Brief CBT for acute stress disorder

Domain II · Behavioural & cognitive · Richard Bryant · 1998

What it is

Brief CBT for acute stress disorder (ASD) is a short, early, trauma-focused CBT course. It is given only to adults who meet ASD criteria (or have clinically important acute PTSD symptoms) in the first month after a trauma. It is not offered to everyone who has been exposed. Its aim is to prevent…

Format

• Format. Individual, face to face, weekly. Five sessions of about 90 minutes, delivered by clinical psychologists working from a manual, with weekly supervision of adherence and case notes. Some later versions use six sessions (the 2005 hypnosis trial and the ISTSS manual).
• Timing. The trials started treatment within 2 weeks of the trauma, in people who met ASD criteria. ASD covers reactions from 2 days to 4 weeks after the event. NICE NG116 recommends individual trauma-focused CBT for adults with ASD or clinically important PTSD symptoms within 1 month of a trauma,…

Evidence status, as the guide reports it

• 2008 trial: exposure arm = vivid verbal reliving with all perceptual and emotional detail, then imaginal and in vivo exposure homework, with relapse prevention in the final session. Cognitive restructuring arm = monitoring and challenging thoughts with Socratic questioning, probabilistic reasoning…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• repeated non-completion signals avoidance (section 5).
• reserve for trained hypnotherapists. Monitor for increased dissociation rather than engagement.
• a client agreeing only to please you. Check understanding by asking them to explain the rationale back in their own words.
• the client can state the plan in their own words. Residual avoidance at the end should be added to the self-directed hierarchy.
• relief and "that's exactly me" responses mean it is working. Shame about the reactions ("I should be over it") is material for cognitive restructuring.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.