Critical Care and PTSD

This resource describes the aspects of critical care which can lead to the development of PTSD.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Editable version (PPT)

An editable Microsoft PowerPoint version of the resource.

Overview

Post-traumatic stress disorder (PTSD) can develop after intensive medical interventions. This resource describes the unique aspects of critical care that may contribute to PTSD, including invasive procedures, prolonged treatment, and the impact of sedation and delirium. Understanding these factors can enhance clinical engagement and outcome for survivors navigating post-discharge recovery.

Why Use This Resource?

Clinicians working with PTSD patients post-critical care can greatly benefit from understanding the distinct experiences that influence PTSD development in this context.

Explore unique PTSD triggers arising from critical care experiences.
Gain valuable insights into patient appraisal of traumatic experiences.
Address complex trauma memories intertwined with hallucinations and delusions.
Enhance therapeutic interventions with tailored psychoeducation.

Key Benefits

Understanding

Insight into how specific critical care features contribute to PTSD.

Identification

Helps clients identify triggers and address maladaptive beliefs.

Treatment

Supports treatment planning for persistent trauma symptoms.

Education

Provides a psychoeducational tool for clients and therapists.

Who is this for?

Post-Traumatic Stress Disorder (PTSD)

After exposure to life-threatening medical interventions in critical care.

Anxiety

Arising from fears related to medical treatment.

Integrating it into your practice

Educate

Use the handout to provide clients with a clearer understanding of their experiences.

Discuss

Foster discussions to explore clients' beliefs and appraisals.

Memories

Facilitate memory reprocessing using the structured timelines of patient experiences.

Support

Encourage exploration of sensory and body memories for comprehensive trauma work.

Visit

Utilize site visits or records access to help clients contextualize ICU experiences.

Theoretical Background & Therapist Guidance

Post-traumatic stress disorder (PTSD) following critical care is a significant clinical issue. Patients in intensive care often undergo invasive procedures, experience profound disorientation, and may be subjected to prolonged sedation and isolation. These factors can lead to altered states of consciousness, fragmented memory encoding, and intense feelings of powerlessness — all of which heighten vulnerability to trauma responses. Research suggests that around 1 in 5 survivors of intensive care go on to develop PTSD, which is substantially higher than the general population incidence (Kilpatrick et al., 2013; Murray et al., 2020).

From a cognitive-behavioural perspective, PTSD following critical illness can be understood as arising from disrupted processing of traumatic experiences. Memories encoded during critical care often include hallucinations, delusions, or somatic sensations that result from delirium or sedation. These experiences may persist post-discharge as intrusive, trauma-like memories. The cognitive model proposed by Ehlers and Clark (2000) emphasises that PTSD develops when individuals interpret the trauma and its aftermath in a way that creates a continuing sense of threat—beliefs such as “I’m going mad” or “I’m permanently changed” are common in this context.

Therapy should focus on helping patients reprocess these memories and revise maladaptive beliefs. ICU memories are often fragmented or confused, and they may blend factual events with hallucinated content. Constructing a narrative using memory recall, medical records, and critical care diaries can help patients make sense of their experience (Murray et al., 2020). Exposure techniques are useful not only for visual memories but also for somatic ones—such as discomfort linked to intubation or catheterisation — that may function like traditional flashbacks. Sensory triggers (e.g., beeping monitors, body positions) should also be addressed in therapy.

Clinicians should also be prepared to work with mistrust or paranoia linked to ICU experiences. For example, patients may develop suspicious beliefs about healthcare staff due to interactions while delirious. These responses are not psychotic symptoms but post-trauma interpretations shaped by delirium and fear (Griffiths & Jones, 1999; Jackson et al., 2007). Psychoeducation about the effects of critical illness and the normalising of hallucinations and cognitive disruption during ICU stays can be powerful tools in helping clients reappraise and recover.

What's inside

Information on PTSD development related to critical care.
Guidance on addressing fragmented trauma memories.
Insight into PTSD symptoms post-delirium or sedation.

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FAQs

Critical care can involve invasive and bewildering experiences, leading to the development of PTSD. These include feelings of powerlessness, isolation, and repeated exposure to potentially traumatic medical interventions.

Clinicians should be aware of the fragmented and sometimes hallucinatory nature of memories. Addressing these through therapeutic exposure and creating coherent memory narratives can aid recovery.

Yes, PTSD symptoms can persist long after discharge, requiring targeted interventions like cognitive behavioral therapy to address.

How This Resource Improves Clinical Outcomes

By offering clinicians a detailed understanding of the nuances of PTSD following critical care:

Promotes better insight into client experiences and symptom development.
Offers strategies for addressing complex symptoms like hallucinations.
Strengthens therapy through targeted psychoeducation and exposure work.
Facilitates creation of coherent trauma narratives for improved processing.

Clinicians Who Use This Resource Also Use

[Free Guide] Critical Illness Intensive Care And Post-Traumatic Stress Disorder (PTSD)

References And Further Reading

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345.
Griffiths, R. D., & Jones, C. (1999). Recovery from intensive care. BMJ, 319(7207), 427-429.
Jackson, J. C., Hart, R. P., Gordon, S. M., Shintani, A., Truman, B., & Ely, E. W. (2007). Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: Assessing the magnitude of the problem. Critical Care, 11(1), R27.
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM–IV and DSM–5 criteria. Journal of Traumatic Stress, 26(5), 537-547.
Murray, H., Grey, N., Wild, J., Warnock-Parkes, E., Kerr, A., Clark, D. M., & Ehlers, A. (2020). Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. Cognitive Behaviour Therapist, (April 2020)