Medical Trauma Debriefing
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Medical Trauma Debriefing

It was only since 1994 that the Psychiatric Definition (DSM IV) recognized that medical conditions especially of a life threatening nature could cause Post Traumatic Stress. Since then there has been a fair amount of research establishing the incidence of PTSD in such conditions as Cancer, Heart Disease, Post Surgery, etc. To establish continued compliance with treatment and to deal with such factors as avoidance ( the person feeling that they cannot enter the treatment center for follow ups after the initial diagnosis and treatment) it has become necessary to do Medical Trauma Debriefing.Medical Trauma Debriefing is important, and, in fact, life saving. There are many trauma debriefing methods and most of these can be adapted to deal with medical trauma where the incident becomes the heart attack or the cancer diagnosis followed by the treatment, complicated by the imprint of impending death (which of course is not always realistic.People can survive for many years) It is suggested that Medical Trauma Debriefing, as a preventive measure be incorporated automatically and routinely into the treatment of certain medical and surgical conditions especially in Oncology.

Part of my research for my PhD in Psychology at University of Witwatersrand Medical School (South Africa), dealt with Medical Trauma and its influence on treatment compliance.

It was only in 1980 that the term Poat Traumatic Stress Disorder (PTSD) was officially introduced into the psychiatric classification system. At this time, any kind of medical trauma was specifically excluded. However in 1994, in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) of the Americal Psychiatric Association, there was a shift in emplasis from the traumatic event itself , to the psychological experience of the person who takes part in the event (e.g. being diagnosed with or surviving cancer.

It is therefore only recently that life-threatening ilness has been considered as a traumatogenetic stressor ..

To establish continued compliance with treatment and to deal with such factors as avoidance ( the person feeling that they cannot enter the treatment centre for follow ups after the initial diagnosis amd treatment) it has become necessary to do Medical Trauma Debriefing.

There are many trauma debriefing methods and most of these can be adapted to deal with medical trauma where the incident becomes the heart attack or the cancer diagnosis followed by the treatment, complicated by the imprint of impending death (which of course is not always realistic.People can survive for many years)

The medical trauma debriefing model used for this research included five components which could be introduced interchangeably within the intervention depending on the needs of the patient and the natural flow of the sessions.

These were:

1. Telling the story.

This involved detailed description of the experience of illness (cancer in this research) in sequence, including facts, feelings, cognition and sensations. Cognitive distortions about the illness were also discussed as there are so many misconceptios and fantasies surrounding it.

2. Normalizing the symptoms.

The patient was encouraged to discuss the similar trauma on others and not only on him/her self. The patient would see that their reactions were experienced in a similar way by other patients. At this stage there was a certain amount of education about PTSD symptoms as well as to other reactions of guilt, depression and shame.

3. Addressing self blame and survivor gult (restoring self respect)

Patients have many cognitive distortions about themselves, their abilities and their reactions and are often filled with self blame .Patients were taught to identify these dysfunctional automatic thoughts.

4. Encouraging mastery.

The patient was taught to replace negative, debilitating cognitions with positive, self enhancing thoughts and actions.

5. Facilitating creation of meaning.

The person's belief system was engaged and he/she was encouraged to look for meaning beyond his or herself. Goals, even short term ones could be defined. Certain perceptions were changed and reframed, such as the difference between the cancer (in this case) VICTIM and the cancer SURVIVOR.

Classical trauma debriefing deals with War trauma, attempted murder or hi jacking situations, etc.

Let's look at the heart attack. The person wakes up with intense pain and nausea feeling a crushing weight on his chest . These people sweat profusely and have difficulty breathing.

What do they say to themselves. "I am going to die. I won't survive this."

What do they say next? "Perhaps this is nothing. Perhaps I strained myself, hurt my back or something. People will think I am a total idiot if I wake them up at 2 in the morning and say I am having a heart attack. But perhaps I am going to die."

Trauma?  Intense trauma; enough trauma for them to run away from their condition a year or two later when they feel better and halve or discontinue their medication.

Again, Medical Trauma Debriefing is important, and, in fact, life saving.

It is suggested that Medical Trauma Debriefing, as a preventive measure be incorporated automatically and routinely into the treatment of certain medical and surgical conditions especially in Oncology.

Dr. Ruth Benjamin. Clinical Psychologist

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