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Creating a Treatment Plan for Acute Stress Disorder: What to Include + Example

Acute stress disorder (ASD) is a mental health concern that individuals can experience within a month of experiencing a traumatic event. Symptoms associated with ASD resemble those of PTSD, however, these symptoms do not indicate the presence of PTSD until the individual has experienced them for more than 4 weeks. Research has indicated that over 80% of individuals who develop ASD develop PTSD 6 months later, there is no causation between ASD and PTSD, and there are cases where individual symptoms do not progress. In these situations, the individual may still be at risk of developing PTSD down the road. Keep reading to learn how to create an evidence-based treatment plan for acute stress disorder, with an example.

Studies have indicated that the prevalence of ASD among trauma survivors ranges from 6% to 30%. There are notable differences in the prevalence of ASD among individuals whose trauma was the result of a natural disaster, compared to those whose trauma involved acts of violence.

Cognitive-behavioral therapy (CBT) is the treatment of choice when working with clients who are experiencing ASD. Individuals who receive treatment utilizing CBT shortly after the time of the trauma are less likely to develop PTSD when compared to those who receive no treatment after a traumatic event. CBT can be an effective approach with virtual appointments, with appropriate modifications. Exposure therapy is another commonly used treatment for ASD. Pharmacotherapy can be used in some cases to help manage mood symptoms, symptoms including avoidance and recurrent memories are typically not responsive to medications.

View our Counseling treatment Plan that corresponds with this resource

Setting Goals and Objectives With Clients in Your Acute Stress Disorder Treatment Plan

When you begin thinking about ASD treatment plan goals for your client, it is important to take a step back and look at your client as a whole person. Mental health conditions are complex and rarely straightforward. This means that it is important to consider their history of mental illnesses, previous trauma, and other related factors in their treatment plan. Clients who have been misusing drugs or alcohol to cope with their symptoms may benefit from a focus on healthy coping skills, and psychoeducation about the progression of substance use disorders.

Evaluations for acute stress disorder should explore your client’s current safety, emotional support, practical support for the traumatic event itself (i.e. law enforcement, lawyers, or advocates), as well as suicidality concerns. These factors can help you determine if your client would benefit from inpatient or outpatient care. ASD symptoms typically begin anywhere from 3 days to 4 weeks after a trauma, meaning that some may have just experienced their trauma and may still be wrapping their head around what has happened to them.

The initial steps in treatment for a client who you believe has developed ASD are to help them understand their current mental health concerns, what has led to it, and where they can go from here. It is important to instill a message of hope into this because people can have various emotional reactions after a trauma. After that, you can work towards helping clients learn to cope with their symptoms so that they can begin addressing the root of their mental health concerns.

What to Include in a Treatment Plan for Acute Stress + Example

For the remainder of this article, we will be referencing a hypothetical case study of a woman named Jane who has developed ASD after experiencing trauma. This example will help us walk through the exact steps of what can be included in a treatment plan for ASD. 

Case Example:

Jane is a 32-year-old woman who recently experienced a traumatic event involving domestic violence with her partner. This incident occurred one week ago, and since then, Jane has been struggling with various mental health symptoms. She frequently experiences intrusive memories and flashbacks of the traumatic event, which disrupt her daily life and cause significant distress. Jane also reports having nightmares related to the incident, feeling detached from her surroundings, and experiencing an inability to experience joy or pleasure in activities she once enjoyed. She avoids places, people, and activities that remind her of her partner and the traumatic evening. Additionally, Jane has difficulty sleeping due to worries about having nightmares and experiences irritability and hypervigilance. She had a follow-up appointment with her primary care physician a few days ago because of injuries she received, and he provided her with a referral to the outpatient mental health treatment facility you work in. Jane denied taking any psychotropic medications and reported taking OTC pain medication for her injuries.  Jane shared that she has struggled with anxiety in the past, especially in periods of high stress or significant changes. Jane denied having any current SI concerns and denied a history of suicidal ideation, intent, and attempts.

Since the traumatic event, Jane has moved into her brother’s house and plans on remaining there for the immediate future. She identified him as a safe person and noted that she feels welcomed and supported in his home with his wife and two children. Jane does not wish to have her family involved in treatment but is willing to have her brother as an emergency contact. She denied being in contact with her partner and noted that she currently has a restraining order and has a lawyer working on initiating a divorce.

Agencies Involved and Plans for Care Coordination

In this case example, it would be appropriate to be in contact with her primary care physician if she is comfortable doing so. Consulting with her doctor can provide you with additional details that she may not have mentioned to you.

Example for Jane:

Other Agency: J.’s Primary Care Physician

Plan to Coordinate Services: Speak with J.’s referring Physician to confirm her engagement in treatment, and to inform of her treatment plan

Other Agency: None at this time

Plan to Coordinate Services: N/A

Clinical Diagnoses

Based on the information provided, Jane meets the criteria for Acute Stress Disorder. Her symptoms have developed within 1 month of experiencing a trauma, and she has met the other criteria for this diagnosis. In this case example, we will use the Acute Stress Disorder Interview to explore her experience with ASD symptoms and their severity.

Evaluations for ASD heavily rely on a clinical interview with thorough questions, a physical exam, and some questionnaires or screeners. Examples of screeners or questions you could use during an assessment include:

  • Acute Stress Disorder Interview (ASDI)
  • Impact of Event Scale-Revised (IES-R)
  • PTSD Checklist for DSM-5
  • Beck Depression Inventory-II

Example for Jane:

Acute Stress Disorder, 308.3 (F43.0)

Supporting Assessments: Acute Stress Disorder Interview, Score 76

Current Medications and Responses

Jane has indicated that she is not currently taking psychotropic medications and that her doctor advised her to take OTC medications for pain.

Example for Jane:

OTC pain medications, as needed to manage pain

Presenting Problem and Related Symptoms

This section of your treatment plan will describe your client’s presenting concern in detail from a clinical perspective. Your description should provide readers with a thorough understanding of your client’s current symptoms, level of impairment, and overall emotional wellness.

Example for Jane:

Jane Doe, a 35-year-old marketing executive, presents with symptoms consistent with acute stress disorder following a recent domestic violence incident with her partner. Jane reports intrusive memories, nightmares, avoidance of trauma reminders, negative mood alterations, and heightened arousal. Assessment using the Acute Stress Disorder Interview (ASDI) confirms significant symptomatology. Jane is diagnosed with acute stress disorder and is initiated on a treatment plan involving cognitive-behavioral therapy, psychoeducation, relaxation techniques, safety planning, and social support.

Goals and Objectives

The goals and objectives of your acute stress disorder treatment plan should be specific in detail, realistic, and attainable for your client. Goals can be overarching, or long-term goals your client is working towards, with smaller goals, or objectives, that can be accomplished during this journey. Your counseling sessions will be tailored to work toward your client’s unique symptoms and needs. The therapeutic approach and interventions used should be evidence-based and appropriate for your client.

Example for Jane:

Goal 1

Presenting problem: Intrusive Thoughts Causing Clinical Distress

Long Term Goal:  Reduce Intrusive Symptoms and Negative Thought Patterns

Objective 1: Implement cognitive restructuring techniques to challenge and modify Jane’s negative beliefs and interpretations related to the traumatic event, replacing them with more adaptive and balanced thoughts.

Objective 2: Introduce mindfulness practices, such as mindfulness meditation and grounding exercises, to help Jane cultivate present-moment awareness and reduce rumination on intrusive memories and worries.

Objective 3: Teach relaxation techniques, including diaphragmatic breathing and progressive muscle relaxation, to help Jane manage physiological arousal and promote a sense of calmness and relaxation

Goal 2

Presenting problem: Emotion Dysregulation

Long Term Goal: Improve Emotional Regulation and Coping Skills

Objective 1: Incorporate cognitive-behavioral strategies to identify and address triggers for emotional distress, helping Jane develop effective coping strategies to manage overwhelming emotions.

Objective 2: Encourage regular mindfulness practices to enhance Jane’s emotional regulation skills, allowing her to observe and accept her thoughts and emotions without judgment and respond to them more adaptively.

Objective 3: Facilitate the use of relaxation techniques as coping tools during times of heightened stress or emotional arousal, empowering Jane to self-soothe and regulate her emotions in challenging situations.

Goal 3

Presenting Problem: Impaired Functioning and Reduced Quality of Life

Long Term Goal:Enhance Overall Well-Being and Quality of Life

Objective 1: Integrate cognitive restructuring techniques into Jane’s daily life, encouraging her to apply learned cognitive skills to challenge negative thoughts and promote a more positive and resilient mindset.

Objective 2: Support the consistent practice of mindfulness exercises, both formally and informally, to foster greater self-awareness, self-compassion, and acceptance of her experiences and emotions.

Objective 3: Promote the regular use of relaxation techniques as part of Jane’s self-care routine, emphasizing their role in reducing stress, enhancing relaxation, and improving overall well-being and quality of life.

Specific Interventions to Be Used

The therapeutic interventions used should align with the therapeutic approach being used, which is appropriate for the concerns your client is experiencing. It is important to keep in mind that two clients can have the same mental health concern, yet experience different symptoms and challenges. Treatment plans should be tailored to address the unique needs of your clients. This section of your treatment plan can be a helpful resource for identifying who is responsible for carrying out actions that will work towards accomplishing their treatment goals.

Example for Jane:

Intervention/Action: Psychoeducation

Responsible Person: Counselor A

Intervention/Action: Cognitive restructuring

Responsible Person: Counselor A

Intervention/Action: Introduction and use of mindfulness and relaxation practices

Responsible Person: Counselor A and Jane

Intervention/Action: Relaxation techniques including, but not limited to, diaphragmatic breathing and progressive muscle relaxation

Responsible Person: Counselor A

Family Involvement

Similar to other mental health conditions, having social support can reduce feelings of isolation with acute stress disorder. While Jane has reported having a close relationship with her brother, she is not comfortable involving him in her care past the extent of an emergency contact. Should she choose to involve her brother or any other family members in her treatment, she is welcome to do so at any point, and adjustments can be made to her treatment plan.

Example for Jane:

At this time, Jane does not wish to involve his family in his treatment

Additional Services and Interventions

Additional treatment services can be used to enhance Jane’s treatment experience and provide additional sources of support. As your time with Jane progresses, you may find other resources or services that would be of value and can make the appropriate referrals.

Examples for Jane:

  • Provide referral for group therapy
  • Provide referrals for holistic therapies, such as yoga, acupuncture, or art therapy
  • Provide referrals for peer support groups
  • Discuss community resources including domestic violence shelters, legal advocacy services, and crisis hotlines

Estimation for Completion

The estimated time of completion for Jane will be dependent on the severity of her symptoms, level of impairment, and the progress she is making in treatment. Often, individuals with ASD may begin to see improvement in their symptoms within the first few months with the use of CBT. However, the full resolution of symptoms can take up to a year and can change throughout their treatment experience. Because of this, the estimated time for completion should be edited to reflect current progress.

Example for Jane:

6 months of weekly sessions, to be adjusted as needed

Aftercare Plans

Aftercare plans should be reflective of your client’s current needs because treatment can end early for any number of reasons. This section of your treatment plan can be adjusted when you have your scheduled reviews to reflect changes that have occurred.

Example for Jane:

  • Continued therapy and counseling
  • Group therapy
  • Medication management, if medications are used
  • Continue with regular use of relaxation strategies

Final Thoughts On Creating a Treatment Plan for Acute Stress Disorder

We hope that reviewing our sample treatment plan for acute stress disorder has provided you with some insight into factors that should be considered. Treatment plans should address your client’s unique needs, experiences, and symptoms while prioritizing the development of the therapeutic relationship. Once you have established safety and stabilization, you can use your outlined interventions to promote healing and resilience.

Clients who are experiencing Acute Stress Disorder often benefit from the use of empathy, compassion, and understanding. Their trauma has had a significant impact on their lives, and they are trying to navigate a way forward after this life-changing experience. Respecting a client’s autonomy can have a pivotal role in their healing experience.

Clinicians who find value in utilizing worksheets during their sessions are encouraged to review the Acute Stress Disorder Worksheets available through TherapyByPro, as well as their editable Treatment Plan. Worksheets can be a valuable resource in session, and provide clients with a reference of topics discussed in treatment while outside of session.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health forms, worksheet, and assessments here.

View our Counseling treatment Plan that corresponds with this resource

Resources:

Kayla Loibl, MA, LMHC
Author: Kayla Loibl, MA, LMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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