The ICD shock and stress management program: a randomized trial of psychosocial treatment to optimize quality of life in ICD patients.
BACKGROUND
Implantable cardioverter defibrillator (ICD) patients potentially face significant psychological distress because of their risk for life-threatening arrhythmias and the occurrence of ICD shock.


METHODS
The purpose of this study was to test an ICD stress and shock management program delivered in either a six-week format or a one-day workshop format. This intervention was aimed at reducing psychological (anxiety) and physiological (salivary cortisol) markers of distress in ICD patients. Secondary endpoints included measures of quality of life (QOL) and patient acceptance of device therapy, as well as biological mediators of inflammation (TNFalpha and IL-6).


RESULTS
The ICD stress and shock management program resulted in the reduction of anxiety (P < 0.05) and cortisol levels (P < 0.05) in both the six weekly sessions format and the one-day workshop. Measures of anxiety decreased more rapidly with weekly intervention (P = 0.05). Both formats also resulted in a significant increase in patient acceptance of the ICD (P < 0.01). Follow-up assessment from posttreatment (T2) to four-month follow-up (T4) indicated no significant change in depression scores from posttreatment for all groups taken together, but there was a significant group by time effect, such that the workshop group displayed an increase in depression scores from T2 (M = 8.71, SD = 4.39) to T4 (M = 13.57, SD = 11.90), P < 0.05.


CONCLUSIONS
These results suggest that structured interventions for shocked ICD patients involving ICD education and cognitive-behavioral strategies can reduce psychological distress and improve quality of life, regardless of format.
Sears
Samuel F
SF
Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida 32610, USA. ssears@phhp.ufl.edu
Sowell
Lauren D Vazquez
LD
Kuhl
Emily A
EA
Kovacs
Adrienne H
AH
Serber
Eva R
ER
Handberg
Eileen
E
Kneipp
Shawn M
SM
Zineh
Issam
I
Conti
Jamie B
JB
D000223:Adaptation, Psychological; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D015928:Cognitive Behavioral Therapy; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012463:Saliva / Q000737:chemistry; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome
D006854:Hydrocortisone