Definition

An acute stress reaction is a reaction to extraordinary life stress, both physical and mental, which occurs after a few minutes or even immediately after the event occurs. Acute stress reactions last no more than four weeks or one month. If this stress reaction lasts for more than one month, this condition is called post-traumatic stress disorder (PTSD). Acute stress reaction has another similar name, namely acute stress disorder.

Causes

Acute stress reactions have a clear cause, namely extraordinary life stress. This stress can take the form of suddenly losing a loved one, experiencing a serious injury, witnessing a terrible incident directly (not through any media), and experiencing physical, mental or sexual violence.

However, not everyone who experiences a traumatic event will experience an acute stress reaction. This depends on a person's vulnerabilities that existed even before the traumatic event occurred.

Risk factor

Factors that can increase the risk of an acute stress reaction are:

• Female gender
• People with mental disabilities
• Low level of education
• History of traumatic experiences
• History of mental disorders (including acute stress reactions or PTSD)
• Personality disorders
• Genetic or hereditary

These traumatic experiences vary greatly from person to person, but in general, they are experiences that are considered life-threatening, for example, violence and crime. Other examples could be traffic accidents, natural disasters, or terrorists.

A person does not need to experience the event directly to experience an acute stress reaction. Witnessing the incident without being hurt can also cause this reaction. Therefore, people who are victims, such as refugees, asylum seekers, and even helpers, such as police, health workers, and firefighters, are equally at high risk of experiencing acute stress reactions and, subsequently, PTSD.

Symptoms

The symptoms of an acute stress reaction are usually a changing mix of symptoms. Initially, a person may appear fixated, accompanied by narrowed attention, difficulty understanding the senses, and difficulty recognizing time, place, and other people. Furthermore, the person may increasingly withdraw from his environment or, conversely, become restless and overly active. Not only that, this symptom is usually accompanied by physical symptoms such as increased heart rate, cold sweats, and a flushed face. These symptoms usually appear within a few minutes after the event occurs and disappear within a few hours to 2-3 days. Other symptoms can include partial or complete amnesia (memory loss).

Other symptoms of an acute stress reaction can include:

Intrusion. Intrusion can be defined as "re-experiencing an event". Memories related to traumatic events can appear suddenly or can take the form of recurring dreams and flashbacks. Usually, this condition is accompanied by an intense psychological response

Dodge. People who experience acute stress will try to avoid sharing thoughts and feelings that remind them of the traumatic event or even avoid anything that could remind them of the incident.

Overactive. This is characterized by risky or aggressive behavior, as well as the potential for self-harm. The person may also experience sleep disturbances and hypervigilance and be more easily startled

Symptoms related to mood. This can involve negative thoughts, feelings, and moods. People with acute stress reactions may feel alienated from themselves and others, blame themselves or feel disinterested in carrying out their usual activities.

These symptoms are usually disturbing enough that a person cannot carry out their daily activities.

Diagnosis

If you may be experiencing an acute stress reaction, health workers, whether doctors, psychiatrists or psychologists, can ask you several questions regarding the traumatic event and the symptoms you are experiencing. Health workers will listen to your complaints carefully to understand the condition you are experiencing. This is usually difficult to do because people who experience acute stress reactions still remember the traumatic event. Therefore, usually, a person will need more than one visit to report their condition.

Usually, health workers will also try to rule out the possibility of using illegal substances, side effects of drugs, other health problems, and other mental disorders. Questionnaires can also be used to detect acute stress reactions in children and adults.

Management

Management of acute stress reactions begins when this condition is recognized. Usually, this condition can be recognized immediately after a traumatic event occurs. Management that can be carried out in the initial phase is:

• Patient safety. Helpers, whether health workers, police, soldiers, firefighters, or volunteers, will make sure someone is safe first and knows how to get help
• Emotional support. This support can be provided by anyone, for example, close friends and family. If this is not possible, health workers can provide support by teaching skills to deal with acute stress reactions
• Practical support. The recovery process after a traumatic event is often difficult. Someone may need help with reporting to the police, seeking help for daily living, taking time off work, and insurance claims. If there is disability due to an accident, the person will need further medical assistance
• Follow-up. People who experience significant traumatic events are advised to have regular check-ups for six months after the traumatic event occurs to help them deal with acute stress reactions or PTSD (if it persists)
• Tendency to end life. Health workers will try to evaluate how likely a person is to end their life after a traumatic event, especially if there are other mental disorders, such as depression

Long-term management of acute stress reactions (which can last a month or more) can be in the form of psychotherapy. Psychotherapy is a therapy that involves discussions between patients and therapists for various purposes, such as the following:

• Cognitive behavioral therapy focuses on trauma. This therapy aims to increase knowledge related to trauma psychology, skills in dealing with symptoms, recognizing and controlling mental disorders, as well as exposure therapy
• Exposure therapy. This therapy involves controlled exposure to a traumatic source, which aims to relieve the memory of the trauma and reduce the level of fear. Initially, this therapy may cause symptoms to worsen temporarily, but it can train a person in the long term

Meanwhile, drug therapy is often not necessary for acute stress reactions. If someone experiences sleep disorders, health workers can prescribe medication to help sleep and provide tips and tricks to improve sleep quality.

Complications

The main complication of an acute stress reaction is that the condition progresses to post-traumatic stress disorder (PTSD). Complications of acute stress reactions beyond PTSD can include mood disorders and substance abuse disorders. Mood disorders can include depressive disorders (with or without suicidal tendencies), anxiety disorders, and panic disorders. Meanwhile, substance abuse disorders can involve alcohol or narcotics, psychotropic substances, and other addictive substances (NAPZA).

Prevention

Prevention of acute stress reactions is difficult because we cannot know when a traumatic event will occur in the future. However, there are several things you can do to reduce the risk of an acute stress reaction, for example by immediately visiting a doctor if you have just experienced a traumatic event a few hours earlier. In addition, people who work in high-risk environments such as the military can undergo training, preparation, and counseling to reduce the risk of acute stress reactions and PTSD if they experience a traumatic event. This training, preparation, and counseling can involve simulating traumatic events and counseling to strengthen coping mechanisms.

When to see a doctor?

If you have recently experienced a traumatic event and feel sad, worthless, or panicked, anxious, and have difficulty controlling your emotions and working, you should immediately visit a health professional. Acute stress reactions that are not treated appropriately can progress to PTSD, and have the potential to disrupt your daily life and your relationships with other people.