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PTSD in the ICU: Treatment

Psychological Treatment for PTSD
Nick and I decided that we could explore the potential benefits of psychological therapy to help him overcome his ongoing trauma at that time. We embarked on trauma focused cognitive behaviour therapy. To do that, we firstly had to ensure that Nick had a good understanding of his difficulties, and explain those using psychological models. This formulation of his problems is an absolutely crucial part of treatment, and gets real credibility both to his treatment and his ongoing prognosis as well. The first stage of treatment beyond formulation then was to provide some psycho-education as to what trauma is and why it presents.
Beyond that, we then spent some time ensuring he had the skills that were going to be required to allow him to adapt to the stimuli that continued to provoke anxiety. The central tenet of psychological interventions for PTSD involve exposure therapy. If we are going to deliberately expose people to stimulate, provoke anxiety we need to make sure that patients have got the skills to be able to manage that anxiety that were deliberately provoking. So we spend time doing relaxation training and providing cognitive skills to challenge some of the cognitions that drive the anxiety, and some of the physiological reactions that occur with acute anxiety and panic.
Once the patient feels confident that they can control some of these physiological symptoms, we’re then in a stage that we can start exposing them to the types of stimuli, memories, thoughts, tangible items that may well provoke the anxiety. And we do that in a very controlled and graded manner. At times we are fortunate enough that we can do that in vivo, meaning that we can bring the patients back into the ICU, show them the bed that they were in, show them the devices that were used, meet the staff that they encountered along the way. Other times we don’t have that opportunity, and we have to rely on imaginary exposure, which can be just as effective and sometimes even more efficient.
For Nick, we were able to revisit the case notes from within ICU, but also the patient diaries, that we now routinely keep. These are diaries which are maintained by staff and patients, sometimes, and their families, which give an account of all the things that the patient goes through whilst they’re in ICU, and explain what’s happening to them and why. So when patients are discharged they’re given their diary and can revisit that when they feel able to do so, and help clarify exactly what was going on at that time.
In a controlled way, we were able to go through the diary and separate the fact from the fiction of what happened to ensure that the narrative of his trauma was clear and accurate. And this idea of creating a narrative is really one of the unique characteristics of any psychological intervention for PTSD. [UPBEAT MUSIC]

In week 1 Dr John Sharp introduced Nick, a heart transplant patient, who was making excellent physical advances following his transplant but struggling with his psychological adjustment. In this follow-up video, Dr Sharp discusses the role of psychological therapies in supporting people with PTSD, particularly TF-CBT and psychoeducation.

Image of Dr John SharpDr John Sharp is a consultant clinical psychologist working within the Scottish National Advanced Heart Failure Service. He oversees psychological services for people with heart failure being considered for or in receipt of advanced therapies including heart transplantation and mechanical circulatory devices.

Make some personal notes about why is ‘formulation’ an integral part in the treatment described by Dr Sharp.

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Post-Traumatic Stress Disorder (PTSD) in the Global Context

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