Acute Stress Disorder and Forms of Narrative Disruption

Intervening with persons in the immediate aftermath of potentially traumatic events poses a number challenges for clinicians. Particularly in clinics that serve military personnel or other populations whose livelihoods may depend on regaining functioning efficiently following trauma, there is a need for sensitive and effective psychotherapies for acute stress disorder (ASD), a diagnostic category which attempts to capture maladaptive responses to trauma within the initial four weeks. In this context, Palgi and Ben-Ezra (2010) developed “Back to the Future,” a novel treatment for ASD guided by narrative and constructivist understandings of posttraumatic adjustment (e.g., Neimeyer, 2009; White & Epston, 1990). One of the distinctive aspects of Palgi and Ben-Ezra’s approach involves a departure from exposure-oriented models of psychotherapy so as not to strengthen the substantive core of the traumatic experience for the survivor—called the “traumatic nucleus”—in the early adjustment period. My discussion of Palgi and Ben-Ezra’s case of Mr. G and related general issues uses a framework of three common forms of narrative disruption after trauma. Specifically, I first discuss “narrative dominance” as a particular strength of the “Back to the Future” model and raise a general question about the possible negative ramifications of the ASD diagnosis itself. I next discuss “narrative dissociation” and its implications for the nature of the diagnosis of ASD. Finally, I discuss “narrative disorganization” and several empirical studies that suggest the importance of exposure in directly addressing the “traumatic nucleus” among ASD sufferers, in contrast to the recommendations of the “Back to the Future” model to minimize attention to this component in the acute adjustment period.