Data_Sheet_2_The long wave of COVID-19: a case report using Imagery Rehearsal Therapy for COVID-19-related nightmares after admission to intensive care unit.docx

IntroductionThe COVID-19 pandemic caused several psychological consequences for the general population. In particular, long-term and persistent psychopathological detriments were observed in those who were infected by acute forms of the virus and need specialistic care in the Intensive Care Unit (ICU). Imagery rehearsal therapy (IRT) has shown promising results in managing nightmares of patients with different traumas, but it has never been used with patients admitted to ICUs for severe COVID-19 despite this experience being considered traumatic in the literature.
MethodsThe purpose of this case study is to describe the application of a four-session IRT for the treatment of COVID-related nightmares in a female patient after admission to the ICU. A 42-year-old Caucasian woman who recovered from a pulmonary rehabilitation program reported shortness of breath, dyspnea, and everyday life difficulties triggered by the long-COVID syndrome. She showed COVID-related nightmares and signs of post-traumatic symptoms (i.e., hyperarousal, nightmares, and avoidance of triggers associated with the traumatic situation). Psychological changes in the aftermath of a trauma, presence, and intensity of daytime sleepiness, dream activity, sleep disturbances, aspects of sleep and dreams, and symptoms of common mental health status are assessed as outcomes at the baseline (during the admission to pneumology rehabilitation) at 1-month (T1) and 3-month follow-up (T2). Follow-up data were collected through an online survey.
ResultsBy using IRT principles and techniques, the patient reported a decrease in the intensity and frequency of bad nightmares, an increase in the quality of sleep, and post-traumatic growth, developing a positive post-discharge.
ConclusionImagery rehearsal therapy may be effective for COVID-19-related nightmares and in increasing the quality of sleep among patients admitted to the ICU for the treatment of COVID-19. Furthermore, IRT could be useful for its brevity in hospital settings.

引言：新型冠状病毒肺炎（COVID-19）大流行对普通人群造成了多方面的心理后果。具体而言，感染重症型病毒且需在重症监护病房（Intensive Care Unit, ICU）接受专科救治的患者，出现了长期且持续的精神病理损害。意象排练疗法（Imagery Rehearsal Therapy, IRT）在针对各类创伤患者的噩梦管理中已展现出良好前景，但目前尚无其应用于因重症新冠入住ICU患者的相关报道，尽管这类住院经历在学界已被认定为创伤性事件。
方法：本案例研究旨在描述针对一位ICU出院后女性患者，采用为期4次的意象排练疗法治疗新冠相关噩梦的实践过程。研究对象为一名42岁高加索女性，曾完成肺康复治疗，后因长新冠综合征出现呼吸困难、气促及日常生活功能障碍，并表现出新冠相关噩梦与创伤后症状（如过度觉醒、噩梦发作、回避创伤相关触发因素）。研究在基线阶段（肺康复住院期间）、1个月随访（T1）及3个月随访（T2）时，对以下结局指标进行评估：创伤后心理变化、日间嗜睡的存在情况与严重程度、梦境活动、睡眠障碍、睡眠与梦境特征，以及常见精神健康症状。随访数据通过线上问卷收集。
结果：通过运用意象排练疗法的原理与技术，患者自述噩梦的强度与发作频率均有所降低，睡眠质量得到提升，同时出现了创伤后成长，形成了积极的出院后适应状态。
结论：意象排练疗法或可有效改善因重症新冠入住ICU患者的新冠相关噩梦，并提升其睡眠质量。此外，由于疗程简短，该疗法在临床住院场景中具有较高的应用价值。