When patients leave intensive care, they not only need to recover physically, but also mentally.

Around one in five of these patients have symptoms of post-traumatic stress disorder (PTSD) that can last for years, if left untreated.

Patients are admitted to the intensive care unit (ICU) because they have a life-threatening illness or injury. While in the ICU they can receive complicated, but essential medical treatment, surgery and monitoring.

“We’ve come to understand that when they’re discharged, a substantial number of these patients suffer from unpleasant and long-lasting psychological problems, such as PTSD,” explains Southampton’s Andrew Bates.

“It’s very important that we find ways to get this sorted out for them. Simply put, we want to help them to a complete recovery.”

Andrew is researching whether a talking therapy can help patients with PTSD after intensive care to recover. He is conducting this research as part of a three-year NIHR Clinical Doctoral Research Fellowship (CDRF), which he started in April 2022. 

Ending the memory loop

For people with PTSD, distressing memories keep coming back, either as flashbacks in the daytime or in their dreams at night. Each time this happens, they can feel the same intense emotions that they had during the actual experience. 

It’s as if they are stuck in a loop, with the same memories on repeat. This experience can disturb life in many ways, consistently affecting quality of life, physical recovery from being so unwell, and even their work and social relationships.

 

A therapy called Eye Movement Desensitisation and reprocessing (EMDR) has been shown to be effective at breaking this loop, allowing people with PTSD to recover. It is recommended by the NHS, but it has never been tested for ICU patients. It is important to do this research to ensure that it works just as well for our patients. 

During EMDR, a therapist will ask the patient to talk about distressing memories from their experience, while their eyes follow the therapist’s fingers moving from side to side. 

It’s thought that this mimics the rapid eye movement (REM) phase of sleep. This is how the brain naturally processes memories, but it doesn’t happen in people with PTSD because the jolt of adrenaline triggered by the memory always wakes them up and interrupts the process.

Andrew had EMDR himself, following a very distressing experience while working as an intensive care nurse. He describes the EMDR as ‘transformative’, allowing him to put these memories into the past and come to terms with his experience.

“I thought wow, this has worked for me,” he says. “Let’s see if it can work for our patients.” 

The EMERALD research study

To undertake this important work, Andrew is now leading the EMERALD study, as part of his CDRF, and as a researcher at the NIHR Southampton Biomedical Research Centre.

Patients leaving the intensive care unit at University Hospital Southampton are assessed for symptoms of PTSD. Those who have symptoms are then randomly assigned to receive either usual care, as part of the control group, or EMDR. 

A year after leaving intensive care, the researchers will see if patients in the EMDR group had a greater improvement in their mental health than those in the control group.

To deliver the study, he is working with supervisors from ICU and psychiatry, drawing on the expertise from both specialities. Prof Mike Grocott leads intensive care research at UHS, David Baldwin is Professor of Psychiatry at Southern Health NHS Foundation Trust, and Dr Rebecca Cusack is an ICU Consultant at UHS

Going forward, they hope to continue this unique partnership between the two specialities, moving on to larger scale trials if EMERALD proves successful. They also intend to investigate in more detail what causes PTSD and how it develops.

Supported ‘every step of the way’

The NIHR have now funded Andrew for three personal training awards, which he is very grateful for. He says that support from SoAR, particularly Executive Director Prof Alison Richardson and former Associate Director Kay Mitchell, has really helped him achieve this. 

“I’ve been very lucky that, since I came to Southampton in 2017, I’ve had Kay Mitchell as my professional mentor,” he says. “She’s also an intensive care nurse, like me, so we both know the problems and we speak the same language. She’s helped me to use the infrastructure of SoAR and the support the team can offer.” 

He says that he felt well prepared for his CDRF interview, where he was questioned by a panel of 13 professors, following a mock interview and feedback on his presentation by Alison.

“No one can do this work alone. Every step of the way, I’ve been supported by SoAR,” he says.