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Biblical Counseling: Compare and Contrast Secular Counseling Theories

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Evidence-based answers from the Family Physicians Inquiries Network

What is the most effective way to relieve symptoms of acute stress disorder?
EVIDENCE-BASED ANSWER

James M. Scott III, MD; Neil Nipper, MD Eglin Air Force Base Family Medicine Residency, Eglin AFB, Fla Rita Smith, MS, MEd Lackland Air Force Base Medical Library, Lackland AFB, Tex

A

cognitive behavioral therapy (CBT) that emphasizes exposure-based treatment is the most effective intervention for adults with acute stress disorder (ASD) (strength of recommendation [SOR]: B, meta-analysis of limited-quality randomized controlled trials [RCTs]). Exposure-based therapy reduces

symptoms in adults with ASD more than CBT that focuses on cognitive restructuring; both therapies are better than no treatment at all (SOR: B, a limited-quality RCT). Avoid drug treatment within 4 weeks of appearance of symptoms, unless distress is too severe to be managed with psychological treatment alone (SOR: C, consensus guideline).

Evidence summary
ASD refers to a constellation of psychological symptoms that can occur within 4 weeks after a traumatic event.1 (For more on ASD, see http://www.psychologynet.org/dsm/stress. html.) Patients with symptoms that persist beyond 4 weeks or develop after 4 weeks are diagnosed with post-traumatic stress disorder (PTSD). Approximately 12.5% of people who experience a traumatic event develop ASD, and 10% develop PTSD, although not all patients who develop PTSD have preceding ASD.2 Early identification and treatment of ASD can decrease the percentage of patients who go on to develop PTSD.2
Exposure-based therapy works better than cognitive restructuring A 2009 meta-analysis of small, limited-quality RCTs noted that CBT based on re-exposure to memories of the traumatic event, when started within 3 months of the event, is more effective than supportive counseling for adults

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