Signs of post-traumatic stress disorder in caregivers following an expected death: a qualitative study.

BACKGROUND: Complications of grief are an important area of investigation with potential to improve the well-being of palliative care caregivers. There has been little study of the prevalence or significance of post-traumatic stress disorder for those bereaved after an expected death. AIM: To identify evidence suggestive of post-traumatic stress disorder symptoms in a population of bereaved caregivers of patients who have died of ovarian cancer. DESIGN: Caregivers' recollections of their end-of-life experiences were coded and analysed, using qualitative data obtained from interviews 6 months after the patient's death. SETTING/PARTICIPANTS: Australian Ovarian Cancer Study-Quality of Life Study is a population-based epidemiological study using mixed methods to explore caregivers' experiences following the expected death of a woman with ovarian cancer. Thirty-two caregivers from the Australian Ovarian Cancer Study-Quality of Life Study participated in semi-structured telephone interviews 6 months post-bereavement. RESULTS: When describing the patient's death at their 6-month interview, all interviewees used language consistent with some degree of shock and traumatisation. For the majority, there was also evidence suggesting resilience and resolution. However, a number of interviewees describe intrusive memories associated with physical sights and sounds that they witnessed at the deathbed. CONCLUSIONS: This exploratory study demonstrates the phenomenon of the 'shocked caregiver'. If trauma symptoms are present in bereaved carers in palliative care, it has implications for palliative care provision. Given that trauma symptoms may be distinct from prolonged grief disorder, this may also have implications for provision of bereavement counselling. Further research into this phenomenon is required.

The effect of attentional re-training and threat expectancy in response to acute pain.

This study aimed to investigate the efficacy of implicit attention re-training (AR) on pain ratings, threshold and tolerance during the cold-pressor task and to determine whether the effectiveness of AR was affected by threat expectancy. One hundred and four undergraduate psychology students were randomly assigned to receive either threat-alleviating or threat-inducing information about the task. Participants were then re-randomized to receive an AR that either trained them to implicitly attend to neutral and ignore pain-related stimuli (neutral training) or to attend towards pain-related stimuli (pain training). Hence, the present study had a 2 (threat expectancy: high vs low) x 2 (AR: pain vs neutral) design. Manipulation checks confirmed that the threat manipulation was effective in increasing threat expectancy and the training paradigm shifted attentional biases in predicted directions. Results showed that, relative to neutral re-training, those in the pain re-training group reported higher levels of pain 30s into the cold pressor task and registered pain more quickly. There was no difference in tolerance between the groups, nor pain at tolerance. This was the same pattern of results found for the threat induction. For initial pain ratings, there was an interaction that closely approached significance (p=0.053). These results show that AR affects individual's perceptions of and their responses to pain during an experimental task in a similar way to increasing the threat expectancy of the task. Future research should trial AR in real-life settings to determine whether these results can be generalized.