A New Study Shows How We Can Prevent Some Cases of PTSD

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We barely know how to treat mental illnesses, so it’s difficult to figure out how to prevent them in the first place. But as I wrote at some length last year, research into stopping breakdowns before they occur has advanced dramatically in the past few years. Now comes news of a method that can keep patients who have experienced trauma from developing posttraumatic stress disorder, or PTSD, before it even starts.

The paper — published last week in the journal Critical Care — looked at 352 patients in intensive-care units. If you make it out of an ICU alive, you often develop mental problems. Many former ICU patients can’t quite remember all the procedures done to keep them alive; some of those procedures recur to the recovering patients in awful flashbacks. “These memories are frequently described by patients as very vivid, realistic and frightening,” write the authors of the new paper, a European team led by Christina Jones and Richard Griffiths of the Unversity of Liverpool in the U.K. Sometimes, the team writes, ICU patients become convinced that nurses and doctors were trying to kill them.

Consequently, these patients can begin to avoid any conversation about emotions; many are also prone to agitation. Flashbacks, emotional avoidance, and what psychologists call “increased arousal” are three symptoms that, over a long period, reliably lead to full-blown PTSD. According to the new paper, about 1 in 10 ICU patients develops PTSD. (More on Time.com: Photos: An Army Town Copes with PTSD)

If we know what leads ICU patients to develop PTSD, how can we stop them from doing so? The authors decided to study ICU patients from six hospitals in six different countries. All had been the victims of physical trauma serious enough for them to go on ventilators. Those too confused to give informed consent were excluded. None had ever been diagnosed with PTSD.

The prevention method was based on simple reasoning: if ICU patients develop PTSD because they have unresolved memories about what happened to them in the hospital, then let’s show them precisely what happened. Nurses spent a few minutes each day writing up diaries for each patient about what had been done to save them that day; the nurses were instructed to use plain language. The diaries were accompanied in most cases by photos. And so a hazy, painful event became something the patients could see for themselves after they left the hospital. The diaries and photos were the only treatment; there were no unusual, expensive drugs. (More on Time.com: Video: Soldiers’ Voices: Their Thoughts on the Pullout)

The intervention worked brilliantly. Among the 352 patients recruited in recovery, about half were randomized to get the diaries; the other half didn’t get them. After three months, the diary group showed a significant reduction in scores on a test that measures posttraumatic symptoms. They were less than half as likely to qualify for a PTSD diagnosis as the control group. According to the paper, the diaries and photos helped patients “fill in gaps in their memories, place any delusional memories into context and aid psychological recovery.”

This method not only works but is highly cost-effective. No new drug had to be developed, and no new bureaucracy had to be created. But of course it wasn’t free. Nurses had to spend an extra few minutes each day writing up the diaries, and someone had to compile and deliver them to the patients. But compare that to the cost of treating full-blown PTSD, and the advantages are obvious.

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