title: Manual for the psychotherapeutic treatment of acute and post-traumatic stress disorders following multiple shocks from implantable cardioverter defibrillator (ICD).
abstract: BACKGROUND
  In view of the increasing number of implanted cardioverter defibrillators (ICD), the number of people suffering from so-called "multiple ICD shocks" is also increasing. The delivery of more than five shocks (appropriate or inappropriate) in 12 months or three or more shocks (so called multiple shocks) in a short time period (24 hours) leads to an increasing number of patients suffering from severe psychological distress (anxiety disorder, panic disorder, adjustment disorder, post-traumatic stress disorder). Untreated persons show chronic disease processes and a low rate of spontaneous remission and have an increased morbidity and mortality. Few papers have been published concerning the psychotherapeutic treatment for these patients.
  
  
  OBJECTIVE
  The aim of this study is to develop a psychotherapeutic treatment for patients with a post-traumatic stress disorder or adjustment disorder after multiple ICD shocks.
  
  
  METHODS
  Explorative feasibility study: Treatment of 22 patients as a natural design without randomisation and without control group. The period of recruitment was three years, from March 2007 to March 2010. The study consisted of two phases: in the first phase (pilot study) we tested different components and dosages of psychotherapeutic treatments. The final intervention programme is presented in this paper. In the second phase (follow-up study) we assessed the residual post-traumatic stress symptoms in these ICD patients. The time between treatment and follow-up measurement was 12 to 30 months.
  
  
  METHODS
  Thirty-one patients were assigned to the Department of Psychocardiology after multiple shocks. The sample consisted of 22 patients who had a post-traumatic stress disorder or an adjustment disorder and were willing and able to participate. They were invited for psychological treatment. 18 of them could be included into the follow-up study.
  
  
  METHODS
  After the clinical assessment at the beginning and at the end of the inpatient treatment a post-treatment assessment with questionnaires followed. In this follow-up measurement, minimum 12 months after inpatient treatment, posttraumatic stress was assessed using the "Impact of Event Scale" (IES-R).
  
  
  METHODS
  Inpatient treatment in a large Heart and Thorax Centre with a Department of Psychocardiology (Kerckhoff Heart Centre).
  
  
  RESULTS
  From the 18 patients in the follow-up study no one reported complaints of PTSD. 15 of them reported a high or even a very high decrease of anxiety and avoidance behaviour.
  
  
  CONCLUSIONS
  The fist step of the treatment development seems to be successful. It shows encouraging results with an acceptable dosage. The second step of our work is in process now: we evaluate the treatment manual within other clinical institutions and a higher number of psychotherapists. This leads in the consequence to a controlled and randomised comparison study.
authors.affiliation: Department of Psychocardiology, Kerckhoff Clinic Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Jordan
authors.affiliation: Cardiac Psychology, Hanusch Hospital, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Titscher
authors.affiliation: Department of Psychocardiology, Kerckhoff Clinic Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Peregrinova
authors.affiliation: Evangelische Hochschule (University of Applied Sciences), Darmstadt, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Kirsch
keywords: Eye Movement Desensitisation and Reprocessing (EMDR); ICD shocks; adjustment disorder; anxiety; depression; electrical storm; implantable Cardioverter Defibrillator; multiple ICD shocks; post-traumatic stress disorder; psychotherapy; trauma symptoms