Cognitive therapy for post-traumatic stress disorder in the context of Post-Intensive Care Syndrome - Family: a case study

Abstract The current case study was completed as part of the routine psychological therapy delivered in a Critical Care Psychology Service in the United Kingdom. For families of critically ill patients, an admission to the intensive care unit (ICU) can be a distressing and potentially traumatic experience. Relatives of ICU patients may, therefore, face ongoing psychological difficulties after their loved one’s discharge from hospital, an experience recognised as Post-Intensive Care Syndrome - Family (PICS-F). Psychological morbidity associated with PICS-F includes post-traumatic stress disorder (PTSD). Despite high rates of PTSD within this population, there are currently no published guidelines available for the treatment of PTSD in relatives following an ICU admission. Clinicians working in this field are consequently required to adapt existing psychological models and protocols recommended for treating PTSD, for application to ICU-related traumatic stressors. This case study describes how cognitive therapy for PTSD (CT-PTSD) was tailored to treat a 60-year-old female experiencing PTSD following her husband’s admission to the ICU. It also illustrates how critical illness can be conceptualised as an intangible loss that triggers a grief experience for relatives of ICU patients, causing PTSD symptoms to persist. The client attended 14 weekly sessions of CT-PTSD. Treatment included cognitive strategies for panic, imaginal re-living and a site visit, as well as consideration of the role of non-death loss and disenfranchised grief in the client’s experiences. At the end of treatment, the client no longer presented with clinically significant symptoms of PTSD, as assessed on the Impact of Events Scale-Revised (IES-R). Key learning aims It is hoped that this case study will enhance the reader’s understanding of the following areas: (1) The delivery of CT-PTSD when working with relatives of former patients admitted to the ICU. (2) The experiences of intangible loss and disenfranchised grief for relatives of former ICU patients and how these can contribute to the maintenance of PTSD symptoms. (3) The utility of the dual process model (DPM; Stroebe and Schut, 1999) as a framework when adapting the CT-PTSD model to the context of supporting relatives of former ICU patients.