Dr Robert London

PTSD: A Hidden Danger After a Serious Illness

Bottom Line/Health p 9-11 (October 2014)

Bottom Line/Health interviewed… Robert London, MD, a practicing physician/psychiatrist for more than three decades, who is on the professorial staff of NYU School of Medicine. He developed the short-term psychotherapy unit at the NYU Langone Medical Center and ran this program for 20 years.

If you’ve been successfully treated for a serious illness, you’re likely to feel so much relief at having dodged a bullet that you may downplay or dismiss the emotional trauma following your medical care.

overlooKeD proBleM: Survivors of a traumatic medical situation — for example, a stay in the intensive care unit or treatment for a heart attack or cancer—are at increased risk for post-traumatic stress disorder (PTSD).

SUrpriSinG fact: PTSD can strike weeks—or even years—after an illness. Symptoms may include nightmares, flashbacks, irritability and feeling detached (depersonalization) and emotionally numb. Ignoring PTSD after a serious medical situation carries its own risks. Without treatment, symptoms worsen, impacting the sufferer’s social, family and work relationships.

hoW to fiGht ptSD

Anyone who suffers PTSD after a serious illness—or wants to help prevent it—can benefit from one or more of the following…*

• Cognitive behavioral therapy typically involves weekly visits with a therapist for several months during which sufferers learn to reprocess the traumatic events by gaining a new perspective on the past trauma and improving skills to cope with the distressing thoughts that arise from it.

• Prolonged exposure therapy involves the patient revisiting the specific trauma in a safe environment through guided imagery until it’s no longer distressing. To find a psychologist or psychiatrist trained in these therapies, consult the Association for Behavioral and Cognitive Therapies, ABCT.org.

• Hypnosis helps people reprocess traumatic memories first by using relaxation strategies and then a series of visual images to slowly reintroduce the trauma. This is usually coupled with pleasant visualizations that reduce the anxiety of the traumatic memory. Patients generally require four to 16 sessions. To find a qualified hypnotherapist near you, consult the American Society of Clinical Hypnosis,ASCH.net. Other therapies to consider…

• EMDR. With eye movement desensitization and reprocessing (EMDR), the therapist asks the patient to perform certain eye movements, such as following the therapist’s finger from side to side, while the patient is talking about the trauma. The exercise is repeated, this time focusing on positive memories to help the brain reprocess the trauma so that the emotional distress is decreased.

EMDR usually requires four to 12 sessions and has been approved as a PTSD treatment by the US Department of Defense. To find an EMDR-trained practitioner, consult the EMDR International Association, EMDRIA.org.

• Medications. Antidepressants known as selective serotonin reuptake inhibitors(SSRIs), which work by raising the level of the moodboosting chemical serotonin in the brain, have been shown to help with PTSD, especially if depression is present. Sertraline(Zoloft) and paroxetine(Paxil) are two SSRIs that have been approved by the FDA specifically for PTSD.

• Support groups.Most PTSD sufferers find it helpful to join a support group of other people who have had similar experiences. Family members may also find comfort from support groups aimed at those caring for someone with PTSD. To find a support group near you, check the psychology/psychiatry department at your local hospital.

Specific StepS that help

In addition to the steps above, the following strategies help prevent or treat PTSD in patients after…

• An ICU stay. Even though most ICU patients receive lifesaving care, ICUs are high-intensity settings with constant noise and bright lights, which can further traumatize an already vulnerable, perhaps disoriented patient. One-quarter of those admitted to a hospital ICU have symptoms of PTSD after their stays.

to prevent ptSD in icU patientS: Unlike most PTSD survivors, who have flashbacks about actual events, ICU patients often suffer flashbacks about delusions or hallucinations that occurred during their stays—a relatively common problem among these patients.

   What helps…

   ICU diaries,where nurses and family members record what’s happening daily while the patient is hospitalized, are one way to reduce the risk for PTSD. After discharge, the patients are given the diary to review with a nurse or family member whenever the patient feels anxious. This process helps establish what actually occurred during the patient’s stay rather than focusing on the frightening details of their misperceptions.

   Music therapy, which relaxes and distracts seriously ill patients during the hospital stay, helps reduce the likelihood of lasting psychological trauma. If permitted, a patient could listen to favorite music through headphones. 

Heart attack. Around 12% of heart attack sufferers develop PTSD, and those who do are more likely to experience a second heart attack. Some heart attack survivors may go into a state of anxiety or panic whenever they feel shortness of breath, fearing that another heart attack is on the way. This often creates a vicious circle of symptoms and worry.

   TO PREVENT HEART-RELATED PTSD: Heart patients should seek counseling to learn calming strategies such
as relaxation techniques. Heart patients who have a lot of support from their families and friends—especially so that the patient can ask for help when needed—are also less likely to develop PTSD. Having this type of readily available assistance appears to reduce the feelings of vulnerability and helplessness, which so often occur in heart attack survivors.

Cancer. PTSD can follow treatment for any type of cancer. As with other conditions, the more intense or frightening the situation, the higher the chance for PTSD.

   TO PREVENT CANCER-RELATED PTSD: For some patients, learning all the specifics of their disease from their
doctors can help reduce anxiety while others prefer to know as little as possible. In either case, talk to
your doctor about your risk for recurrence and steps you can take to monitor for any early signs that the
cancer may be returning. As with other serious illnesses, family support is crucial in helping cancer patients readjust psychologically after treatment.

*These therapies are generally covered by health insurance. Check with your carrier.