CT-PTSD following a COVID-19 ICU admission in the context of unresolved grief, delirium and incurable cancer: a single case design with an older adult client

Abstract

Abstract This case study recounts an application of Ehlers and Clark’s (2000) cognitive model of post-traumatic stress disorder (PTSD) to post-intensive care unit (post-ICU) PTSD. An AB single case design was implemented. The referred patient, Rosalind (pseudonym), completed several psychometric measures prior to the commencement of therapy (establishing a baseline), as well as during and at the end of therapy. Idiosyncratic measures were also implemented to capture changes during specific phases of treatment. The importance of the therapeutic alliance, particularly in engendering a sense of safety, was highlighted. Findings support the use of cognitive therapy for PTSD (CT-PTSD) with an older adult, in the context of a coronavirus infectious disease (COVID-19)-related ICU admission. This case is also illustrative of the effectiveness of implementing CT-PTSD in the context of co–morbid difficulties and diagnoses of delirium, depression, and complicated grief. Key learning aims (1) To recognise the therapeutic value of CT-PTSD in addressing PTSD following a COVID-19 admission, in the context of complicated grief and delirium. (2) To consider the importance of a strong therapeutic alliance when undertaking CT–PTSD. (3) To understand the intersection of complicated grief and delirium in the context of ICU trauma. (4) To consider the challenges in working with PTSD, whereby the target trauma (COVID–19 ICU admission) is linked with ongoing uncertainty and continuing indeterminate threat.