Psychological consequences of awareness and their treatment. 
Gunilla Sydsjo, Psychotherapist, PhD, Professor, Dept of Obstetrics and Gyneacology, University hospital, S-581 85 Linköping, Sweden.
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Abstract
Awareness is a serious complication with an incidence of 0.1 – 0.2%. To prevent this negative outcome a thorough perioperative management of anaesthesia is necessary.
The experience of awareness during general anaesthesia is considered to degree of severity of stress that may induce PTSD. Therefore, an important question is whether PTSD is a result of the trauma per se or are the symptoms more dependant on factors related to how the individual cope with the event. The most frequently reported intense experiences that awareness patients describe are; unable to communicate, trapped in an immobile body, helplessness, terror, fear, panic, feeling unsafe, abandoned, betrayed by medical staff and fear of pain. The initial emotional response has also been considered most severe if pain is experienced.
The empirical literature on treatment of PTSD has evolved rapidly in the past two decades. This has led specialists to state that Cognitive Behavioral therapy [CBT] and Eye Movement Desensitization and reprocessing [EMDR] should be considered as first–line treatments. The growing evidence that PTSD is characterized by psychobiological dysfunction has led to increased interest in evaluating the effects of medication. SSRI has been found to be effective in the treatment of PTSD, acting on reducing the core symptoms such as intrusions, avoidance and hyperarousal symptoms. In addition, a combination of SSRI and CBT/EMDR has been found to be effective both in the short and long term.
A CBT model for treatment will be discussed in the presentation.