This article looks at the research of Dr Manda Holmshaw PhD, consultant clinical psychologist and Clinical Director of Moving Minds, and Wilson Carswell OBE FRCS, Medical Director of Moving Minds. It looks specifically at the need for psychological rehabilitation alongside physiological rehabilitation for those who have been involved in a road traffic accident.
For those who have been injured in a Road Traffic Accident, rehabilitation is now acknowledged as playing an important role in helping the victim to recover more speedily from their injuries and get back to their normal work and social activities. However it is not always acknowledged that psychological rehab can be as important as physiological, especially in cases where prolonged problems or illness is brought on by trauma.
When a person is involved in a Road Traffic Accident (RTA), they often experience severe panic in the moment, believing that they are going to die or suffer serious injuries. The brain has defence mechanisms in operation to remove these sorts of memories from the forefront of the mind, enabling the person to deal with the trauma a short time after they are formed. But, in some cases of trauma this process is interrupted and the person may begin to suffer from long term psychological problems stemming from the accident. Such conditions include Post Traumatic Stress Disorder (PTSD) and Travel Anxiety and can prevent the person from resuming an active and happy life.
Professor Mayou conducted an experiment in Oxford with 1000 consecutive RTA victims as they arrived into Accident and Emergency. The patients were given a number of standard psychological tests to determine whether they were experiencing any psychological problems following their accident. These tests were followed up over the next three years. The majority of the test group did were not badly injured enough to require hospital admission, but 1 person in 3 showed to be suffering from a psychological disorder. This number reduced slowly over the test period to 1 in 4 people psychologically effected three years after their accident.
This is a significant problem when you consider that the majority of the group involved in the study were not even admitted to hospital yet still 25% of them were suffering from conditions including depression and PTSD years after the RTA took place.
Diagnosis and Evaluation
Psychologists have spent some years looking at varying kinds of psychological illness. From there, tests have been developed to look at symptoms to determine into which problem a patient may be suffering from. Tools used by psychologists to support their diagnosis and have been widely validated are the following:
CAPS is ‘the Clinician Administered PTSD Scale’ which asses the severity of already established PTSD in a patient. Here PTSD can be established as mild, moderate, severe or extreme and the correct degree of treatment can be administered.
The IES (Impact of Event Scale) estimates how the traumatic event has affected the patient. The test looks at the symptoms of intrusion and avoidance and measures these but is not a formal measure of the PTSD itself. A score of 26 or more indicates significant emotional distress.
HADS stands for the Hospital Anxiety and Depression Scale and looks at whether the patient suffers from either condition and rates the severity as mild, moderate, severe or extreme. The General Health Questionnaire GHQ. The four sections sub categorised in this test measure the symptoms of anxiety, insomnia, social dysfunction and severe depression. Finally the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) are used as a screening test for these conditions.
Psychological Assessment
For an RTA victim, psychological assessment is an important part of managing a person who has experienced this kind of trauma and possibly sustained injuries. It should be conducted by a Clinical Psychologist or Psychiatrist in their consulting premises or sometimes at the person’s home.
During psychological assessment the client’s psychological health before the accident is assessed, along with noting details of the accident and injuries. Then the tools mentioned above are used alongside clinical impressions to give a diagnosis and prescribe the correct course of treatment. This is usually a 90 minute consultation and costs between £300 and £500.
The Rehabilitation First Code of Practice is used by many when producing psychological reports which means the report is independent and can be used by all parties if the individual chooses to make apersonal injury claim for compensation.
Treatment
The commonest treatment at present is expectant, where the person hopes and expects to return to good health immediately! But as Dr Mayou’s experiment shows, this often doesn’t happen. The cost of this treatment is often significant; a person may not be able to return to work for some time and struggle with to return to a normal social life.
Medication plays a role and is especially helpful to those suffering from depression. However RTA victims, often PTSD or Travel Anxiety sufferers won’t find that drugs are helpful to the brain to integrate their bad experience.
Counselling is used in many circumstances including treating people with PTSD but is not recommended for people whose symptoms derive from one traumatic event. Counselling has shown that symptoms are unalleviated even after a long period of counselling.
Recommended treatments for these conditions include CBT, which is Cognitive Behavioural Therapy developed by psychologists over many years of study, exposure therapy, and EMDR (eye movement desensitisation and reprocessing). The principle of CBT is that a person’s thoughts affect their psychological well being, and by challenging unhelpful thoughts and testing new ways of behaving they can affect their mood and wellbeing.
EMDR, used extensively in the eighties, works to allow the reprocessing of the feelings and emotions experienced in the accident or traumatic event. This is achieved by getting the patient to recall memories from the experience itself whilst the therapist stimulates their brain with eye movements or sound. EMDR seems as effective as CBT when treating PTSD cases but often takes less sessions to produce the same effect.
Exposure therapy is used less frequently with more current emphasis on CBT, but involves a person with PTSD confronting the traumatic situation. This has also produced good results but is extremely emotional for the individual.
Getting Help
If you have been in a road traffic accident and are concerned that you may be suffering psychological problems due to the accident, you should consult your GP who will be able to make the suitable referrals for you to receive any treatment you may need.
You could also be entitled to make a personal injury claim for compensation. To find out more about making a claim, you should contact an experienced legal practice to handle your case such as Duncan Gibbins Solicitors based in Manchester who specialise in RTA cases and offer a no win, no fee service.
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