Psychotherapy for Posttraumatic Stress Disorders Among Cardiac Patients after Implantable Cardioverter Defibrillator Shocks. Feasibility and Implementation of a Psychocardiological Therapy Manual in Inpatient Cardiac Rehabilitation

Abstract

Context: The reported psychopathological symptoms in patients following implantable cardioverter defibrillator (ICD) shocks differ. Reports concern mostly psychosocial distress with trauma-related symptoms: high hyperarousal, re-experiencing, and avoidance behavior. Patients suffering from these impairments require targeted therapy. Until now, only a few publications report psychological treatment for patients with ICD shocks. The aim of the present work was to examine whether the implementation of the specific psychotherapy, including eye movement desensitization and reprocessing (EMDR), during inpatient cardiac rehabilitation is safe and feasible (health-care study) and to explore whether this intervention leads to a reduction of psychopathology in cardiac patients after ICD shocks. As we have no control group design, we can only describe the change but we do not know whether the health status would be the same without our intervention. Methods: Twenty cardiac patients who were distressed after receiving ICD shocks were included in this study. Before and after the 3–5-week psychocardiological inpatient treatment (cardiac rehabilitation including psychotherapy) as well as 6 and 12 months after discharge, the patients were assessed for the following psychological variables: posttraumatic stress, depression, anxiety, and various measures of vital exhaustion and self-efficacy (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-4th Edition Disorders [SCID], Impact of Events Scale-Revised [IES-R], Beck Depression Inventory [BDI], Hospital Anxiety and Depression Scale [HADS] [Hospital Anxiety and Depression Scale-Anxiety (HADS [A])/Hospital Anxiety and Depression Scale-Depression (D)], Shortened Maastricht Exhaustion Questionnaire [MQ], and General Self-Efficacy Scale [SE]). Results: At baseline, 84.2% (n = 16) of the participants suffered from posttraumatic stress symptoms as assessed by the SCID (68.4% [n = 13] measured by the IES-R). Symptoms of depression were observed in 72.2% (BDI) or in 63.2% (HADS [D]) of patients and anxiety in 78.9% of patients (HADS [A]). The measurements confirm a significant reduction in the symptoms of posttraumatic stress (IES-R: P =0.000), depression (BDI: P = 0.009; HADS [D]: P = 0.000), anxiety (HADS [A]: P = 0.000), and vital exhaustion (MQ: P = 0.006), 1 year after patients underwent treatment. No significant changes were observed in perceived SE (P = 0.194). No significant correlations between medical variables and psychopathology were found (adequate/inadequate shocks; number of shocks; primary/secondary prevention). No appropriate/inappropriate shocks were delivered within the treatment period. Conclusion: Our results suggest that an inpatient cardiac rehabilitation program with intensive targeted psychotherapy including EMDR is a safe intervention for posttraumatic stress in patients who are distressed after receiving ICD shocks. In particular, patients accepted the EMDR treatment, emotional arousal was tolerable, and no cardiac complications occurred during EMDR confrontation. Future strategies could be investigating the impact of intervention on long-term effect, stability, and mortality in this population. In addition, our study showed that some patients had a very long time between ICD shocks and the beginning of the professional therapy. Hence, this leads to the finding that a waiting control group could be acceptable by the ethical commission.