The effect of family-authored diaries on posttraumatic stress disorder in intensive care unit patients and their relatives: A randomised controlled trial (DRIP-study)

Abstract Background. Emotion regulation (ER) is a key process underlying posttraumatic stress disorder (PTSD), yet, little is known about how ER changes with PTSD treatment. Understanding these effects may shed light on treatment processes. Methods. We recently completed a randomised controlled trial demonstrating that a breathing-based yoga practice (Sudarshan kriya yoga; SKY) was not clinically inferior to cognitive processing therapy (CPT) across symptoms of PTSD, depression, or negative affect. Here, in secondary exploratory analyses (intent-to-treat N=85; per protocol N=59), we examined whether self-reported ER (Difficulties in Emotion Regulation Scale; DERS) and physiological ER (heart rate variability; HRV) improved with treatment for clinically significant PTSD symptoms among US Veterans. Results. DERS-Total and all six subscales improved with small-to-moderate effect sizes (d = .24-.66) following CPT or SKY, with no differences between treatment groups. Following SKY (but not CPT), HR max–min (average difference between maximum and minimum beats per minute), normalised HF-HRV (high frequency power), and LF/HF (low-to-high frequency) ratio improved (moved towards a healthier profile; d = .32-.55). Conclusions. To our knowledge, this is the first study to demonstrate that a breathing-based yoga (SKY) improved both voluntary/intentional and automatic/physiological ER. In contrast, trauma-focused therapy (CPT) only reliably improved self-reported ER. Findings have implications for PTSD treatment and interventions for emotional disorders more broadly. Trial registration: Secondary analyses of ClinicalTrials.gov NCT02366403.

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Intensive Care Diaries and Relatives’ Symptoms of Posttraumatic Stress Disorder After Critical Illness: A Pilot Study

American Journal of Critical Care ◽

10.4037/ajcc2012569 ◽

2012 ◽

Vol 21 (3) ◽

pp. 172-176 ◽

Cited By ~ 90

Author(s):

Christina Jones ◽

Carl Bäckman ◽

Richard David Griffiths

Keyword(s):

Intensive Care Unit ◽

Posttraumatic Stress Disorder ◽

Intensive Care ◽

Critical Illness ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Controlled Trial ◽

Family Members ◽

Intensive Care Patients ◽

Close Family

Background Relatives of patients recovering from critical illness are at risk of developing posttraumatic stress disorder. Objectives To test whether providing a diary to intensive care patients and their relatives reduces the level of symptoms related to posttraumatic stress disorder in the relatives. Methods Observational study of close family members of patients who stayed more than 72 hours in an intensive care unit, recruited in 2 centers of a 12-center randomized controlled trial examining the effect of a diary outlining the details of the patients’ stay in the intensive care unit on the development of new-onset posttraumatic stress disorder in patients. The close family members of the patients were recruited to examine the additional effect of the provision of the patient’s diary on the family members’ symptoms related to posttraumatic stress syndrome. Results Thirty-six family members were recruited, and 30 completed the study. Family members of patients who received their diary at 1 month had lower levels of symptoms related to posttraumatic stress disorder (P = .03) at the 3-month follow-up than did the control family members. Conclusions Provision of a diary may help psychological recovery in patients’ families after critical illness.

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