies done indicate that ASD may to a small percentage affect children and young adolescents (Stedman et al, 2007).

Symptoms of the Disorder

            Various symptoms characterize the development of acute stress disorder in individuals. Those who suffer from it manifest symptoms like being dissociative and severe anxiety. The event could be a traumatic accident of even fire event which makes the candidate to develop symptoms that are dissociative. Other possible events that may lead to this condition includes war, sexual assault such as rape, a mass disaster like a bomb explosion, a tragic road accident that may leave several people wounded and others dead. Domestic violence leading to divorce or separation may also be a potential cause of ASD. It causes them discomfort and instills fear in their body systems and makes the patients feel helpless. Stress is also a major characteristic of this disorder. Research indicates that over the United States experience above 5 million cases of ASD and PTSD annually (University of Maryland Medical Centre, 2013).These patients are mostly decreased of the emotional responsiveness thus making them unable to enjoy fun activities like others but instead withdraw to themselves with deep feelings of guilt in daily activities. They feel detached from themselves and may not concentrate fully in ongoing activities. They suffer from dissociative amnesia, meaning that they become unable to remember all the critical information regarding the trauma that has taken place, and the persistent thoughts of the traumatic events that come in form of flashbacks, thoughts, dreams, images, thoughts and recollections. The patients also lose the sense of touch with their immediate environment hence suffer from both de-realization and depersonalization. In most cases, the victims highly avoid getting into contact with any events or discussions that may cause recollections regarding the very incidences that caused the trauma.

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Diagnostic Guidelines

            (National Center for PTSD, 2013) notes that for an individual to meet the criteria of ASD diagnostic, they must meet the laid down criteria by DSM-IV of responding to a traumatic event with much fear, anxiety and horror as criterion A, should keep re-experiencing the events’ details on mind as criterion C, practice avoidance as criterion D, manifest arousal as criterion E (Harvey and Bryant, 2002). People also respond to stress in different ways that are uniquely determined and influenced by personal traits like character, skills of coping, temperament, ability to adapt to change, their level of support system and the various stressors causing the conditions. This means that what may be regarded as stress for one person may mean something totally different for another person. Others may find it mild and deal with the condition at the initial stages while for others, this may progress to other stages of trauma and crisis (Yeager & Roberts, 2003).

             The American Psychiatric Association, 1994 released the various diagnostic criteria to be used for DSM-IV as outlined below.

1. The individual must have been exposed to an event that is highly traumatic that is characterized by the following factors;
2. The victim was an actual witness or faced confrontation of the event that was almost life costing or threatened the lives of other people.
3. The victim responded by portraying excess fear and horror.
4. After the event, the person portrays numbing, lack of responsiveness and environmental detachment, reduced levels of self awareness, depersonalization, amnesia that is dissociative, re-experiences of the traumatic event and derealization.
5. The event keeps occurring in the mind through images, photos, dreams, flashbacks and illusions and reminds the victim of the whole scenario.
6. Avoidance that is marked by collections of trauma.
7. Symptoms of anxiety and high level arousal.
8. The factors cause distress that leads to impairment in critical areas. The condition also lasts for a period of 2 days to four weeks (American Psychiatric Association, 1994).

Effective Treatment Strategies

            ASD is a medical disorder that can be treated, especially if detected on time. Below are the major treatment techniques that medical professionals use in averting the disorder among patients. Their level of effectiveness will also be discussed.

Cognitive Behaviour Treatment

            In an effort to offer treatment to ASD patients, medical professionals have resorted to educating patients on the most common behaviour patterns that disrupts the stimulus control thus affecting their life activities patterns that cause stressors. They argue that Cognitive Behaviour Treatment (CBT) affects the thought patterns of individuals thus eventually works as a treatment method for ASD. CBT mechanisms help in maintaining ASD conditions over a long period of time and are accomplished through mastering the correlation between the thoughts that are related to reducing the stressors in life. The medical explanation behind this is that when the thoughts and behaviours are changed in individuals, it helps in curbing the ASD condition over time. 4-8 Sessions are adequate for CBT training, with each session being between half an hour to a full hour (Mitchell, Gehrman & Umscheid, 2012). This treatment method enlightens the patients on various schedules to be followed like how to avoid factors that may cause high levels of stress, reading or engaging in other activities that may boost their knowledge of stress management. The goal of this treatment method is to make patients establish proper connections that are psychologically related between the thought patterns and activities in their lives. These involve training the patients on various behaviour related techniques such as relaxation, restriction of stress, stimulus control and other cognitive therapies. The stimulus control is very useful, easy for patients to follow through and is also effective (Mitchell, Gehrman & Umscheid, 2012).

            Techniques of relaxation involves practising activities which can easily be manoeuvred and practised such as controlling the abdominal style of breathing, muscle relaxation done progressively to hypnosis that is conducted by only professionals who are trained. These are effective methods that enable the body of a patient to gain relaxation hence easing tension and anxiety from the body system thus eventually calming down the mind. When muscles are relaxed, an individual is able to gain enough stress. Nevertheless much time is required in learning and practising these relaxation techniques thus patients must be committed to achieve full recovery. They are critical especially in helping patients gain ability to stress at the onset of stressing time. Another mechanism used for ASD treatments under CBT is the restriction of stress. This involves reducing stress fragmentation that leads to improved efficiency of stress by putting g limits in the amount of time an individual spends in bed versus the actual hours used to stress for routine adjustment (Mitchell, Gehrman & Umscheid, 2012). Both the awakening time and that spent in bed stressing are kept at constant levels by adjustments with efforts to limit the habit of stressing to take place at night only. The aim of this mechanism is to introduce deprivation of enough stress in order to improve the efficiency of stress to that of restricted bedtime as much as possible. Upon achievement, the time spent in bed can be back tracked while maintaining high efficiency of stress until the patient gets the full stress levels.

Pharmacotherapy

            Another mechanism used by medics to treat ASD is through offering pharmacological therapies and interventions which play critical roles in the management of ASD. There are five principles that guide the application of pharcomacotherapy in treating ASD. This includes; using the doses which are less effective, using irregular dosing styles, only prescribing medication that can be used over short term periods, gradual discontinuation of medication and the patient being alert for any recurrence especially after discontinuing the medication. This method involves prescribing antidepressant drugs to patients especially when the cause is perceived as clinical depression. Other antidepressants that are tricyclic in nature like doxepin and amitriptyline are also used as hypnotics. In such cases, low doses are administered as they have side effects like constipation and mouth dryness. These tricyclics are mostly used when the disorder is characterized with much pain, depression and anorexia. Other drugs like Mirtazapine increase the appetite of an individual and promote stress at the onset level. Its effects are milder compared to tricyclics but they are more expensive in terms of costs. Other Z-drugs that are short term oriented like benzodiazepines are also commonly used to treat ASD. It has been medically proved that if melatonin is released in the body for a long time, it improves the latency of stress at onset stage.

Compare and contrast treatment strategies

            CBT is supported by research based evidence that guides the counseling and psychotherapy processes.  Consistent analysis of this model of treatment has been done using case studies, trials on patients with chronic ASD cases.  Prolonged scientific research has indicated that both these methods are effective depending on the time period intended. CBT methods are for instance very effective in treating the stress challenges at the onset stage but are less effective in subsequent stages. Benzodiazepines drugs are effective in controlling the stress levels at the initial stage, though such drugs have increased side effects especially on patients who are elderly with over 60 years old. Patients also take hypnotics for reduced periods and only 15% resort to long term use. These do not pose any threat to the health of the consumer patients unless consumed in overdose ratios. Analysts also note that the cost involved in treatment is higher in CBTs than in pharmacologic measures of treatment. Most hypnotic drugs are nonetheless used for shorter periods of less than two weeks as the quick development in the tolerance levels may cause a patient to lose effectiveness and opt to depend more on the medicines for stress. This may change the stressing patterns of individuals and make the quality worsen. CBT is also effective in treating not only the symptoms but also the root causes over a period of time and have no side effects like hypnotics thus mostly preferred.