Acute Stress Disorder – When Stress Takes Over After a Traumatic Event

The Patient: 

Jeffery, a 59-year-old male, had been in a recent car accident. He was still very shaken up from the incident and was having intense anxiety, panic attacks, and sleeping problems. He was constantly ruminating about the accident having fearful thoughts about what he could have done better, He found it difficult to concentrate at work because he was becoming easily startled by any loud noise,  and was impacting his ability to work. He started feeling inadequate and comparing himself to others and felt everyone was doing better than him and making more money, and that he would never reach their level. He was also having bouts of anger and found himself snapping at his wife whenever he became irritable. It was taking a toll on him both physically and emotionally.

The Diagnosis: 

After our initial session, Jeffrey was showing signs of Acute Stress Disorder (ASD). The disorder is characterized by acute stress reactions that typically occur within one month after a person is exposed to a traumatic event. The disorder may include signs of increased stress, negative mood, avoidance, and dissociation. Some may have difficulty concentrating, an inability to experience positive emotions, sleep disturbances, and irritability.

Jeffery could not get through a regular day without falling into the cycle of worry, sleeplessness, and irritability. He was finding it more difficult to tolerate the uncertainty at work and communicate with his wife. 

During our discussions, he noted he was having additional symptoms such as flashbacks, rapid heart rate, and feelings of guilt about the accident. It was making him want to dissociate because the psychological distress was too much. The effects were almost unbearable, causing him to resort to avoidance tactics like snapping at his wife whenever she complained he was being distant and wasn’t listening to her. Jeffery felt he should be able to just shake off the uncomfortable feelings and get back to the way he was before the accident.

Trauma can cause your brain to remain in a state of hypervigilance and trap you in a constant state of strong emotional reactivity. Being in a negative mood state can also alter the way we think. Jeffery was trapped in this state and was continuing to think about the accident. This is a common reaction to trauma, and since his symptoms were happening within a month after the accident occurred, it was clear he was suffering from acute stress disorder, and that if left untreated, it can lead to post-traumatic stress disorder (PTSD). 

The Treatment: 

In order to help Jeffrey minimize the impact that his thoughts and feelings were having in his personal, professional, and social life, it was important to develop a treatment plan to explore his symptoms more fully.  To work through the ASD, I focused on Cognitive Behavioral Therapy (CBT) a top-down strategy to help him make sense and provide perspective with his cognitive symptoms. CBT is an effective treatment for ASD, used in the early stages of the traumatic response to help challenge unhealthy thought processes and emotions connected to the trauma. 

We started treatment by incorporating mindfulness into our sessions so he could slow down and observe his thoughts. I had him make lists of the thoughts he was ruminating about. This would allow him to look at the effects they were having and how they were hurting him and getting in the way of his work life and relationship with his wife. We incorporated compassion and care with the desire to help Jeffery process his thoughts, and he was able to become more present and aware of his reactions and acknowledge the reality of the trauma that he was trying to avoid. 

He also shared that after the accident, he had to deal with so many doctors and specialists to heal the physical issues, that it brought up his old feelings of not being good enough. While he was in physical therapy, he felt limited, like he couldn’t do anything. He started feeling worthless, and that is when he started comparing himself to his coworkers and having feelings of inadequacy. He had trouble sleeping and when he would get to work, the anxiety would kick in. We worked on his tendencies to avoid his physiological responses and snapping at others when he became irritated. I helped him practice experimenting with new ways to approach the problems at work.

I used cognitive restructuring to build his awareness of his behaviors and then reduce his reactions to the stresses he was facing. After the accident, he began having maladaptive thought processes around the memories of the accident and bringing it into other areas of his life. I gave him homework sheets to look at the cognitive distortions that he was relying on, so he could become aware of his negative tendencies. He was using “should” statements like “I should be able to shake it off.” He was also catastrophizing his failures if he didn’t reach his own expectations for certain goals he had set. He’d have extreme thoughts that it was over and he would never succeed again. We worked together to help him trade his negative thoughts by replacing them with more adaptive thinking.

We started with helping him put his feelings into words using techniques that would help ease his anxiety. We were able to increase his connection to his emotions and his reactions and reduce the impacts of the triggering responses. Instead of just focusing on the worst that could happen, we worked on how he could include positive self-talk and identify the progress he was making, rather than negative thinking which is a typical response in ASD.

I used CBT interview strategies to help calm his nerves. The technique helps you to understand what is causing you to be anxious, how it will impact you if you continue to think this way, and how you can look at healthier ways to think about the situation. He was able to look at his initial interpretation and find alternatives.

Together, we came up with specific goals for him to work on, and he was able to write down affirmations and encouraging statements to redirect his thinking. I also had him work on a gratitude list to help him make a conscious effort when interacting with his wife. A study of couples found that individuals who took time to express gratitude for their partner not only felt more positive toward the other person but also felt more comfortable expressing concerns to each other about their relationship.

Results:

Jeffery had a noticeable reduction in his anxiety. He was able to recognize any early triggers and process his thoughts in a more useful way. As treatment progressed, rather than jumping to conclusions and take things personally, he is now able to be more positive, see different perspectives, and move through the situation. He has new resources and coping skills that have enabled him to be aware of his thoughts and emotions; identify how situations can influence his emotions, and work through any dysfunctional thoughts and behaviors to have better outcomes. He has since regained his social skills with other people at work and has learned to move past the negative comparisons. Jeffery feels more confident with problem-solving skills and regulating his emotions when they arise without having anxiety attacks and he is sleeping better. He is much more open to exploring other options and dealing with change. CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either an individual or group format.

Disclaimer: Names and identifying characteristics have been changed to protect the privacy of individuals.