Affective Distress and Implantable Cardioverter Defibrillators: Cases for Psychological and Behavioral Interventions

Abstract

The implantable cardioverter defibrillator (ICD) may be associated with some degree of psychological maladjustment, especially in patients experiencing high rates of discharge. This article reviews the psychological literature related to ICDs and presents two case examples illustrating common psychological complications related to multiple discharges. A brief, psychological intervention can be implemented to improve patient adjustment. To explain possible processes by which psychological complications may develop in ICD patients, two well-established psychological theories of learning and behavior, classical conditioning and learned helplessness, are reviewed. Multidisciplinary teams that include consultation with clinical psychologists are suggested for the routine care of ICD patients.

Avoidance behaviors in patients with implantable cardioverter defibrillators

“…Evidence from case studies suggests that even brief psychological intervention can help to reduce pathologic anxiety among patients with ICDs. 17,18 Although patients with ICDs visit their cardiac specialist for regular medical monitoring, the assessment of psychological symptoms or psychopathology is relatively rare. Consultations focus largely on physical symptoms, and unless patients volunteer information relating to their psychological wellbeing, problems with anxiety, depression, or avoidance behaviors may go unnoticed by health professionals.…”

The prevalence of anxiety and depression in adults with implantable cardioverter defibrillators: A systematic review

“…Moreover, anxiety and depression may differentially impact women, minorities, and young adults or elderly individuals [13,44,45]; thus, published research among these groups of ICD recipients is needed. Regardless, psychological intervention is warranted for patients with significant adjustment difficulties or psychiatric diagnoses [46][47][48]. Cognitive behavioral approaches have been shown to reduce symptoms of anxiety and depression among ICD patients [46,[49][50][51][52].…”

Understanding implantable cardioverter defibrillator shocks and storms: Medical and psychosocial considerations for research and clinical care

“…Specifically, the experience of aversive shock, the recognition of potential mortality, and the perceived lack of control or predictability over one's medical condition can lead to a state of "learned helplessness" that may make patients with ICDs vulnerable to anxiety and depressive disorders. 20 In fact, recent research highlighted patients with ICDs as "an appropriate risk population for a prospective study of the development of anxiety disorders." 21 The experience of shock has been regularly linked to poor psychological and QOL outcomes in the ICD literature.…”