Startle Reactivity and Peritraumatic Dissociations in Acute Stress Disorder

Startle reactions and their relationship to dissociative symptoms were assessed in acute stress disorder (ASD) patients. Electromyographic (EMG) responses, heart-rate reactions (HRR), and skin conductance responses (SCR) to startle stimuli were compared between victims of mixed traumatic events (n = 31) and healthy controls without trauma exposure (n = 20). All ASD patients met criteria for acute stress disorder (although 12 of them did not demonstrate the required number of dissociative symptoms). Compared to controls, ASD patients showed increased HRR and slower habituation, as well as increased SCRs to the startle stimuli. There were no significant group differences in relation to EMG responses. In ASD patients, reported intensity of peritraumatic dissociations was related to lower EMG startle magnitude and more rapid EMG habituation, suggesting a protective mechanism of dissociative symptoms that may come into effect in response to arousing situations and stimuli.

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FC25-01 - Effects of additional exposure to psychoeducation and relaxation in acute stress disorder

European Psychiatry ◽

10.1016/s0924-9338(11)73656-2 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1953-1953

Author(s):

G. Sartory

Keyword(s):

Stress Disorder ◽

Prolonged Exposure ◽

Acute Stress ◽

Acute Stress Disorder ◽

Progressive Relaxation ◽

Trauma Network ◽

Significant Group ◽

Autonomic Responses ◽

Supportive Counseling

IntroductionMeta-analytic studies found exposure to be the most effective treatment in PTSD. Results are less clear with regard to acute stress disorder.ObjectivesTo evaluate the additional effect of exposure therapy to supportive counseling.AimsThe assessment of subjective measures and the heart-rate (HR) response to trauma reminders in the two treatment conditions.MethodsForty recent trauma victims with acute stress disorder were randomly assigned to three sessions of either prolonged exposure (PE) or supportive counseling (SC) with both groups also receiving psychoeducation and progressive relaxation. PE was administered imaginal and in vivo, both being therapist-assisted. Assessments were carried out before and after treatment and again after three months. Patients were shown ideosyncratic trauma-related pictures and autonomic responses assessed. Four years later, patients were asked by telephone whether they had required further treatment.ResultsThere were no significant group differences with regard to symptomatic improvement at the end of treatment. Before treatment both groups showed HR acceleration to trauma-related pictures. After treatment the PE group showed attenuation of the HR-response and a reduction of spontaneous skin conductance fluctuations (SF) whereas the SC group showed a decelerative (orienting) HR response and an increase in SF. Over the next four years 43% of the SC group and and 9% of the PE group required further treatment.ConclusionThe data show that SC, unlike PE, fails to attenuate autonomic responses to trauma-related stimuli suggesting that the former treatment fails to reorganize the trauma network.

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