Intended for healthcare professionals

Practice Practice Pointer

Immediate management of acute psychological trauma in conflict zones

BMJ 2023; 380 doi: (Published 08 February 2023) Cite this as: BMJ 2023;380:e071851
  1. Neil Greenberg, professor of defence mental health1,
  2. Darren Minshall, defence consultant adviser in psychiatry2,
  3. Amos Simms, senior lecturer, academic department of military mental health2
  1. 1King’s College London, UK
  2. 2Ministry of Defence, UK
  1. Correspondence to N Greenberg, neil.greenberg{at}

What you need to know

  • Most people exposed to traumatic situations will cope well

  • Individuals with acute stress reaction symptoms can be readily identified

  • Effective management strategies are swift and simple; they include rapidly connecting with and reorienting affected individuals

After witnessing a roadside bomb explosion, an experienced conflict journalist becomes mildly distressed but manages, calmly, to ensure the aftermath is filmed for the next news broadcast. However, a young mother, who had chosen that moment to flee to safety with her family, experiences the same incident as being severely threatening and consequentially experiences high levels of distress, including being highly vigilant, having recurrent distressing thoughts of the explosion, and finding it very difficult to sleep.

Immediate management of acute psychological trauma (acute stress reactions) in conflict zones can help reduce the risks of prolonged short term distress (acute stress disorder) and of developing post-traumatic stress disorder or other mental illness.

We present approaches to managing acute psychological trauma that require no specialist equipment or lengthy training; ie they can be used in all resource settings. Although these techniques have been developed mostly for military, media, and charity groups, they can be applied in any environment (although with adults only).

How do people respond after threatening or traumatic situations?

Experiencing and/or witnessing incidents such as natural or human made disasters, combat, serious accidents, sexual violence, and assault1 can prompt immediate post-trauma arousal. The nature and degree of someone’s acute reaction depends on many factors, including previous trauma experience, genetic risk, training, level of personal threat, and health status before the exposure. Most people will not develop an acute or chronic mental illness. However, some may develop an acute transient condition, known as an acute stress reaction, which is the main focus of this article.

Acute stress reactions

Acute stress reaction is defined by the ICD-11 as transient emotional, somatic, cognitive, or behavioural symptoms (box 1) that …

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