CBT reduces fear and restores function for patients after cardiac defibrillator implantation

A recent article in Current Psychiatry reviews the negative effects on quality of life for people who receive an implantable cardioverter defibrillator (ICD) for irregular heart rhythms. These effects are particularly severe after the first experience of a “shock”—or ICD discharge. Though life-saving, these high-energy electrical discharges (shocks) are typically painful, and many patients experience anxiety, anger, and a sense of helplessness.

After a shock, patients instinctively begin to analyze the events or behaviors leading to the shock—which are often routine and not truly associated with the discharge event—so that they can avoid or even eliminate them from their lives. The fear of another shock and the fear of anything that could precipitate one can result in a “fear of fear” cycle. Patients may then start limiting their lifestyles so dramatically that depression ensues.

The authors suggest that this scenario can be avoided by routine cognitive-behavioral assessments during follow-up visits after the ICD implantation. Ideally, treatment consists of a combination of medication, psychotherapy, and support. With CBT, patients are guided to see how their thoughts about the device might be erroneous. Daily logs of ICD-related thoughts and cognitive re-structuring are useful CBT strategies.

In an example referenced in this article, eight sessions of CBT, which included exposure therapy and relaxation training, allowed a patient to resume most of his activities, and had a beneficial effect on his personal relationships and quality of life.

Study authors: D. P. Gibson, K. K. Kuntz  

 

Antidepressants used in combination with CBT reduces risk of teen suicide

The use of the antidepressant fluoxetine (Prozac) alone has been associated with increased suicidality among teens and children, leading to black-box warnings on antidepressants in those populations. This in turn has caused serious concern in parents and has discouraged prescription, according to some researchers. A recent report on this issue focused on combining Cognitive Behavioral Therapy (CBT) with the fluoxetine and found that “adding CBT to medication enhances the safety of medication. Taking benefits and harms into account, combined treatment appears superior to either monotherapy as a treatment for major depression in adolescents.”

In a related report, the researchers added that cognitive behavior therapy “should be made readily available as part of comprehensive treatment for depressed adolescents” and added that such a shift in the current practice would be of “considerable public health relevance.”

Adolescent Depression & Suicide Prevention: National Review of Cognitive Behavioral Therapy

A national review of treatments for depressed adolescents (ages 13-17), with special focus on preventing teen suicide, finds Cognitive Behavioral Therapy (CBT) to be highly effective. Age-appropriate adaptations of CBT yielded these key results: “CBT achieved a higher remission rate among youth (60%) than either systemic behavior family therapy (37.9%) or nondirective support therapy (39.4%).” Additionally, CBT yielded no adverse effects.

(The reporting agency is a program of the US Department of Health and Human Services Substance Abuse & Mental Health Services Administration.)