Exposure Therapy Helps Prevent PTSD, Study Finds

Acute stress disorder (ASD) is an anxiety disorder that, in some respects, closely resembles another anxiety-related condition called post-traumatic stress disorder (PTSD). In fact, the majority of people who initially develop ASD in the aftermath of a traumatic event later go on to develop diagnosable cases of PTSD. Psychotherapists who treat acute stress disorder can significantly ease the symptoms of the condition with a treatment approach called exposure therapy. In turn, people who receive effective exposure therapy for ASD have reduced risks for the development of PTSD.

Acute Stress Disorder Basics

Acute stress disorder is a relatively new mental health diagnosis that first received an official definition in the 1994 version of the Diagnostic and Statistical Manual of Mental Disorders or DSM, a standard reference guide published by the American Psychiatric Association. According to the DSM definition, people affected by the disorder develop extremely unpleasant emotional states—such as helplessness, terror or horror—either during or directly following a traumatic event that endangers their own lives or the lives of others. They also develop varying degrees of dissociation, a condition that severs some of the natural psychological connection between a person and his or her surroundings, or alternately, severs some of the affected individual’s connection to his or her sense of self.

Potential manifestations of dissociation in a person with ASD include memory loss regarding some aspect of a traumatic event, a diminished sense of personal reality, a diminished belief in the reality of one’s surrounding environment, and a generally dazed or disconnected mental state. Other common ASD symptoms include an unwanted reliving of a traumatic event while sleeping or awake, a conscious or unconscious avoidance of anything that reminds the affected individual of the source of his or her trauma, and an unusual activation of the body’s natural response to heightened stress, known popularly as the “fight-or-flight” reaction. As noted previously, some of these symptoms strongly resemble the symptoms of PTSD. However, while PTSD can only be diagnosed one month or later following a traumatic event, an ASD diagnosis must be given before the one-month period following a trauma comes to a close.

Exposure Therapy Basics

Exposure therapy is a form of psychotherapy that purposefully exposes a patient to the source of his or her anxiety-based stress reactions in a controlled setting. By successfully confronting the after effects of a traumatic event, the patient develops something called an “extinction memory.” When traumatic reactions get triggered in future moments of stress, this memory of confronting one’s fears essentially counteracts those reactions and gives the patient an increased ability to function normally and retain a sense of autonomy and personal well-being. Exposure therapy is just one of a number of specific techniques that belong to a wider psychotherapeutic approach known as cognitive behavioral therapy or CBT.

In a study published in 2008 in the Archives of General Psychiatry, a team of researchers from the University of New South Wales examined the effectiveness of exposure therapy in treating people affected by acute stress disorder. They also compared the results of exposure therapy to the results of another cognitive behavioral therapy technique, called cognitive restructuring, that doesn’t involve such a direct confrontation with the source of patients’ anxiety-based fears. This comparison was performed out of concern that exposure therapy might place too much mental/emotional strain on people dealing with the symptoms of ASD. During the study, a group of 90 ASD patients received either five weekly sessions of exposure therapy or five weekly sessions of cognitive restructuring. These participants then received follow-up assessments both six weeks and six months after the conclusion of their treatment.

According to current standard guidelines, people affected by serious stress-related symptoms a month after receiving an ASD diagnosis usually qualify for a diagnosis of PTSD. After examining the data gathered six weeks after treatment, the University of South Wales researchers concluded that 33 percent of the people who received exposure therapy for ASD later met the diagnostic criteria for PTSD. By comparison, 63 percent of the people who received cognitive restructuring for ASD met the PTSD criteria. After six months, 37 percent of the people treated with exposure therapy qualified for a PTSD diagnosis, while (as before) 63 percent of the people treated with cognitive restructuring qualified for such a diagnosis.

Based on these findings, the authors of the study made three determinations. First, they verified the effectiveness of exposure therapy as an ASD treatment. They also concluded that exposure therapy is more effective than the less direct treatment approach used during cognitive restructuring. Finally, they concluded that early use of exposure therapy in ASD-affected people with high risks for PTSD can significantly reduce the number of ASD cases that eventually turn into PTSD.