This article focuses on the research conducted by Dr Manda Holmshaw PhD, consultant clinical psychologist and Clinical Director of Moving Minds, as well as Wilson Carswell OBE FRCS, Medical Director of Moving Minds. The article delves into the importance of road traffic accident victims undergoing both psychological rehabilitation and physiological rehabilitation.
The rehabilitation of those injured in a road traffic accident has been acknowledged as being important in assisting the victim to recover faster from their injuries and resume their routine work and social activities. However, the fact that psychological rehabilitation is as important as physiological, especially with regard to cases where trauma causes prolonged illness or problems has not always been acknowledged.
In the moment when an individual is involved in a Road Traffic Accident (RTA), they normally experience severe panic, believing that they are going to suffer serious injuries or even succumb to them and die. The defence mechanisms in the brain operate for the removal of these memories from the front of the mind, thereby enabling the victim to deal with such trauma shortly after they are formed. However, this process is interrupted in some cases of trauma and the person may begin to suffer long term psychological problems as a result of the accident. These conditions include Post Traumatic Stress Disorder (PSTD) and Travel Anxiety which may hinder the resumption of an active and happy life for the victim.
An experiment in Oxford was conducted by Professor Mayou with 1000 RTA victims as they arrived into Accident and Emergency. The patients underwent various standard psychological tests to detect if they were experiencing any psychological problems after the accident. The tests were followed up in the next three years. The majority of the test subjects were deemed not badly injured enough to require admittance into a hospital, although one in three was showed to be suffering from a psychological disorder. Over the test period, this number gradually reduced to one in four victims showing effects of psychological disorder three years following the accident.
When it is taken into account that the majority of the test group were not even admitted to hospital, this is a significant problem as years after the occurrence of the RTA, 25% of them suffered from conditions such as depression and PTSD.
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.
Assessment
For a 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.
A psychological assessment usually costs between 300 and 500 and lasts for around an hour and a half. During this time a test will determine the health of the person prior to their accident and the details of the accident will be noted. The Psychologist will then use the tools mentioned to diagnose any conditions present and then prescribe the correct course of treatment. Many Psychologists reports use the Rehabilitation First Code of Practice which means the form of reporting is independent and can be used in a claim for compensation if necessary.
Treatment
The commonest treatment used is ‘expectant’, which means that the person expects to make a quick recovery. As the experiment shows this is unrealistic and often costly for the individual when you consider loss of working days.
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.
Depending on the circumstances of your accident you might be entitled to make a Personal Injury Claim. You should look for solicitors who specialise in personal injury and offer a no win, no fee service to take your case such as Duncan Gibbins Solicitors based in Manchester.
For more information about compensation claims or to speak directly to a specialist personal injury, visit Duncan Gibbins Solicitors website for details.