title: A randomized controlled trial of cognitive behavior therapy tailored to psychological adaptation to an implantable cardioverter defibrillator.
abstract: OBJECTIVE
  To evaluate a eight-session cognitive behavior therapy (CBT) intervention tailored to adaptation in implantable cardioverter defibrillator (ICD) patients; and to test for treatment group by gender interaction effects.
  
  
  METHODS
  Patients receiving their first ICD implant were randomized to CBT or usual cardiac care. Primary outcomes measured at baseline, 6-month, and 12-month follow-ups were symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), posttraumatic stress disorder symptoms (Impact of Events Scale-Revised), and phobic anxiety (Crown-Crisp Experiential Index). Secondary outcomes were quality of life (Short Form-36 Physical Component Summary and Short Form-36 Mental Component Summary) and ICD shocks or antitachycardia pacing therapies.
  
  
  RESULTS
  Of 292 eligible patients, 193 consented and were randomized to CBT (n = 96) or usual cardiac care (n = 97). Eighty percent were male; mean age was 64.4 years (standard deviation = 14.3); and 70% received an ICD for secondary prevention. No baseline differences were observed between the treatment conditions; however, women scored worse than men on all psychological and quality of life variables (p < .05). Eighty-three percent completed follow-up. Repeated-measures analyses of covariance revealed significantly greater improvement with CBT on posttraumatic stress disorder total and avoidance symptoms for men and women combined (p < .05) and significantly greater improvement in depressive symptoms and Short Form-36 Mental Component Summary only in women (p < .01). No differences were observed between treatment conditions on ICD therapies over follow-up.
  
  
  CONCLUSIONS
  A CBT intervention to assist adaptation to an ICD enhanced psychological functioning over the first year post implant.
authors.affiliation: Department of Psychology, York University, Behavioural Sciences Building, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3. jirvine@yorku.ca
authors.forename: Jane
authors.initials: J
authors.lastname: Irvine
authors.forename: Jill
authors.initials: J
authors.lastname: Firestone
authors.forename: Lephuong
authors.initials: L
authors.lastname: Ong
authors.forename: Robert
authors.initials: R
authors.lastname: Cribbie
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Louise
authors.initials: L
authors.lastname: Harris
authors.forename: Paul
authors.initials: P
authors.lastname: Ritvo
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
authors.forename: David
authors.initials: D
authors.lastname: Newman
authors.forename: Doug
authors.initials: D
authors.lastname: Cameron
authors.forename: Sabine
authors.initials: S
authors.lastname: Johnson
authors.forename: Ana
authors.initials: A
authors.lastname: Bilanovic
authors.forename: Ann
authors.initials: A
authors.lastname: Hill
authors.forename: Suzan
authors.initials: S
authors.lastname: O'Donnell
authors.forename: Samuel
authors.initials: S
authors.lastname: Sears
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control; D016896:Treatment Outcome