Acute Stress: Are You Controlled By Your Nerves?

We face stressful situations in our day-to-day that cause behavioral and emotional problems. These problems caused by stress usually go away on their own, but some people are more affected by it, causing a more serious impact and developmental deficiencies. Stress has several types, this one is acute stress, which, if left untreated, can turn into post traumatic stress disorder, or PTSD. To keep this from happening, we’ll explain what is it and give you some tips for overcoming acute stress.

What is acute stress?

According to the American Psychology Association (APA) acute stress is the most common form of stress. It usually comes from pressures of recent past and anticipated demands of the near future. Acute stress is thrilling and exciting in small doses however too much can be exhausting and dangerous. It’s most common symptoms are:

• Stomach, gut and bowel problems such as heartburn, acid stomach, flatulence, diarrhea, constipation, and irritable bowel syndrome.
• Emotional distress — some combination of anger or irritability, anxiety and depression, the three stress emotions.
• Muscular problems including a tension headache, back pain, jaw pain and the muscular tensions that lead to pulled muscles and tendon and ligament problems.
• Transient overarousal leads to an elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath and chest pain.

Most of these symptoms are recognized by anyone. For example, it is the deadline for a project, problems with your car, your son’s grades, etc.

Acute stress can be like a riding a rollercoaster mid-morning, it can be exillarating. However, riding the same rollercoaster after a hectic day can be tiresome. In small doses it’s acceptable, bigger doses acute stress can become a serious problem.

 What is an acute stress reaction (ASR) or acute stress disorder?

It is also referred to as a shock. When citing acute stress reaction it is a psychological condition in response to a terrifying or traumatic event, or witnessing a traumatic event that induces a strong emotional response within the individual. It is said that ASR is the response before being diagnosed Post Traumatic Stress Disorder or PTSD. ASR is characterized by re-living and avoiding reminders of an aversive event, as well as generalized hypervigilance after initial exposure to a traumatic event. ASD is differentiated from PTSD as a disorder that precedes it, and if symptoms last for more than one month, it will develop into PTSD. It can thus be thought of as the acute phase of PTSD

It has a set of characteristics where the person re-lives and actively avoids reminders of the aversive event. There is a general hyper vigilance towards anything related to the traumatic event. If the symptoms last more than a month it is considered PTSD.

Diagnostic Criteria of Acute Stress Disorder or Acute Stress Reaction

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these are the criteria:

A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:

• Directly experiencing the traumatic event.
• Witnessing, in person, the events as it occurred to others.
• Learning that the traumatic events occurred to a close family member or close friend.
• Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related.

B. The presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:

Intrusion symptoms

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event.
• Recurrent distressing dreams in which the content and/or affect of the dream are related to the events.
• Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event were recurring.

Negative Mood

• Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Dissociative Symptoms

• An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing.)
• Inability to remember an important aspect of the traumatic events (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

Avoidance symptoms

• Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
• Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

Arousal symptoms

• Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
• Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
• Hypervigilance
• Problems with concentration Exaggerated startle response

C. The duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g. medication or alcohol) or other medical condition (e.g., mild traumatic brain injury) and is not better explained by a psychotic episode.

Acute stress and the brain

The nervous system and its sympathetic branch help the body prepare for stress by generating a set of physiological responses. The body’s response to stress is also named “fight-or-flight response”, the blood flow to skeletal muscles, the heart, and brain increases, etc.

Acute stress is associated with these responses from the sympathetic nervous system. Adrenaline and noradrenaline are released from the medulla of the adrenal glands. They are the hormones that allow for our heart rate to increase and prepare the body for combat of escape.

When a person is serene the locus ceruleous is not stimulated, however, when the person senses the stimulus is new, the brain activates the sensory cortex through the thalamus to the brain stem. This increases activity in the locus ceruleous and the person becomes alert to their environment. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis.

Thase and Howland discovered that the more the stimulus is perceived as a threat the more intense the discharge in the locus ceruleous and the faster the fight or flight response is activated.

Watch this short video on the brain differences between acute stress and chronic stress or read more on the brain and stress.

How is Acute Stress disorder different from PTSD?

PTSD symptoms are very similar to those of acute stress, the symptoms are nearly identical. Actually, a diagnosis of Acute Stress Disorder becomes a diagnosis of PTSD almost automatically if the symptoms continue for beyond 30 days.

An Acute Stress Reaction can be diagnosed up to 2 days after an event occurs and the symptoms tend to go away on their own. However, when the symptoms don’t subside it turns into PTSD. That’s why treading an acute stress reaction is of utter importance.

Therapy and medication to treat acute stress

Exposure therapy may be very helpful in these cases. It’s a technique that consists of the patient visualizing the situation that is causing them stress with as much detail as they can. Narrative exposure therapy is a very common one in these cases. The patient should remain relaxed and try to see the situation from a positive point of view. This way they will feel safe when they face the situation and can work to overcome it.

Your therapist may be able to recommend cognitive therapy that may help overcome acute stress. These therapies are centered around the patient analyzing their thoughts and realizing when they are thinking negatively about a stressful situation or trauma. With cognitive therapy, the patient works to return to how they were before they suffered so much stress.

As far as medications, talk to your doctor so you can find out how they may help you. Some medications may help you sleep, reduce panic attacks, depression, etc. It’s is important to use these medications solely as a tool to your recovery, and not as a cure. If you are under a lot of stress, you should continue with therapy.

Relaxation and positive thoughts for treating acute stressful

Relaxation techniques have shown to be very helpful for reducing stress and reducing the symptoms of illnesses derived from acute stress, like insomnia, hypertension, migraines…

Try meditating: Concentrate on your breathing and ignore everything else that causes you stress, until you reach a change in your consciousness and forget about everything else. You’ll need to be in a calming place and focus on only one sound to be able to clean your mind of all your thoughts. You can also focus on an image or word, like “calm”. Dedicate 15-30 minutes a day to meditate.

You need a support network: This will be really helpful when you’re fighting against the symptoms of acute stress. It’s important to have support when you’re feeling weak, which is why talking to friends and family about your problems can help free from your negative problems.

Keep your negative thoughts in check: Each time you have a negative thought that changes you somehow, write it down in a notebook. This way, you’ll see the common patterns of your stressful thoughts. If you can recognize them before they happen, you’ll be able to learn how to manage your stress and keep it from owning you.

Try to think positively: When you know what negative thoughts affect you the most, try to trade them for happier ones. Each time that you feel yourself being taken over by negative thoughts, fight back and try to think positively. Positive thoughts have an amazing power over us, just like negative ones. It’s important to make sure the positive thoughts ultimately win.

References

Thase, M. E., & Howland, R. H. (1995). Biological processes in depression: An updated review and integration. In E. E. Beckham & W. R. Leber (Eds.), Handbook of depression (2nd ed., pp. 213-279). New York: Guilford Press.

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. The American Journal of Psychiatry, 156, 1780-1786.

Kring, A.M., Davison, G.C., Neale, J.M. & Johnson, S.L. (2007) Abnormal Psychology. USA: John Wiley & Sons.

This article is originally in Spanish written by Borja Echeverría, translated by Alejandra Salazar.

Alejandra Salazar

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.