ICYMI: Read Part 1 of this 2-part blog series!

Acute Stress Disorder (ASD) is a psychological response to a traumatic event that typically arises within a month of the experience. If untreated, ASD can evolve into Post-Traumatic Stress Disorder (PTSD). Additionally, individuals with PTSD are at an increased risk of developing substance use disorders (SUD), as they might use substances to cope with their distress. Effective prevention strategies are essential to stop ASD from escalating into PTSD and SUD. This blog explores these strategies, with a special focus on the cultural aspects that clinicians need to consider.

ASD is a condition that can occur in the immediate aftermath of a traumatic event. The symptoms typically appear within three days to one month following the event and can significantly impair an individual's ability to function. The symptoms of ASD are similar to those of Post-Traumatic Stress Disorder (PTSD) but are of shorter duration. According to the Diagnostic and Statistical Manual of Mental Disorders, the symptoms of ASD are categorized into five groups:

• Intrusion: Recurrent, involuntary, and intrusive distressing memories, flashbacks, and nightmares. Feeling or acting as if the traumatic event is recurring.
• Negative mood: Persistent inability to experience positive emotions: A pervasive feeling of sadness, hopelessness, or a lack of pleasure in previously enjoyable activities.
• Dissociation: Feeling detached from oneself or one's surroundings, such as feeling in a daze, time slowing down, or the world feeling unreal.
• Avoidance: Efforts to avoid distressing memories, thoughts, or feelings.
• Arousal: Sleep disturbances, irritability, hypervigilance, and problems with concentration.

Strategies that Consider Multicultural Factors to Decrease the Risk of Acute Stress Disorder Becoming PTSD

Cultural factors significantly influence how individuals experience and cope with trauma. Clinicians must understand and integrate cultural aspects into their prevention and treatment strategies. This involves understanding cultural attitudes towards mental health, trauma, and substance use and tailoring interventions accordingly. Therapists who are culturally responsive and sensitive to clients’ backgrounds could increase engagement, treatment satisfaction, and health outcomes.

The following reflective questions can guide the clinicians’ exploration to gain a deeper understanding of the client's multicultural factors.

• Addressing Stigma: Recognizing and addressing the stigma associated with mental health and substance use in different cultures is vital. Creating a safe and non-judgmental environment encourages individuals to seek help without fear of discrimination or shame.

• Are there any stigmas or perceptions within your culture that influence how you feel about this event?
• How do you think your cultural background influences your willingness to seek help?
• Are there any cultural considerations I should be aware of to better support you?
• Language and Communication: Providing therapy in the individual’s native language and using culturally relevant metaphors and examples can enhance engagement. Overcoming language barriers is crucial for effective communication and therapy.
• Do you speak another language?
  • Do you prefer to share your story in your primary language?
  • As your clinician, how can I respect and support your cultural perspective as we work through this together?
  • How can we incorporate your cultural strengths and resources into your treatment plan?
• Incorporating Traditional Healing Practices: Integrating community and traditional healing practices can enhance the effectiveness of treatment. In many cultures, rituals, storytelling, and spiritual practices are integral to healing from trauma.

• What cultural beliefs or values are relevant to understanding this event and its impact on you?
• What cultural resources (e.g., spiritual practices, community leaders) are available to support you through this time?
• Are there specific cultural rituals or practices that you think would help you process and heal from this event?

Psychoeducational Resources

• Psychological First Aid (PFA) is a critical tool that provides immediate support and stabilizes the affected individual soon after the traumatic event. PFA involves ensuring physical and emotional safety, offering comfort, and connecting individuals to further resources and services.
• PTSD Coach App is available in Spanish and English. This app supports clients by providing several resources to manage symptoms after being exposed to a traumatic event.
• Podcast: PTSD Bytes-Provides up-to-date educational information about PTSD.
• Entendiento el TEP: Guía para familiares y amigos- A guide for families and friends about PTSD.

Educating individuals about the symptoms and risks of ASD and PTSD empowers them to recognize early signs and seek help promptly. Awareness campaigns and educational programs can play a significant role in reducing stigma and promoting mental health literacy. Preventing ASD from developing into PTSD and a concurrent SUD involves a multifaceted approach that includes early intervention, effective psychological therapies, robust social support, and cultural sensitivity. By addressing these aspects, mental health professionals can significantly mitigate the long-term impact of trauma and improve the overall well-being of individuals at risk.

References

American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC.

Bryant, R. A. (2011). Acute stress disorder as a predictor of posttraumatic stress disorder: A systematic review. The Journal of Clinical Psychiatry, 72, 233-239. doi: 10.4088/JCP.09r05072blu

Ford, J., Grasso D., Elhai, J., & Courtois, C. (2015). Social, cultural, and other diversity issues in the traumatic stress field. Posttraumatic Stress Disorder. 503–546. doi: 10.1016/B978-0-12-801288-8.00011-X

National Institute of Mental Health. (May 2024). Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

US Department of Veterans Affairs. (2021). Acute stress disorder. https://www.ptsd.va.gov/professional/treat/essentials/acute_stress_disorder.asp

About the Authors

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Isa Vélez Echevarria, PsyD, is a Puerto Rican clinical psychologist. She is the Ohio State Project Manager for the Great Lakes Addiction, Mental Health, and Prevention Technology Transfer Centers managed by the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison.  During her pre-doctoral internship at Children’s Institute in Los Angeles, CA, she obtained a certification as Interpersonal Psychotherapy Clinician. She was trained in Trauma-Focused Cognitive Behavioral Therapy and Family Therapy. In addition, she provides telehealth services to communities of color in Massachusetts and Puerto Rico. Her clinical work has focused on culturally tailored and trauma-informed services to Latinx communities.

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Mark Sanders, LCSW, CADC, is the Illinois state project manager for the Great Lakes ATTC, MHTTC, and PTTC. He's an international speaker and behavioral health consultant whose presentations and publications have reached thousands throughout the United States, Europe, Canada, West Indies, Lithuania, and Guam. Hes the recipient of four lifetime achievement awards, including NAADAC’s prestigious Enlightenment Award, the National Association for Addiction Professionals’ 50^th Anniversary Legends Award, the Illinois Certification Board's Professional of the Year Award and Jessica Hayes Lifetime Achievement Award, and the Barbara Bacon Award for outstanding contributions to the social work profession as an alumnus of Loyola University.