- Cognitive behavioral therapy (CBT)
- Team debriefing after care of critical patients
- Mindfulness-based stress management (MBSR)
- Teaching effective methods to use meditation or mental cues to “self-relax”
Studies examining the efficacy of CBT have demonstrated that this treatment has been useful and effective for a wide range of psychological problems, particularly in mental health disorders in children.6 However, at present, there is minimal and low-quality evidence that CBT and mental and physical relaxation reduce occupational stress more than no intervention in health care workers.7 Many of us are not in the practice of utilizing CBT or mindfulness in our daily work and may not be aware of what these practices involve. CBT involves increasing happiness by changing the way we respond emotionally and behaviorally to certain problems. MBSR encourages a person to focus only on their immediate present, paying attention to emotions, thoughts, and somatic feelings at that given moment. It is targeted to teach an individual to calm the mind, in turn helping to cope with times of stress. With successful use of CBT and MBSR, an individual can then move on to using meditation or verbal cues to relax and regroup in times of high stress.
Explore This IssueACEP Now: Vol 38 – No 01 – January 2019
Team debriefing is best led by physicians or charge nurses after a critical event. This can allow the group involved to reflect on the experience. These few minutes can also be used as an opportunity to recognize team members traumatized by events and identify them for follow-up in case they require assistance.
Education of these critical methods may be accomplished by involving our psychiatry colleagues or specialists in these fields to develop learning programs geared toward emergency medicine physicians.
To those of you who have been practicing for some time, this all may sound a little “kitschy.” We trained and began our careers in an era where we view outward emotion as a sign of weakness. Perhaps we see it that way because we have become hardened, disconnected, and estranged. We are no longer in touch with the normal emotions associated with the illness, trauma, and death all around us. Perhaps we should view expression of our emotions in a different light, a sign of our own humanity.
As a group, we must have a high index of suspicion for PTSD in our colleagues (see Table 1 for a list of criteria for PTSD). We need to have our leaders advocate for effective support programs for our colleagues with PTSD. We need to develop real programs for individuals with PTSD to seek help without recourse, whether it is psychiatric therapy or time off. The road to recovery for emergency physicians who suffer from PTSD requires that we finally recognize it and ensure it is not ignored.