The Effect of Psychological Intervention on Patients' Long‐Term Adjustment to the ICD: A Prospective Study

Abstract

This study prospectively examined the role of cognitive behavioral therapy (CBT) in (1) alleviating psychological and somatic distress, and (2) lowering arrhythmic events requiring shocks. Forty-nine of 61 consecutive patients were randomized into therapy (CBT, n = 25) or no therapy (NT, n = 24) and completed a battery of self-report questionnaires at baseline and at 9-month follow-up. CBT was administered at preimplant, predischarge, and at seven routine follow-up visits. Patients were 65 +/- 10 years old, 65% were men, and 92% Caucasian. Eighteen (72%) CBT patients and 18 (75%) NT patients were retained at follow-up. Compared to CBT patients, NT patients reported higher levels of depression (P = 0.046), more anxiety (P = 0.013), more psychological distress (P = 0.015), poorer overall adjustment (P = 0.009), and poorer sexual functioning (P = 0.003). Mean number of shocks did not differ between the CBT and NT groups (2.85 vs 2.30, respectively); however, more patients in the CBT group (61%) than the NT group (33%) received shocks (P = 0.070). At follow-up, a subgroup analysis revealed that the significant differences observed between the CBT and NT groups were attributable to the patients who received shocks in both groups. In conclusion, CBT was associated with decreased depression, decreased anxiety, and increased adjustment for ICD recipients, particularly among those patients receiving shocks. CBT can be administered effectively at routine follow-up visits or transtelephonically with little added inconvenience to the ICD recipient.

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

“…The effects of ICD implantation and shock may be appropriately addressed with structured, formal psychosocial interventions provided by specialist mental health providers as illustrated by Kohn et al 30 These researchers used individual cognitive-behavioral therapy to reduce psychological distress in patients newly implanted with ICDs to determine if such therapy would also reduce arrhythmic events requiring shocks for termination. They randomized 49 patients with ICDs to active treatment versus no treatment.…”

Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators

“…However, a limited number of quantitative investigations was available. Kohn et al 11 demonstrated cognitive-behavioral therapy (CBT) which included psychoeducation, stress management, and the examination of distorted thoughts about ICD-specific concerns; it was associated with significantly less depression, anxiety, and adjustment difficulties compared with controls at 9-month followup. More recently, Frizelle et al 12 demonstrated the effectiveness of a CBT intervention in reducing anxiety and depressive symptoms and improving quality of life in patients with ICD in the cardiac rehabilitation setting over a period of 6 weeks.…”

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

“…Given the positive outcomes of studies using cognitive behavioral training and techniques, 160,163,166,167,169,170 clinicians are encouraged to incorporate these strategies into their communication, education, and support activities for ICD patients. Formal CBT may involve a series of 8 to 10 individual or group sessions for those who are clinically anxious and/or depressed and referred to a trained provider.…”