A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study

Hosey, Megan M.; Wegener, Stephen T.; Hinkle, Caroline

doi:10.3390/jcm10040872

Cited by 9 publications

(8 citation statements)

References 42 publications

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“…Psychologists successfully applied therapeutic suggestion to reduce anxiety of patients on non-invasive ventilation [ 25 ]. An embedded ICU rehabilitation psychologist was successful providing consultations to patients with prolonged hospitalization, which led to a reduction in anxiety ratings [ 26 ]. Many of these benefits were similarly endorsed as potential positives of greater psychiatry involvement by the majority of respondents in the current study as well.…”

Section: Discussionmentioning

confidence: 99%

Psychiatry’s role in the prevention of post-intensive care mental health impairment: stakeholder survey

et al. 2022

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Background Many critical illness survivors experience new or worsening mental health impairments. Psychiatry consultation services can provide a critical role in identifying, addressing, and preventing mental health challenges during and after admission to the acute medical care setting. However, psychiatry involvement in the ICU setting is lower than in other hospital settings and the conventional process in many hospitals requires other care providers to request consultation by psychiatry. Despite these differences, no studies have sought ICU provider perspectives on psychiatry consultation’s current and desired role. We aimed to obtain stakeholder feedback on psychiatry’s current and desired roles in the ICU, and potential benefits and drawbacks of increasing psychiatry’s presence. Methods A web-based survey obtained perspectives from 373 critical care physicians and advance practice providers, bedside nurses, physical and occupational therapists, pharmacists, and consultation-liaison psychiatry physicians and advance practice providers at a tertiary care center using multiple choice and open-ended questions. Descriptive information and content analysis of qualitative data provided information on stakeholder perspectives. Results Psychiatry’s primary current role was seen as assistance with management of mental health issues (38%) and suicide risk assessments (23%). 46% wished for psychiatry’s increased involvement in the ICU. Perceived benefits of increased psychiatry presence in the ICU included early psychological support in parallel with medical care, identification of psychiatric factors impacting treatment, and facilitation of family understanding of the patient’s mental state/delirium. An additional perceived benefit included reduction in provider burnout through processing difficult situations and decreasing family psychological distress. However, one concern included potential conflict among providers regarding treatment. Conclusions Those who work closely with the critically ill patients think that increased psychological support in the ICU would be beneficial. By contrast, psychiatry’s current involvement is seen to be limited, perhaps driven by varying perceptions of what psychiatry’s role is or should be.

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Section: Discussionmentioning

confidence: 99%

Psychiatry’s role in the prevention of post-intensive care mental health impairment: stakeholder survey

et al. 2022

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“…In another study from same center, a clinical psychologist embedded in the medical ICU practice provided consultation, assessment and treatment for anxiety to patients in acute respiratory failure. Following completion of 6 sessions of about 30 min duration each, the authors reported significant after-session decreases in the visual analog scale anxiety score compared to baseline pre-intervention data [ 14 ]. Clinical psychologists also conducted educational sessions for ICU patients in Italy with investigators reporting a significant reduction in IES-R scores and a trend toward lower HADS scores at 12 months after hospital discharge in trauma patients compared to historical controls [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

A pilot study of trained ICU doulas providing early psychological support to critically ill patients

et al. 2021

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Background Over a third of critical illness survivors suffer from mental health problems following hospitalization. Memories of delusional experiences are a major risk factor. In this project, ICU doulas delivered a unique positive suggestion intervention targeting the vulnerable time period during critical illness when these memories are formed. Methods Adult critically ill patients were recruited for this single-arm, prospective pilot study. These ICU patients received a positive suggestion intervention daily during their ICU stay in parallel with their medical treatment. The intervention was designed to be delivered over a minimum of two sessions. Feasibility was defined as intervention delivery on ≥ 70% of ICU days after patient enrollment. As a secondary analysis, psychometric questionnaires were compared to those of a historic control cohort of patients receiving standard care in the ICU using adjusted linear regression models. Results Of the 97 patients who received the intervention and were alive at the end of their ICU course, 54 were excluded from analyses mostly for having received only one session because of a short ICU length of stay of < 2 days, transitioning to comfort care or not wanting to answer the study questionnaires. Forty-three patients who completed 2 or more sessions of the positive therapeutic suggestion intervention provided by two trained ICU doulas received it for a median of 4 days (IQR 3, 5), with each session lasting for a median of 20 min (IQR 14, 25). The intervention was delivered on 71% of days, meeting our pre-determined feasibility goal. Compared to historical controls (N = 299), patients receiving the intervention had higher severity of illness and longer length of stay. When adjusted for baseline differences, patients both with and without mechanical ventilation who received the intervention scored lower on the Hospital Anxiety and Depression Scale (HADS)—Depression subscale. The intervention was also associated with reduced HADS-Anxiety subscale among ventilated patients. Conclusions Positive therapeutic suggestion delivered by ICU doulas is feasible in the ICU setting. A randomized trial is warranted to better delineate the role that positive suggestion and ICU doulas may play in ongoing interprofessional efforts to humanize critical care medicine. The study was registered on clinicaltrials.gov (NCT03736954) on 03/14/2018 prior to the first patient enrollment https://clinicaltrials.gov/ct2/show/NCT03736954?cond=ICU+Doulas+Providing+Psychological+Support&draw=2&rank=1.

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“…Outpatient psychological interventions targeting these symptoms may help to improve cognitive functioning, while simultaneously treating distressing symptoms. Evidence‐based practices for treating psychiatric conditions have recently been modified for ICU survivors and shown promising outcomes, including cognitive therapy for anxiety in the context of respiratory distress and PTSD following ICU stay 172‐174 . Early interventions in the ICU, where patients receive psychological support upon admission (eg, educational interventions relating to critical illness, anxiety management skills), have shown positive outcomes for psychological recovery following critical illness 175 .…”

Section: Literature Review/methodsmentioning

confidence: 99%

Intensive care‐related cognitive impairment: A biopsychosocial overview

Tingey

Dasher

Bunnell

et al. 2022

PM&R

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Advancements in critical care medicine have improved survival rates for patients experiencing critical illness in intensive care units (ICUs). Although mortality has declined, more than half of ICU survivors experience functional impairments that persist beyond discharge. Of particular concern is ICU‐related cognitive impairment, which can extend across the care continuum, ranging from acute and transient presentations in the ICU (eg, delirium) to long‐term impairments years after discharge. ICU‐related cognitive impairment has received increased attention in the literature, particularly as it relates to ICU survivors who have received and survived critical care in the context of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic and are now experiencing postacute sequelae of SARS‐CoV‐2 infection. The medical complexity and heterogeneity of ICU survivors, coupled with the multifactorial etiology of ICU‐related cognitive impairments, lead to challenges in how to optimize care for ICU survivors at various stages of recovery. This review aims to provide an overview of cognitive outcomes associated with critical illness by integrating recent literature focused on etiology, assessment, and interventions in the context of ICU‐related cognitive impairments. The narrative review employs a biopsychosocial framework to comprehensively evaluate the multifactorial nature of ICU‐related cognitive outcomes. Authors also highlight that multidisciplinary teams composed of key rehabilitation providers are likely best suited for optimizing recovery trajectories of ICU survivors.

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A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study

Cited by 9 publications

References 42 publications

Psychiatry’s role in the prevention of post-intensive care mental health impairment: stakeholder survey

Psychiatry’s role in the prevention of post-intensive care mental health impairment: stakeholder survey

A pilot study of trained ICU doulas providing early psychological support to critically ill patients

Intensive care‐related cognitive impairment: A biopsychosocial overview

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