Repetitive transcranial magnetic stimulation combined with imaginal exposure therapy for adolescents with acute stress disorder: case report

Acute stress disorder (ASD) is a transient psychiatric disorder that may arise subsequent to abrupt, extreme trauma exposure, and serves as a reliable indicator for the subsequent development of posttraumatic stress disorder (PTSD) (Bryant, 2011; Battle, 2013). It exhibits rapid progression in the aftermath of trauma and persists for a duration of days or weeks (not exceeding one month), manifesting symptoms of dissociation, re-experiencing, avoidance, and hyperarousal (Bielas et al., 2018). In the absence of efficacious and prompt intervention, ASD is linked to substantial morbidity and functional impairment (McLean et al., 2022). However, there is a deficiency in terms of providing sensitive diagnosis and effective treatment for adolescents diagnosed with ASD, with the majority of current approaches being derived from PTSD treatment. The prevailing strategies for addressing PTSD in children and young individuals primarily involve psychological intervention and pharmaceuticals, including selective serotonin reuptake inhibitors (SSRIs) (Smith et al., 2013). Nevertheless, the efficacy of SSRIs in adolescents with ASD remains suboptimal (Robb et al., 2010; Locher et al., 2017; Boaden et al., 2020).