Nic Schmoyer was pursuing his Master of Science degree in Mental Health Counseling at PCOM when a class project sparked his interest in medical trauma. During a trauma counseling course, Schmoyer and his group were tasked with creating training for medical students to recognize and address medical trauma.
“From there, I immersed myself in literature related to traumatic experiences in medical settings and the associated biopsychosocial consequences,” Schmoyer said. “This led to intentional efforts to seek out experiences where I could prepare healthcare professionals to prevent and respond to medical trauma, and directly provide psychotherapy to those who have had traumatic healthcare experiences.”
Now, as a second-year doctoral student in counselor education and supervision at Old Dominion University, Schmoyer is applying the skills he acquired at PCOM to helping patients who are dealing with concerns associated with medical trauma.
Medical trauma is the experience of traumatic stress as a result of interactions with the medical system, which may include procedures (i.e., surgeries), new diagnoses (i.e., cancer), and professionals in healthcare settings. These healthcare settings may include primary care clinics, general hospitals, and specialty medical clinics, among others.
Common experiences that may be related to medical trauma include medical events (i.e., heart attack, stroke) or procedures (i.e., emergency cesarean section, intubation due to COVID-19 infection).
“There is no standard example or experience for medical trauma,” Schmoyer explained. “A common thread between traumatic medical experiences that may contribute to medical trauma is the real or perceived threat to life as a result of an event or interaction within a healthcare setting.”
The symptoms of medical trauma can vary greatly and are highly subjective. They may include intrusive thoughts or memories of the traumatic event, avoidance of medical procedures or settings, anxiety, depression, anger, and feelings of helplessness or hopelessness. Some individuals may also experience physical symptoms such as headaches, insomnia, and fatigue.
“It is important to recognize that there are no set symptoms for individuals who are experiencing medical trauma,” Schmoyer said. “If you are experiencing a significant deviation in your behavioral health that greatly affects various domains in your life after a major medical event, procedure, or interaction, you may be experiencing symptoms related to medical trauma.”
Medical trauma can be targeted using evidence-based counseling approaches that have been shown to be effective in the treatment of trauma.
According to Schmoyer, these approaches may include cognitive behavior therapy, cognitive processing therapy, acceptance and commitment therapy, and prolonged exposure therapy.
“Within these treatment approaches, individuals who are experiencing medical trauma can expect a trained professional to assist them in processing their experiences,” Schmoyer said.
This may entail examining patterns and engaging in new patterns that can be helpful in meaningfully re-engaging with medical settings and professionals. Depending on client and physician comfort, a client’s primary care physician or psychiatrist may prescribe medications as a supplement to psychotherapeutic treatment.
However, Schmoyer cautioned, this may be contingent on physician comfort and awareness of medical trauma, the presence of diagnostic symptoms related to trauma and/or stressor-related disorders, and other factors.
“It is important to follow up with a trained behavioral health professional so that they can assess your symptoms and provide you with a tailored behavioral health treatment plan,” Schmoyer advised.
PTSD may be diagnosed after a medically traumatic event (i.e., procedure, acute medical concern) if there was exposure to actual or threatened death. Additionally, certain clinicians may diagnose PTSD if an individual has enduring symptoms related to recurrent exposure to real or perceived danger as a result of enduring somatic threat (EST) related to the symptoms and experiences of the chronic condition.
The current edition of the Diagnostic and Statistical Manual of Mental Disorders—the DSM-5-TR—does not specifically indicate that PTSD can be diagnosed as a result of interactions with a life-threatening illness, Schmoyer explained. Other diagnoses that may be applicable include mood disorders (e.g., major depressive disorder), anxiety disorders (e.g., panic disorder, agoraphobia), or other trauma and stressor-related disorders (e.g., acute stress disorder, adjustment disorder).
“In the process of gathering information and administering diagnostic assessments, a behavioral health clinician can help you determine what would be the most appropriate diagnosis, if one is needed, to help you place a name to your experience, give you the treatment that will be most effective, and help you receive financial assistance through insurance if applicable,” Schmoyer said.
As a graduate student at PCOM, Schmoyer had the opportunity to engage in interprofessional collaboration through interprofessional education (IPE) seminars.
“This introduced me to the skills, knowledge, and values of other professionals, allowing for a holistic approach to health and wellness,” he said.
The experience, he explained, provided a better understanding of how to broach the topic of trauma-informed medical systems to leaders and clinicians in interdisciplinary healthcare settings, share values related to professional counseling and behavioral health with other professionals, and incorporate the strengths of various types of providers to enhance the provision of biopsychosocial health and wellness services.
Schmoyer further credits the advanced training he received in cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) with contributing to his ability to critically conceptualize each individual’s concerns and apply evidence-based practices to promote their health and wellness.
“My degree at PCOM helped prepare me to provide trauma-informed behavioral health services in a sensitive, effective manner,” Schmoyer explained. “PCOM also allowed me to learn how to effectively work as part of an interdisciplinary healthcare team, which is a vital component for preventing and responding to medical trauma in healthcare settings.”
Schmoyer advises anyone who may be suffering from medical trauma to connect with a behavioral health clinician. Additionally, Schmoyer encourages patients to not be afraid to advocate for their needs and experiences when in medical settings in the future.
“As a client and patient in healthcare settings, you have the right to request compassionate, trauma-informed care,” he explained.
Individuals should talk with their providers and express any concerns. Schmoyer also suggests exploring whether the medical setting being utilized offers behavioral health consultations or appointments, as the availability of these services are rising.
“If medical trauma is addressed within the silo of behavioral health, we are missing a crucial component of healing from medically traumatic events,” Schmoyer said. “Only through a team-based approach can we truly recognize and address medical trauma.”
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