NET - primary care: Caring for patients with traumatic stress sequelae following intensive medical care

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In Germany, two million treatment cases are treated at Intensive Care Units (ICUs) every year. More than half of them suffer from long-term functional, psychological or medical sequelae as a result. Posttraumatic stress disorder (PTSD) is a frequent sequela and symptoms may remain for years after ICU discharge. While waiting for specialist psychiatric/psychotherapeutic services, the General Practitioner (GP) is the main health professional attending to the patient. The trauma-related symptoms arise from a failure to construct adequate memories of the traumatic experiences: In PTSD, sensory, cognitive, and affective representations have lost association with the contextual and episodic memory system. The goal of trauma-related therapy is to reconnect the memory fragments. In "Narrative Exposure Therapy" (NET), the patient builds a narrative that focuses on the contextualization of traumatic experiences. Counsellor and patient together design a "lifeline", consisting of relevant biographical events. This specifically relies on the GP's skill at taking comprehensive medical and psycho-social histories. Subsequently, the patient recounts the stressful situations to recover contextual details of the traumatic event ¿ rather than intrusive memories. We apply for a cluster-randomized controlled trial (N=340) to evaluate whether a brief NET primary care-intervention for post-ICU-patients with posttraumatic symptoms effectively improves clinical outcomes as assessed using the Posttraumatic Stress Diagnostic Scale (PDS) 6 months after baseline.