Treating the Whole Person
Shepherd Center clinical neuropsychologists discuss the importance of identifying and treating PTSD during the continuum of care for patients who have sustained traumatic injuries.
By Alex Alverson, Ph.D., and Katie Harris, Psy.D.
A major accident or illness changes life in an instant. Individuals who experience a catastrophic injury may not only experience the trauma of the injury itself, but also the trauma of hospitalization. While hospitalization is necessary for patients’ wellbeing, many patients in the intensive care unit (ICU) can experience frightening periods of confusion called delirium. They may be unaware of their medical situation, fear that treatment may hurt them, be unable to recognize loved ones or have hallucinations. Although this is happening in their minds, the fear it causes is entirely real. At Shepherd Center, licensed mental health professionals have specialized training to recognize and treat trauma-related distress. By focusing on treating the whole person and all of their symptoms and experiences, we can improve our patients’ overall quality of life during and after their time with us at Shepherd.
Following a traumatic event, acute stress reactions such as nightmares, disturbing memories, trouble sleeping, feeling on edge and mood changes sometimes go away on their own. However, symptoms may progress to Acute Stress Disorder, and for some people, progress to post-traumatic stress disorder (PTSD) in the months that follow. Identifying and treating these symptoms early may prevent later development of PTSD.
Signs of PTSD can be missed because treating complicated physical injuries often takes priority. Predicting who is at risk for PTSD can also be challenging. This led researchers at Columbia University to develop a form of artificial intelligence that uses a program to predict possible outcomes. Developed on 377 trauma survivors in Atlanta, and tested on 221 trauma survivors in New York City, the researchers used physical and psychological biomarkers collected in the emergency department to predict development of PTSD in the year after the trauma. 90% of participants who the program predicted to be at risk for PTSD were later diagnosed with PTSD. However, a portion of participants considered to be low risk also later developed PTSD. It is unclear whether the program could be helpful for patients seen at Shepherd Center, because patients were not included in the study if they had traumatic brain injury (TBI)*, ICU admission, respiratory distress, hospital admission, surgery or severe pain. However, this interesting study was the first step in using artificial intelligence to predict who might go on to develop PTSD.
At Shepherd Center, our team of psychologists and mental health providers work together with patients, their families and their treatment teams to identify and treat PTSD symptoms along our continuum of care. Once the survival mode ends directly following a catastrophic injury, the process of emotional healing begins. This starts with identifying symptoms of PTSD during inpatient rehabilitation by asking questions about how the trauma is impacting thoughts, feelings and even physical sensations. We help develop coping tools or strategies our patients and their treatment teams can use to reduce emotional distress. If PTSD symptoms continue, we recommend outpatient trauma-focused therapies after leaving the inpatient hospitalization.
Psychological treatment for PTSD is evidenced-based, meaning there are scientific studies supporting its effectiveness in helping reduce or eliminate symptoms. Two of the most effective evidence-based treatments for PTSD are Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). PE helps separate the memory of a trauma from its emotional experience. In other words, the memory of the trauma no longer causes the same fear as the trauma itself. CPT works by changing thoughts and feelings related to the trauma like guilt, shame and anger. Couples-based Cognitive Behavioral Therapy, coping skills training and other interventions can also effectively treat PTSD.
Without treatment, about two-thirds of those who develop PTSD will still have PTSD one year later. About half may still have PTSD 10 years after their trauma. Symptoms of PTSD can take a significant toll on relationships and work and might be complicated by depression or other anxiety disorders. Cultural background, beliefs and values can impact reactions to trauma and the help individuals seek. Talking about trauma can be scary at first, especially when opening up to a stranger. Fortunately, six out of 10 people who receive treatment no longer have symptoms of PTSD when treatment ends. The benefits of these therapies are long-lasting. One study found that 83% of people who completed PE therapy still did not have PTSD after six years. Although the effects of trauma may not be entirely erased, its impact on daily life can improve. It can exist without being personally defining, as the sharp edges dull. Over time and with the support of a psychologist or mental health provider, memories of trauma can fade away from the forefront of the mind to background noise, as people resume what is most important in their lives. With our expertise, we aim to identify and treat the psychological effects of trauma early so that our patients and their families get the most out of their rehabilitation.
*It is important to note that individuals who sustain moderate to severe TBI, such as those admitted to Shepherd Center’s Brain Injury Rehabilitation Program, are far less likely than other trauma survivors to develop PTSD. This is related to a loss of consciousness or a disorder of consciousness, as well as a greater length of post-traumatic amnesia at the time of their injury. These factors can actually prevent the brain from processing the event, meaning the memory of a traumatic injury is never formed. In these cases, we focus on providing support to the family members of these individuals, who may experience distress themselves when learning the details of their loved one’s injury.
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 740 inpatients, nearly 280 day program patients and more than 7,100 outpatients each year in more than 46,000 visits.