Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-12-04T19:22:59.988Z Has data issue: false hasContentIssue false
  • English
  • Français

IAPT CBT treatment for PTSD following COVID-19-related intensive care admission – a case study

Published online by Cambridge University Press:  17 June 2022

Lilian Skilbeck Open the ORCID record for Lilian Skilbeck [Opens in a new window]  and
Suzanne Byrne
Lilian Skilbeck*
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, Stratford, London E15 4ES, UK
Suzanne Byrne
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience. King’s College London, De Crespigny Park, London SE5 8AF, UK
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The current case study was conducted as part of the National Health Services and Health Education England implemented IAPT top-up training in trauma-focused cognitive therapy for post-traumatic stress disorder (PTSD). There has been an increase in the number of clients presenting to IAPT with COVID-19 intensive care unit PTSD since the pandemic. However, there are no current unitary guidelines for psychological therapy for this population. Treatment of PTSD using individual trauma-focused cognitive therapy has been shown to be effective for ICU-PTSD. The National Institute for Health and Care Excellence treatment guidelines recommend adapting existing protocols. This study describes how these recommendations were used in the treatment of COVID-19 ICU-PTSD in a 46-year-old male. It illustrates the use of trauma-focused cognitive therapy for PTSD and how ICU trauma memories including hallucinations were conceptualised. It also illustrates how the challenges of co-morbid panic attacks, long COVID and remote working were managed. The client attended 16 individual, 60- to 90-minute video sessions of trauma-focused cognitive therapy, conducted weekly via Microsoft Teams over a period of five months. The treatment plan was conducted in collaboration with the client’s general practitioner, physiotherapists, cardiopulmonary specialists, and his family. Treatment included a timeline, written narrative and imaginal reliving. It also applied stimulus discrimination, behavioural experiments and site visit. At the end of treatment, the client no longer showed clinically important symptoms of PTSD as assessed on the PCL-5 and interview. This was sustained at 3-month follow-up.

Key learning aims.

It is hoped that the reader will increase their understanding of the following:

  1. (1) Delivery of trauma-focused cognitive therapy for ICU-PTSD.

  2. (2) Cognitive conceptualisation of the trauma memory including hallucinations.

  3. (3) Management of co-morbid symptoms.

Keywords

CBTCOVID-19hallucinationsPTSDtrauma
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e29
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Murray, H., Grey, N., Wild, J., Warnock-Parkes, E., Kerr, A., Clark, D. M., & Ehlers, A. (2020). Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. the Cognitive Behaviour Therapist, 13.CrossRefGoogle Scholar
OXCADAT (2020). Resources for Cognitive Therapy for PTSD, Social Anxiety Disorder and Panic Disorder. Retrieved from: https://oxcadatresources.com/ptsd-training-videos/ Google Scholar

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Arlington, VA, USA: American Psychiatric Publishing.Google Scholar
Arumi, A., Bulbena-Cabre, A., & Bulbena, A. (2021). First person account COVID 19 delirium in a doctor: when death stalks the mind. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.626648 CrossRefGoogle Scholar
Barton, S., Armstrong, P., Wicks, L., Freeman, E., & Meyer, T. D. (2017). Treating complex depression with cognitive behavioural therapy. the Cognitive Behaviour Therapist, 10. https://doi.org/10.1017/s1754470x17000149 CrossRefGoogle Scholar
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735. https://doi.org/10.1097/00005053-198612000-00004 CrossRefGoogle ScholarPubMed
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498. https://doi.org/10.1002/jts.22059 CrossRefGoogle Scholar
Burki, T. K. (2019). Post-traumatic stress in the intensive care unit. The Lancet Respiratory Medicine, 7, 843–844. https://doi.org/10.1016/s2213-2600(19)30203-6 CrossRefGoogle ScholarPubMed
Carfi, A., Bernabei, R., & Landi, F. (2020). Persistent symptoms in patients after acute COVID-19. Journal of the American Medical Association, 324, 503–605. https://doi.org/10.1001/jama.2020.12603 Google ScholarPubMed
Clohessy, S., & Ehlers, A. (1999). PTSD symptoms, response to intrusive memories, and coping in ambulance service workers. British Journal of Clinical Psychology, 38, 251–65. https://doi.org/10.1348/014466599162836 CrossRefGoogle ScholarPubMed
Department of Health (2008). Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit. Retrieved from: https://www.uea.ac.uk/documents/746480/2855738/IAPT_Commissioning_Toolkit_2008_.pdf Google Scholar
Dunmore, E., Clark, D. M., & Ehlers, A. (1999). Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. Behaviour Research and Therapy, 37, 809–829. https://doi.org/10.1016/s0005-7967(98)00181-8 CrossRefGoogle ScholarPubMed
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for posttraumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43, 413–431.CrossRefGoogle ScholarPubMed
Einvik, G., Dammen, T., Ghanima, W., Heir, T., & Stavem, K. (2021). Prevalence and risk factors for post-traumatic stress in hospitalized and non-hospitalized COVID-19 patients. International Journal of Environmental Research and Public Health, 18, 2079. https://doi.org/10.3390/ijerph18042079 CrossRefGoogle ScholarPubMed
Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999). The Posttraumatic Cognitions Inventory (PTCI): development and validation. Psychological Assessment, 11, 303–314. https://doi.org/10.1037/1040-3590.11.3.303 CrossRefGoogle Scholar
Hatch, R., Young, D., Barber, V., Griffiths, J., Harrison, D. A., & Watkinson, P. (2018). Anxiety, depression and post traumatic stress disorder after critical illness: a UK-wide prospective cohort study. Critical Care, 22. https://doi.org/10.1186/s13054-018-2223-6 CrossRefGoogle Scholar
IAPT (2014). Measuring Improvement and Recovery Adult Services version 2. Retrieved from: http://www.oxfordahsn.org/wp-content/uploads/2015/11/measuring-recovery-2014.pdf Google Scholar
Janiri, D., Carfi, A., Kotzalidis, G. D., Bernabei, R., Landi, F., & Sani, G. (2021). Posttraumatic stress disorder in patients after severe COVID-19 infection. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2021.0109 CrossRefGoogle Scholar
King, J., & Gratrix, A. (2009). Delirium in intensive care. Continuing education in anaesthesia. Critical Care & Pain, 9, 144–147.CrossRefGoogle Scholar
Kleim, B., Grey, N., Hackmann, A., Nussbeck, F., Wild, J., Stott, R., & … Ehlers, A. (2013). Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81, 383–393. https://doi.org/10.1037/a0031290 CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle ScholarPubMed
Mason, R. J. (2020). Pathogenesis of COVID-19 from a cell biologic perspective. European Respiratory Journal, 55. https://doi.org/10.1183/13993003.00607-2020.CrossRefGoogle Scholar
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464. https://doi.org/10.1192/bjp.180.5.461 CrossRefGoogle ScholarPubMed
Murray, H., Grey, N., Wild, J., Warnock-Parkes, E., Kerr, A., Clark, D. M., & Ehlers, A. (2020). Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. the Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/s1754470x2000015x CrossRefGoogle Scholar
National Institute for Health and Care Excellence (2009). Rehabilitation after critical illness in adults (NICE Guideline CG83). Retrieved from: https://www.nice.org.uk/guidance/CG83/chapter/1-Guidance#23-months-after-discharge-from-critical-care Google Scholar
National Institute for Health and Care Excellence (2018). Post Traumatic Stress Disorder (NICE Guideline NG116). Retrieved from: https://www.nice.org.uk/guidance/ng116 Google Scholar
National Institute for Health and Care Excellence (2020a). COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NICE Guideline NG188). Retrieved from: https://www.nice.org.uk/guidance/ng188 Google Scholar
National Institute for Health and Care Excellence (2020b). Statement about graded exercise therapy in the context of COVID-19. Guideline in development. Retrieved from: www.nice.org.uk/guidance/gid-ng10091/documents/statement Google Scholar
OXCADAT (2020). Resources for cognitive therapy for PTSD, social anxiety disorder and panic disorder. Retrieved from: https://oxcadatresources.com/ptsd-training-videos/ Google Scholar
Pearson, C. R., Kaysen, D., Huh, D., & Bedard-Gilligan, M. (2019). Randomized control trial of culturally adapted cognitive processing therapy for PTSD substance misuse and HIV sexual risk behavior for Native American women. AIDS and Behavior, 23, 695–706. https://doi.org/10.1007/s10461-018-02382-8 CrossRefGoogle ScholarPubMed
Schweizer, T., Schmitz, J., Plempe, L., Sun, D., Becker-Asano, C., Leonhart, R., & Tuschen-Caffier, B. (2017). The impact of pre-existing anxiety on affective and cognitive processing of a virtual reality analogue trauma. PLOS One, 12, e0190360. https://doi.org/10.1371/journal.pone.0190360 CrossRefGoogle ScholarPubMed
Sharp, M. L., Busuttil, W., & Murphy, D. (2019). Examining physical health conditions and associations of pain, obesity, and function of UK Veterans diagnosed with PTSD and other mental health conditions. Journal of Military, Veteran and Family Health, 5, 75–87. https://doi.org/10.3138/jmvfh.2018-0051 CrossRefGoogle Scholar
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., Gorman, J. M., & Papp, L. A. (1997). Multicenter Collaborative Panic Disorder Severity Scale. American Journal of Psychiatry, 154, 1571–1575. https://doi.org/10.1176/ajp.154.11.1571 CrossRefGoogle ScholarPubMed
Skilbeck, L., Spanton, C., & Roylance, I. (2020). Beyond the COVID-19 pandemic: ‘Learning the hard way’ – adapting long-term IAPT service provision using lessons from past outbreaks. the Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/s1754470x20000379 CrossRefGoogle Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166, 1092. https://doi.org/10.1001/archinte.166.10.1092 CrossRefGoogle ScholarPubMed
UK Research and Innovation (2020). How is coronavirus disease treated in hospital? Coronavirus: The Science Explained – UKRI. Retrieved from: https://coronavirusexplained.ukri.org/en/article/vdt0008/ Google Scholar
White, J., Pearce, J., Morrison, S., Dunstan, F., Bisson, J. I., & Fone, D. L. (2015). Risk of posttraumatic stress disorder following traumatic events in a community sample. Epidemiology and Psychiatric Sciences, 24, 249–257.CrossRefGoogle Scholar
Wild, J., Warnock-Parkes, E., Murray, H., Kerr, A., Thew, G., Grey, N., Clark, D. M., & Ehlers, A. (2020). Treating posttraumatic stress disorder remotely with cognitive therapy for PTSD. European Journal of Psychotraumatology, 11, 1785818.CrossRefGoogle ScholarPubMed
World Health Organization (2021). Expanding our understanding of post COVID-19 condition: report of a WHO webinar – 9 February 2021. Retrieved from: https://www.who.int/publications/i/item/9789240025035 Google Scholar
Submit a response

Comments

No Comments have been published for this article.