scholarly journals Smartphone Delivery of Cognitive Behavioral Therapy for Post-intensive Care Syndrome-Family: A Pilot Study (Preprint)

2021 ◽  
Author(s):  
Amy B. Petrinec ◽  
Joel W. Hughes ◽  
Melissa D. Zullo ◽  
Cindy Wilk ◽  
Richard L. George
Keyword(s):  
Intensive Care ◽  
Cognitive Behavioral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Behavioral Therapy ◽  
Family Members ◽  
Cognitive Behavioral ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Post Intensive Care Syndrome

BACKGROUND Family members of critically ill patients suffer symptoms of post-intensive care syndrome-family (PICS-F), including anxiety, depression, and post-traumatic stress disorder. Post-intensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede recovery of the patient. Cognitive behavioral therapy has become a first-line non-pharmacological treatment of psychological symptoms and disorders, including anxiety, depression, and post-traumatic stress. For mild-to-moderate symptoms, mobile technology delivery of cognitive behavioral therapy without input from a clinician has been found to be feasible and well-accepted with efficacy that rivals face-to-face therapy. OBJECTIVE The purpose of this pilot study is to examine the efficacy of smartphone delivery of cognitive behavioral therapy via a mobile health app on the severity and prevalence of PICS-F symptoms in family members of critically ill patients. METHODS For this pilot study, 60 family members of critically ill patients will be recruited. A repeated measures longitudinal design with randomization to two groups (control, intervention) will be employed. The intervention group will receive cognitive behavioral therapy delivered via a smartphone mobile health app. Bandura’s Social Cognition Theory with an emphasis on mental health self-efficacy forms the theoretical framework of the study. RESULTS Recruitment for the study began in August, 2020. Data collection and analysis is expected to be completed by March, 2022. Primary outcome measures will include symptoms of PICS-F (anxiety, depression, post-traumatic stress), health-related quality of life, and mental health self-efficacy measured at enrollment, 30 days after enrollment, and 60 days after enrollment. CONCLUSIONS The proposed study represents a novel approach to the treatment of PICS-F symptoms, is an extension of previous work by the research team, and will be used to plan a fully powered, randomized, controlled trial. CLINICALTRIAL ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767?cond=Post-Intensive+Care+Syndrome&draw=3&rank=17

Delivering Cognitive Behavioral Therapy for Post–Intensive Care Syndrome–Family via a Mobile Health App

2021 ◽  
Vol 30 (6) ◽  
pp. 451-458
Author(s):  
Amy Petrinec ◽  
Cindy Wilk ◽  
Joel W. Hughes ◽  
Melissa D. Zullo ◽  
Yea-Jyh Chen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cognitive Behavioral Therapy ◽  
Mobile Health ◽  
Behavioral Therapy ◽  
Family Members ◽  
Intervention Group ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Icu Patients ◽  
Post Intensive Care Syndrome

Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

scholarly journals Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Stephana J. Moss ◽  
Krista Wollny ◽  
Therese G. Poulin ◽  
Deborah J. Cook ◽  
Henry T. Stelfox ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Traumatic Stress ◽  
Critically Ill Patients ◽  
Informal Caregivers ◽  
Post Traumatic Stress ◽  
Bereavement Support ◽  
Complex Needs ◽  
Post Traumatic

Abstract Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.

Mood Instability and Irritability

2019 ◽  
pp. 71-77
Author(s):  
David L. Brody
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Pain Control ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Post Traumatic Stress ◽  
Cardiovascular Exercise ◽  
Mood Instability ◽  
Sleep Management ◽  
Post Traumatic ◽  
Anxiety Depression

Often the complaint of mood instability comes from the collateral source. First priority: assess safety. Severe mood instability can lead to suicide. Next, determine whether the problem is actually mood instability, as opposed to sustained major anxiety, depression, or post-traumatic stress disorder. Nonpharmacological interventions are the most important, and include education, sleep management, prescription for cardiovascular exercise, pain control, cessation of alcohol and other disinhibiting substances, such as levetiracetam and cognitive behavioral therapy. Preferred pharmacological options that do not substantially impair cognitive recovery include lamotrigine (Lamictal) and oxcarbazepine (Trileptal). Other options include carbamazepine (Tegretol) when cost is an issue, propranolol (Inderal) when violence is a concern, and low-dose atypical antipsychotics.

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