Stress Reactions

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Major stress involves threat or loss e.g.

  • physical or sexual assault
  • road traffic accidents
  • natural disasters
  • pandemics
  • war
  • bereavement

Reactions to these stressors involve:

  • emotional responses (e.g. sadness, anger)
  • physical symptoms (e.g. sweating, racing heart)
  • psychological responses (e.g. denial, avoidance).

It is normal to experience some or all of these symptoms after a stressful event. It only becomes abnormal when reactions are amplified or prolonged, or the person develops maladaptive coping strategies.

Adjustment Disorder

A range of abnormal responses to life stresses (e.g. separation, loss of job). Usually starts within weeks and lasts less than six months.

Symptoms usually include low mood and anxiousness (but not enough to diagnose depression or anxiety) with physical symptoms like dry mouth, racing heart, sweating.

Manage this with practical support (housing / job advice if necessary), use problem-solving approach (see section) and listen actively to allow space to work though feelings.

Acute Stress Reaction

Onset usually minutes to hours after an exceptional stress and lasts less than three days.

Mixed picture of symptoms such as dazed or perplexed, intensely anxious, racing heart / sweating.

Give practical support – keep person safe, re-orientate, engage family support. See Psychological First Aid in Part 2

Post Traumatic Stress Disorder (PTSD)

Onset usually weeks to months after event and lasts for over one month (acute stress reaction if less than one month).

Symptoms include: 

  • Intrusive thoughts
  • avoidance
  • increased arousal
  • numbness / detachment

Psychological first aid (see section) is the most helpful strategy for distress immediately after the event. (Do not debrief following the event as this can make it worse.) Counselling strategies are often of great help in recovery. Sleeping tablets (benzodiazepines) and antidepressants are very rarely useful in the immediate aftermath of trauma but antidepressants are helpful if other approaches have failed or if there are symptoms of depression. Refer for trauma-focused CBT, if available, or enquire about getting skills training in this area.

Normal Grief

Lasts less than two years. Usual stages: are shock and disbelief – anger – guilt and self-blame – sadness and despair – acceptance. The order is often not as straight-forward as this and people can jump forward and back through the stages during normal grief.

Support people grieving by encouraging them to describe their feelings. No specific treatment needed.

Abnormal Grief Reaction

Delayed onset, greater intensity and more prolonged than normal grief (at least six months). More likely if death was sudden, normal grieving was prevented by situation, there was a difficult relationship with the deceased.

Symptoms are intense and disabling and include: feeling numb, shocked or stunned by the loss and feeling angry or struggling to accept it. Feeling life is empty or confusion about one’s purpose in life is common.

Abnormal grief responds well to encouraging a structured review of the relationship and allowing person to describe their feelings. May need referral for CBT. If person is clearly depressed, treat for depression.