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Working with ICU Vivid Dreams and Hallucinations Laura Barnett Psychotherapist, Croydon University Hospital, UK Croydon University Hospital, UK 27/04/2015.

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Presentation on theme: "Working with ICU Vivid Dreams and Hallucinations Laura Barnett Psychotherapist, Croydon University Hospital, UK Croydon University Hospital, UK 27/04/2015."— Presentation transcript:

1 Working with ICU Vivid Dreams and Hallucinations Laura Barnett Psychotherapist, Croydon University Hospital, UK Croydon University Hospital, UK 27/04/2015

2 ‘A natural sciences paradigm Research into PTSD /ASD Research into PTSD /ASD Research into PTSD correlation with delirium and ‘delusional memories’. Research into PTSD correlation with delirium and ‘delusional memories’. Aim: prevention of delirium, ‘delusional memories’ and PTSD; medicating PTSD.. Aim: prevention of delirium, ‘delusional memories’ and PTSD; medicating PTSD..

3 A humanistic, existential- phenomenological paradigm ‘Vivid dreams and hallucinations’. ‘Vivid dreams and hallucinations’. Seeks the essence of the experience Seeks the essence of the experience Therapeutic Aims: Therapeutic Aims: - Help relieve distress - Make sense of experience. - Make sense of experience. - Validate patient resources. - Validate patient resources.

4 What are ICU dreams and hallucinations? Qualitatively other form of consciousness where sense-making without reference to reality pertains. Qualitatively other form of consciousness where sense-making without reference to reality pertains. Emerges from: Disintegration of the patient’s sensorimotor relationship to the world. Emerges from: Disintegration of the patient’s sensorimotor relationship to the world. Anxiety; depersonalisation; derealisation; disorientation. Anxiety; depersonalisation; derealisation; disorientation.

5 Oneiroid syndrome: a state between dream and wakefulness ‘The oneiroid syndrome cannot and should not be viewed in terms of either a mental deficiency or a psychiatric diagnosis, which…misses the essence of the phenomenon.’ Prof. Schmidt-Degenhard

6 Vivid dreams and hallucinations ‘In understanding hallucinations, one must not start with the distinction between ‘real’ and ‘unreal’, but rather with an inquiry into the character of the relationship to the world in which the patient is involved at any given time.’ Heidegger

7 7

8 The reality of the ITU situation A sci-fi environment A sci-fi environment An experience of different levels of consciousness An experience of different levels of consciousness A fight for survival A fight for survival

9 Did you have any vivid dreams? Routine bedside question Routine bedside question Normalising Normalising Destigmatising Destigmatising Reassuring Reassuring

10 Examples Martin, underwater Martin, underwater Dennis and the sphinx Dennis and the sphinx Sean Sean Thomas Thomas

11 A phenomenological approach Description of events and feelings Description of events and feelings Non-interpretative Non-interpretative What it means for the patient: e.g. underwater dream What it means for the patient: e.g. underwater dream

12 What emerges from these dreams? Life and death theme Life and death theme Active not passive stance Active not passive stance Fight for survival (explicit/implicit) Fight for survival (explicit/implicit) e.g. Terry on the Isle of Man Mandy and the computer

13 Life and Death Dream Themes ‘Paranoid’: Trying to escape; doctors and nurses trying to kill me, pushing drugs; selling body parts; orgies.. ‘Paranoid’: Trying to escape; doctors and nurses trying to kill me, pushing drugs; selling body parts; orgies.. Journey: hi-tech plane; hospital train; boat Journey: hi-tech plane; hospital train; boat Coffin/two coffins Coffin/two coffins

14 Life and Death Dream Themes God-given healing powers God-given healing powers ‘With dead loved ones ‘With dead loved ones ‘Meaningful’ and ‘inspirational’ dreams (e.g. singers; Gloria) ‘Meaningful’ and ‘inspirational’ dreams (e.g. singers; Gloria)

15 ‘Psychoeducation’ Despite transparency, most patients still caught up in horror of experience Despite transparency, most patients still caught up in horror of experience Importance of: - ‘normalising’ Importance of: - ‘normalising’  - making sense Highlighting fight/flight response Highlighting fight/flight response

16 Danger of retraumatisation A Window of Tolerance A Window of Tolerance Reliving dreams after discharge home Reliving dreams after discharge home Retriggering Retriggering ‘Resourcing’, ‘putting on the brakes’ ‘Resourcing’, ‘putting on the brakes’ e.g. Jeremy & the drug pushing nurses Mat and the coffin Mat and the coffin

17 Mat’s coffin

18 Mat in the coffin

19 Mat the coffin and the rainbow Making sense of nightmares can release patients from the grip of panic and dread Making sense of nightmares can release patients from the grip of panic and dread It can help integrate dreams into patient’s survival story It can help integrate dreams into patient’s survival story Offers empowerment and healing Offers empowerment and healing

20 Stressors interfering with wellbeing Patient’s ITU experience not acknowledged Patient’s ITU experience not acknowledged Not knowing ‘what happened’ Not knowing ‘what happened’ Dreams and hallucinations Dreams and hallucinations Uncertainties about the future Uncertainties about the future

21 What can you do? Acknowledge and validate patients’ experience. Acknowledge and validate patients’ experience. Ask about dreams and ‘normalize’ the situation. Ask about dreams and ‘normalize’ the situation. Highlight resources for survivorship. Highlight resources for survivorship.

22 An ‘inspirational’ dream Gloria


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