Case Study

A cure for PTSD? An outcome achieved through Structured Image Framework Theory, exposure therapy and ketamine

Daren J. Wilson
Journal of Applied Neurosciences | Vol 3, No 1 | a10 | DOI: https://doi.org/10.4102/jan.v3i1.10 | © 2024 Daren J. Wilson | This work is licensed under CC Attribution 4.0
Submitted: 03 October 2023 | Published: 29 May 2024

About the author(s)

Daren J. Wilson, Private Practice, Clearview Psychology, New South Wales, Australia

Abstract

This case study explores how an Intensive Care Paramedic (ICP) experienced a significant decline in his diagnosed chronic post-traumatic stress disorder (PTSD) and co-morbid depression and anxiety symptoms following a spontaneous episode of Rapid Atrial Fibrillation (AF) treated with ketamine and cardioversion emergency medical intervention. This article explores how by using therapeutic interventions from a newly developed Structured Image Framework Theory (SIFT) and exposure therapy interventions from prolonged exposure therapy (PET) and Eye Movement Desensitisation and Reprocessing (EMDR) a diagnosed chronic PTSD ICP was able to return to full non-operational ‘off road’ emergency crisis duties. This was owing to developing a more reliable capacity to effectively engage with in vivo exposure exercises involving triggering environmental stimuli, gaining a greater sense of control, understanding the volatility of traumatic triggering, and developing emotional tolerance in order to maintain self-regulating control. This continued to be evident during ongoing PTSD triggering and while being exposed to paramedical emergency information repeatedly disseminated throughout his Australian governmental ambulance working environment. Approximately 12 months after being diagnosed with chronic PTSD, this ICP experienced a life-threatening spontaneous episode of rapid AF, which required an emergency ambulance response to hospital. Once Mr T. reached the emergency department (ED) he was initially given a magnesium infusion and then a bolus dose of verapamil. He was in ED for approximately 2 h prior to his cardioversion. He was given an 80 mg injection of ketamine to sedate him before receiving a 100 joules external shock defibrillation via multifunction electrodes (MFE) to restart his heart, which was unsuccessful in achieving an appropriate heart rhythm reset. Mr T. was then administered 200 joules, before his heart rate reset into sinus rhythm. The 80 mg ketamine injection and subsequent 100 then 200 joules heart restart defibrillations were completed within 3 min. As soon as Mr T. received his 80 mgs of ketamine, he subsequently had a successful 200-joule defibrillation cardioversion. He was not aware of his cardioversion as he experienced what he described as shifts in his ability to emotionally connect and process the world around him. While he remained in a resus bed in ED for the next 17–18 min with his eyes open supported initially by fellow paramedic friends, he described feeling like he had experienced a ‘factory reset’. Mr T. also reported that, after returning to the reality of the ED recovery room, it took approximately 8 h for the effects of the ketamine to wear off and then he went to sleep. The following day Mr T. felt a significant drop in PTSD, depression and anxiety symptoms. This was assessed in clinical therapy sessions and with self-report scales within 2 days of his rapid AF cardioversion episode and then over the next 18 months, with remarkable results. In conclusion, this paper explores how the combination of therapeutic interventions from down-regulating practices – SIFT, PET, and EMDR – prepared Mr T. for the cardioversion rapid AF/ketamine-induced journey that shifted his capacity to process his internal and external worlds. What could have been affected his brain functioning, which then significantly decreased his PTSD, depression and anxiety symptom levels, for now over 18 months? He has not required any ongoing psychiatric medication support throughout his journey and only received therapeutic monitoring sessions since his significant reduction in PTSD symptom levels. To date, Mr T. continues to maintain full-time non-operational ‘off road’ duties within his ICP Australian governmental ambulance workplace environment. 

Contribution: This remarkable case has significantly shifted an intensive care paramedic’s PTSD condition to a predictable long-term stabilised state.


Keywords

chronic PTSD treatment; structured image framework theory; ketamine; rapid atrial fibrillation; trauma exposure therapy; Intensive Care Paramedic (ICP); Structured Image Framework Theory (SIFT); rapid atrial fibrillation

Sustainable Development Goal

Goal 3: Good health and well-being

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