Relational Family Therapy in the Treatment of Sudden Cardiac Arrest Survivors and their Relatives

Abstract

Sudden cardiac arrest is the most common single cause of death in the contemporary world, but the proportion of survivors is increasing thanks to modern intensive methods of hospital treatment. However, data show that survivors experience high rates of neurological and cognitive deficits and poorer emotional well-being, which is a major challenge in treating these individuals and encouraging their integration in everyday life. These issues range from a number of emotional problems, such as anxiety and depression, to lower levels of participation in social life and a low rate of return to their workplace. The need for security and support increases because of the feelings of insecurity, vulnerability and fear of the recurrence of symptoms. Relatives/caregivers who report emotional problems and a higher level of post-traumatic stress are physically and mentally burdened, too. Hence, sudden cardiac arrest is a life-threatening event which is traumatic for survivors and their close relatives. It triggers strong emotional responses that are characteristic of all types of trauma (reliving the trauma, avoidance, negative thoughts and mood, increased agitation). People who have survived trauma thus suffer long-term effects, which are reflected in various dysfunctional behaviours and activities due to inadequate regulation of affective states. Because of these issues, there is a need for effective interventions that can psychologically help patients and relatives after surviving sudden cardiac arrest. In this paper, we will present the model of Relational Family Therapy, which can enable survivors and their relatives to appropriately emotionally-affectively process this experience and thus more appropriately integrate into a new way of life. With the qualitative research method of task analysis, we will show the process of change, which is based on the establishment of a new regulation of affect and allows in-depth processing of difficult emotional states after this event.

One out of three bystanders of out-of-hospital cardiac arrests shows signs of pathological psychological processing weeks after the incident - results from structured telephone interviews

“…Previous studies showed, that families of patients with acute syndromes (e.g. myocardial infarction) show psychological distress [7,[20][21][22][23]. Witnessing an ambulance team performing CPR on relatives is associated with an increased risk of depression 90 days after the event [24].…”

“…Signs of pathological psychological processing might occur only a short time but might also continue over longer periods influencing the life of this person in multiple aspects [7]. In a study by Van't Wout Hofland one out of three caregivers of survivors after cardiac arrest experienced high level of trauma related stress even two years after the event.…”

“…This was intensified, if caregivers witnessed the cardiac arrest [25]. It is therefore important to understand, which persons show signs of pathological psychological processing and identify factors, that might enhance the risk [7].…”

“…In around 50% of OHCA the collapse is witnessed [6]. This is often perceived as a defining moment in life [4,7]. Performing resuscitation is described as emotionally challenging for lay rescuers [5].…”

Neuroethics across the Disorders of Consciousness Care Continuum

“…While little is known about the psychological impact of witnessing brain injury, evidence from literature on effects of OHCA indicates that bystanders might be deeply traumatized; one study found that more than one in three bystanders experienced "pathological psychological processing" weeks following OHCA independent of age or personal relationship to the index patient. [136][137][138] These issues demand further empirical study and the appropriate resources to help bystanders adapt to psychological distress. Further research, education, and capacity-building are needed in these areas to advance responsible systems of hyperacute DoC care.…”