Affective distress and implantable cardioverter defibrillators: Cases for psychological and behavioral interventions

The implantable cardioverter defibrillator (ICD) may be associated with som e degree of psychological maladjustment, especially in patients experiencin g high rates of discharge. This article reviews the psychological literatur e related to ICDs and presents two case examples illustrating common psycho logical complications related to multiple discharges. A brief, psychologica l intervention can be implemented to improve patient adjustment. To explain possible processes by which psychological complications may develop in ICD patients, two well-established psychological theories of learning and beha vior, classical conditioning and learned helplessness, are reviewed. Multid isciplinary teams that include consultation with clinical psychologists are suggested for the routine care of ICD patients.