Traumatic imagery after life-threatening cardiac events
Curley, Alexandra Paula Marie
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Aims There is a growing body of evidence that some individuals are at risk of developing post-traumatic stress disorder (PTSD) after life-threatening cardiac events, such as myocardial infarction (MI) or cardiac arrest, which can result in distress, dysfunction and increased risk of mortality. In relation to this population, this thesis had two aims: to review the evidence regarding whether pain during MI predicts post-traumatic stress symptoms; and to explore the characteristics and impact of traumatic imagery experienced by individuals who develop symptoms of post-traumatic stress subsequent to MI or cardiac arrest. Methods A review of the evidence relating to pain as a potential risk factor for PTSD subsequent to MI is presented in the systematic review. The findings from a qualitative study investigating the characteristics of traumatic imagery and associated behaviours experienced by individuals who have symptoms of post-traumatic stress subsequent to MI or cardiac arrest, are presented in the journal article. Interpretative Phenomenological Analysis (IPA) was used to identify themes in the data. Results The systematic review indicated that there are mixed findings for pain as a risk factor for PTSD subsequent to MI. The limited number of studies in this area and significant methodological limitations within the existing evidence make it difficult to draw any firm conclusions with regard to the relationship between pain and PTSD post-MI. With regard to the qualitative study, the majority of imagery related to flashbacks of the event and were focused mainly on external experiences. Themes arising from the distressing flashback imagery included: loss of control; realisation of threat; negative impact on others; physical sensations; and actions of others. Imaginary elements and distortions were a feature of some traumatic imagery experienced, and non-flashback imagery connected with mortality was also experienced. Imagery was associated with avoidance behaviour and affected behaviour within relationships. Conclusions Findings from the systematic review indicate that further studies are warranted in this area to establish the link between pain and PTSD post-MI. These studies should seek to address methodological limitations of the current evidence by using a standardised pain measurement tool; adopting a prospective design; using a diagnostic tool to measure PTSD; ensuring PTSD is measured at least one month after the MI; assessing prior PTSD of non-cardiac origin; including a sufficient sample size and using an appropriate method of recruitment to improve generalisability. External experiences during a cardiac event are the main focus of traumatic visual imagery experienced by people with intrusive post-traumatic stress symptoms post cardiac event. Specific aspects of the cardiac event may be particularly distressing and these may be represented in post-traumatic visual imagery. Both gradual exposure and imagery rescripting techniques may be useful for reducing distress associated with the imagery, depending on the type of imagery experienced.