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20% dropout rate hinders prolonged therapy. (Intense Therapeutic Experience).

BALTIMORE - The ideal early treatment for acute stress disorder in recent trauma survivors may prove to be a "hot" cognitive therapy that combines the best of cognitive therapy with the best of prolonged exposure therapy.

Of the two treatments, prolonged exposure therapy is more effective in treating acute stress disorder, but 20% of patients find the therapeutic experience so intense that they cannot finish treatment, Richard Bryant, Ph.D., said at the annual meeting of the International Society for Traumatic Stress Studies.

In addition, another 20% of patients do not respond to this therapy within 6 months. That means that at least 40% of people with acute stress disorder are not getting the help they need, he said.

"We need to develop interventions that most people can benefit from," Dr. Bryant said. In his proposed "hot" cognitive therapy, a patient does exposure-type exercises to boost emotional processing without actual in vivo exposure to traumatic stimuli.

"It combines the best from each therapy," said Dr. Bryant, director of clinical psychology at the University of New South Wales in Sydney, Australia.

Dr. Bryant reported on an ongoing study of 40 survivors of nonsexual assault who had developed acute stress disorder and were at risk for posttraumatic stress disorder. They were randomized to prolonged exposure therapy using imagined exposure to traumatic stimuli, cognitive therapy without exposure, and supportive counseling. As expected, more patients are dropping out of prolonged exposure therapy than are dropping out of cognitive therapy or supportive counseling.

"We know that prolonged exposure therapy is more effective than cognitive therapy, but we lose too many people," Dr. Bryant said.

For some, early intervention with cognitive behavioral therapy has the ability to avert the progression of acute distress syndrome to posttraumatic stress disorder.

Treatment is not necessary for most people exposed to a traumatizing event. "Most people are resilient. They'll have a transient stress reaction" and then move on with their lives, Dr. Bryant said.

An estimated 80% of people who develop acute stress disorder after a traumatic event will progress to posttraumatic stress disorder unless they receive treatment. "There is little chance that they will get better without our help," said Dr. Bryant, who added that 70% of people with untreated posttraumatic stress disorder still have it 2 years after diagnosis.

Treatment should be reserved for people who meet the criteria for acute stress disorder that are listed in the DSM-IV In general, patients with acute stress disorder experience dissociation, re-experience, avoidance, and arousal within the first month after the traumatic event.
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Author:Kubetin, Sally Koch
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jan 1, 2003
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