The risk of mental stress and morbidity for healthcare professionals working in the ever-worsening and prolonged corona crisis is considerable[i]. Together with my colleagues, I have raised the issue in professional medical publications over the past year[ii]. Recently, Lääkärilehti continued to write about the topic under the title Joko pää hajoaa? Koronaväsymys koettelee lääkäreitä. Mikä avuksi? (Is your head exploding already? Corona fatigue is testing doctors. What will help?)[iii] The continuation of the situation forces doctors and nurses to endure and the experience of the meaningfulness of the work motivates. However, this cannot continue for long. There is a message from the field that due to corona and e.g. the transition to the Abbot system the exhaustion is already so serious that the resources are no longer enough even to seek help.
International studies suggest that around a third of healthcare professionals will experience psychological symptoms due to the pandemic. People working on the front line have a higher risk factor for insomnia, post-traumatic stress disorder, anxiety and depression than other people working in healthcare. The lack of social support is a significant predictor of mental illness in workers who help others. Now we need information on what kind of methods help professionals cope in this exceptional situation.
The case discussed in this blog post is presented with the person's permission, as always in my blogs. The healthcare professional in question (I'll call her Emily here) came to my reception in the summer of 2020 for targeted EMDR therapy in order to be able to continue working on the front line of treating corona patients. Emily said that she felt at the time that she had worked in the fog at the limits of her powers and had to cut everything else out of her life. She had a strong sense of inadequacy in relation to the demands of her job, and among other things, the fate of a certain patient had been haunting her mind. When Emily entered treatment, she had several symptoms of post-traumatic stress disorder and anxiety.
In the eye movement therapy that lasted 60 minutes with Emily, the first target memory was the interaction Emily had had with a patient with corona in the hospital, where Emily alone them and the patient had been desperate. I asked Emily to focus on the worst moment of the target memory and choose an irrational negative belief about herself related to that event. Emily chose "I am inadequate"as a negative cognition. As a positive cognition in relation to the event, Emily chose "I am enough". The veracity of the positive cognition at the affect level in relation to the mental image was three on a scale of 1–7 (feels completely false-feels completely true) at the start of the treatment. Focusing on the target memory evoked strong feelings of feeling bad and sadness in Emily. The intensity of the feeling of disturbance related to the event on the subjective disturbance unit scale (SUD 0–10, where 10 = maximum possible disturbance and 0 = neutral) was eight and Emily felt this disturbance in her stomach.
The bilateral stimulation with a visual stimulus was started when Emily focused on the target memory and tied the negative cognition "I am inadequate"to it. The stimulus given in rapid bursts quickly led Emily to realizing that as a healthcare professional she had done her best and could not have done anything else. She also remembered how the patient had calmed down during the interaction. In addition, she remembered a situation in which the patient had gotten home from the hospital. The desensitization implemented with bilateral visual stimuli led to the desired result in 25 minutes: the disturbingness of the target memory had decreased to zero, and the veracity of positive cognition ("I'm enough") in relation to the target memory was seven (feels completely true).
Fast processing made it possible to work on another target memory at the same session. As the second target memory to work on, Emily chose the patient's resuscitation situation, which had been accompanied by a lot of uncertainty, which also represented the worst part of the target memory for Emily. Emily found the negative cognition "I'm bad and unfit" and the positive cognition "I'm good and fit"corresponding to the image related to the target memory. The veracity of positive cognition at the affect level was 5 out of 7. The target memory evoked feelings of frustration and anger, and its disturbance was initially 4 out of 10. The desensitization implemented with bilateral visual stimuli led to the desired result in seven minutes: the disturbance of the target memory had decreased to zero (completely neutral) and the veracity of the positive cognition in relation to the target memory was seven.
Emily underwent targeted EMDR therapy three times during the summer. Every time the result of the treatment was the same as the first treatment described here. The disturbance of the events selected as target memories at the initial level decreased as the work progressed, and the stimulation time required to neutralize them also decreased. In connection with each reception, more disturbing memories related to work were neutralized.
I recently contacted Emily to ask for her consent to write this blog and discuss her case report at training events. In the same context, Emily said that she is still working on the front line of treating corona patients and that she now knows how to deal with her experiences in a different way than before. She told me that she hasn't found her work burdensome since our meetings and made me very happy by saying at the end "It's going well, thank you!"
There can't be a more rewarding job than this😊
Helinä Häkkänen
In conclusion: There are very positive experiences in Finland, e.g. of post-trauma workshops aimed at police officers and rescue workers, where work-related traumatic experiences and cumulative stress are worked on with the help of eye movement therapy (EMDR therapy).[iv] These trauma workshops were carried out in person before the corona pandemic. Mielenjuuri has developed a method based on EMDR therapy that can be implemented remotely via video for a group of no more than 5-7 people, which is currently being used by us in professional guidance of social welfare authorities. The skills to use the method with health care personnel exist. Contact us if you are interested in hearing more about it.
References
[i] Häkkänen-Nyholm, H., Lyytinen, N., Heinimaa, M., Heiskala M., & Varis, A. (2020). Koronakriisi haastaa terveydenhuollon ammattilaisten psyykkisen hyvinvoinnin: mitä tästä jo tiedetään? Suomen Lääkärilehti, 23.10.2020 ‐ 43-44/2020.
[ii] Lyytinen, N., Häkkänen-Nyholm, H., & Varis, A. (2020). Terveydenhuollon ammattilaisten psyykkisestä hyvinvoinnista on huolehdittava epidemiatilanteessa. https://www.laakarilehti.fi/ajassa/nakokulmat/terveydenhuollon-ammattilaisten-psyykkisesta-hyvinvoinnista-on-huolehdittava-epidemiatilanteessa/
A PDF-version of the article can be found here: https://helda.helsinki.fi/bitstream/handle/10138/320029/SLL162020_954.pdf?sequence=1&isAllowed=y
[iii] https://www.laakarilehti.fi/ajassa/ajankohtaista/joko-paa-hajoaa/
[iv] Marika Korhonen’s thesis at Police University College Poliisin posttraumatyöapaja työhyvinvoinnin edistäjän.
https://www.theseus.fi/bitstream/handle/10024/260848/ON_Korhonen.pdf?sequence=2&isAllowed=y
