CT-PTSD following a COVID-19 ICU admission in the context of unresolved grief, delirium and incurable cancer:a single case design with an older adult client

This case study recounts an application of Ehlers and Clark's (2000) cognitive model of post-traumatic stress disorder (PTSD) to post-intensive care unit (post-ICU) PTSD. An AB single case design was implemented. The referred patient, Rosalind (pseudonym), completed several psychometric measures prior to the commencement of therapy (establishing a baseline), as well as during and at the end of therapy. Idiosyncratic measures were also implemented to capture changes during specific phases of treatment. The importance of the therapeutic alliance, particularly in engendering a sense of safety, was highlighted. Findings support the use of cognitive therapy for PTSD (CT-PTSD) with an older adult, in the context of a coronavirus infectious disease (COVID-19)-related ICU admission. This case is also illustrative of the effectiveness of implementing CT-PTSD in the context of co-morbid difficulties and diagnoses of delirium, depression, and complicated grief. Key learning aims (1) To recognise the therapeutic value of CT-PTSD in addressing PTSD following a COVID-19 admission, in the context of complicated grief and delirium. (2) To consider the importance of a strong therapeutic alliance when undertaking CT-PTSD. (3) To understand the intersection of complicated grief and delirium in the context of ICU trauma. (4) To consider the challenges in working with PTSD, whereby the target trauma (COVID-19 ICU admission) is linked with ongoing uncertainty and continuing indeterminate threat.</p

Investigating the relationship between guilt and shame proneness and moral injury in veterans that have experienced active deployment

Moral injury accounts for the complexity of symptoms evident in military personnel which go beyond the posttraumatic stress disorder (PTSD) diagnosis. This study sought to investigate the relationship between guilt and shame proneness and exposure to morally injurious events in a sample of British military veterans (n = 104). Participants were recruited through a social media site and completed an online battery of self-report measures. Participants were male (n = 99) and female (n = 5) with a mean age of 47 years. Fifty-one percent of participants achieved scores on a measure of PTSD that would indicate a probable PTSD diagnosis. Results yielded no significant relationship between guilt and shame proneness and exposure to morally injurious events. There was however a significant relationship between PTSD and morally injurious events, accounting for 43% of the variance, with a medium effect size. When working with veterans with PTSD, clinicians need to be assessing for exposure to morally injurious events to tailor interventions successfully. Future research should look to establish an evidence base for psychological interventions for those that have experienced morally injurious events. Closer consideration of contributing factors, such as type of trauma and historical trauma is also needed to develop the construct further

Investigating the relationship between guilt and shame proneness and moral injury in veterans that have experienced active deployment

Moral injury accounts for the complexity of symptoms evident in military personnel which go beyond the posttraumatic stress disorder (PTSD) diagnosis. This study sought to investigate the relationship between guilt and shame proneness and exposure to morally injurious events in a sample of British military veterans (n = 104). Participants were recruited through a social media site and completed an online battery of self-report measures. Participants were male (n = 99) and female (n = 5) with a mean age of 47 years. Fifty-one percent of participants achieved scores on a measure of PTSD that would indicate a probable PTSD diagnosis. Results yielded no significant relationship between guilt and shame proneness and exposure to morally injurious events. There was however a significant relationship between PTSD and morally injurious events, accounting for 43% of the variance, with a medium effect size. When working with veterans with PTSD, clinicians need to be assessing for exposure to morally injurious events to tailor interventions successfully. Future research should look to establish an evidence base for psychological interventions for those that have experienced morally injurious events. Closer consideration of contributing factors, such as type of trauma and historical trauma is also needed to develop the construct further

Evaluating Outcomes and Experience of Eye Movement Desensitization Reprocessing Through a National Health Service Trust’s Staff Support Service

Aim: A National Health Service (NHS) mental health trust developed a pathway offering eye movement desensitization and reprocessing (EMDR) to healthcare professionals (HCPs). This research aimed to evaluate whether EMDR was linked to improvements in posttraumatic stress disorder (PTSD) and sought to understand the experiences of service users. Method: Pre-and post-outcome measures of the Impact of Events Scale—Revised (IES-r), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Work and Social Adjustment Scale (WASAS) were evaluated. Subsequently, a feedback survey was circulated to those who had accessed the service. Results: Analysis revealed statistically significant improvements in measures of PTSD, depression, anxiety, and functioning. The service was rated highly for accessibility and experience. Perceived treatment effectiveness was variable; however, reliving symptoms and sickness absence were reduced, and improvements made during therapy were reportedly maintained. Conclusion: This service evaluation offers preliminary support for the use of EMDR as a useful intervention for HCP. Recommendations that may be more broadly applicable for service development and considerations for future research are discussed.</p

Post-Traumatic Stress Disorder and Killing in Military Combat: A review of existing literature on serving military and veteran populations

Background: Killing during combat is a unique experience and, for the majority, is limited to military service. For those working with military and veteran populations, it is essential to be able to understand this experience and any psychological ramifications.Purpose: This review provides a synthesis of existing literature, addressing the specific question: what is known about the relationship between post-traumatic stress disorder and killing in combat? It summarises what is known of the relationship between these variables and the clinical implications of these findings.Method: A search of existing literature was conducted in a systematic manner in 2017 using electronic databases. A critical appraisal tool was used to inform data extraction and guide the literature review.Results: The literature suggests that those who kill during combat are more likely to report symptoms of PTSD; however, disparity exists as to the statistical significance of this relationship. Factors such as gender and victim characteristics may be influencing factors.Conclusion: The impact of killing during combat must be considered when working therapeutically with military and veteran populations. Future research should aim to recruit military participants from different populations and address some of the difficulties with recruitment—ensuring samples are representative and generalisable

Evaluating Outcomes and Experience of Eye Movement Desensitization Reprocessing Through a National Health Service Trust’s Staff Support Service

Aim: A National Health Service (NHS) mental health trust developed a pathway offering eye movement desensitization and reprocessing (EMDR) to healthcare professionals (HCPs). This research aimed to evaluate whether EMDR was linked to improvements in posttraumatic stress disorder (PTSD) and sought to understand the experiences of service users. Method: Pre-and post-outcome measures of the Impact of Events Scale—Revised (IES-r), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Work and Social Adjustment Scale (WASAS) were evaluated. Subsequently, a feedback survey was circulated to those who had accessed the service. Results: Analysis revealed statistically significant improvements in measures of PTSD, depression, anxiety, and functioning. The service was rated highly for accessibility and experience. Perceived treatment effectiveness was variable; however, reliving symptoms and sickness absence were reduced, and improvements made during therapy were reportedly maintained. Conclusion: This service evaluation offers preliminary support for the use of EMDR as a useful intervention for HCP. Recommendations that may be more broadly applicable for service development and considerations for future research are discussed.</p