Megan Weishaar helps severely burned patients cope and find their way back to everyday life

Megan Weishaar, PhD, is a rehabilitation psychologist at the UCHealth Burn and Frostbite Center in Aurora, Colorado, where she collaborates with medical providers to improve mental and physical health outcomes for burn and frostbite patients during rehabilitation. Many of these patients struggle with intense physical pain as well as issues of psychological trauma, body image, and anxiety because of their injury.

Weishaar is part of a team of physicians, nurses, social workers, and occupational, speech, and physical therapists supporting these patients at the UCHealth Burn and Frostbite Center, which is one of only 77 American Burn Association–verified burn centers in the country. On any given day, she might be applying psychological principles to support hospitalized burn patients with pain, trauma, and anxiety or conducting psychotherapy in the outpatient setting.

The Monitor spoke with Weishaar about how she supports burn patients in and out of the hospital and the common misperceptions about burns and psychological outcomes.

Supporting mental health early on is critical for reducing the impact of trauma and other mental health challenges burn patients can face, and also for promoting positive physical health outcomes. My work with these patients during their hospital stays primarily focuses on helping them navigate the hospital experience, including supporting their engagement with other providers, particularly physical and occupational therapists. In the weeks after a burn, patients can experience significant and severe pain that can increase anxiety. They might struggle to do their physical therapy (PT) exercises, which are so important for long-term recovery and hospital discharge. Pain often spikes after wound care, a surgical procedure, or a PT session. As a result, I work with a patient to cope using guided imagery or breathing exercises.

I also work with providers to help them understand how to better communicate with and best support patients from a psychological perspective. I recently had a burn patient who had to wear a neck brace because of other injuries. They had experienced previous trauma related to strangulation, so putting the brace on and taking it off triggered trauma symptoms, which contributed to difficulty proceeding with care. Along with helping the patient cope with the trauma symptoms when they came up, I worked closely with the physical and occupational therapists to help them understand how to most effectively communicate and approach the patient’s care in the context of this trauma.

Burns often have long-lasting effects on patients and profoundly affect their functioning in a variety of life domains. Post-traumatic stress disorder is common, and so are anxiety and mood disorders, which can persist after [patients] leave the hospital. Along with acute and chronic pain, people with severe burns often experience skin tightness as they recover that can impair their mobility for months to years, depending on the severity and location of the burn. So, they may not be able to exercise, play with their kids, or experience intimacy with their partners like they used to. [A burn] can also significantly affect someone’s body image based upon perceived ways that someone’s body looks or functions after injury. A patient may experience feelings of shame or embarrassment when they go to the store or go on a date, which can keep them from going out and interacting with others, or it can significantly impact their mood or anxiety if they do go out.

A common referral from physicians is someone who has experienced a workplace-related burn injury, whether from working in a kitchen, a factory, or an oil field. They’re typically referred to me for post-traumatic stress disorder. We often work on coping skill building as a foundation. Then we may dive into a specific approach for addressing trauma, such as cognitive processing therapy or prolonged exposure.

As trauma symptoms improve, we might focus on other helpful approaches like nonpharmacological interventions for pain or sleep. I also help people align their behaviors with their values. For example, they may be experiencing depressive symptoms because they want to connect more with their kids after injury, but they can’t do this in the way they used to. It might be hard, for example, to walk to the park and push a child on the swing at certain points in rehabilitation. I’d try to help them pinpoint the underlying value, like quality time with their family, and help them find new ways to live in alignment with what is most important to them.

Clinical and counseling psychologists without specialized rehabilitation psychology training can also use these strategies to help patients after burn injury. If you work with a burn survivor, try to help them establish community with other burn survivors through networks like the Phoenix Society. Therapeutic work can be powerful, but connecting with someone who’s gone through something similar—whether through a peer support program, a conference, or a Facebook group—can help people realize they aren’t alone.

There’s not always a relationship between burn size or severity and psychological outcomes. While the size and depth of the burn can influence how long you stay in the hospital—which in turn can affect psychological outcomes—it’s not true that the patient with the biggest burn always fares the worst. Sometimes, people with smaller burns can have more challenging experiences. So many different factors can impact the patient’s outcome. For example, burn patients often come with previous trauma that may be triggered during the hospital stay.

We have effective methods for treating pain, anxiety, and trauma within the field of psychology. Ensuring early screening, intervention, and ongoing mental health care that fits patient needs are some of the best ways to promote positive outcomes.