Department of Psychology, York University, Behavioural Sciences Building, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3.
Psychosom Med. 2011 Apr;73(3):226-33. doi: 10.1097/PSY.0b013e31820afc63. Epub 2011 Feb 14.
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.
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.
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.
A CBT intervention to assist adaptation to an ICD enhanced psychological functioning over the first year post implant.
评估一项针对植入式心脏复律除颤器（ICD）患者适应问题的八节认知行为疗法（CBT）干预，并检验治疗组与性别间的交互效应。
接受首次 ICD 植入的患者被随机分配至 CBT 组或常规心脏护理组。基线、6 个月和 12 个月随访时的主要结局指标为焦虑和抑郁症状（医院焦虑和抑郁量表）、创伤后应激障碍症状（修订后的事件影响量表）和恐惧症焦虑（Crown-Crisp 体验指数）。次要结局指标为生活质量（SF-36 生理成分综合评分和 SF-36 心理成分综合评分）和 ICD 电击或抗心动过速起搏治疗。
在 292 名符合条件的患者中，193 名同意并被随机分配至 CBT 组（n = 96）或常规心脏护理组（n = 97）。80%为男性；平均年龄为 64.4 岁（标准差 = 14.3）；70%因二级预防而植入 ICD。治疗条件之间无基线差异；然而，女性在所有心理和生活质量变量上的评分均差于男性（p <.05）。83%的患者完成了随访。重复测量方差分析显示，CBT 对男女合并的创伤后应激障碍总分和回避症状的改善显著更大（p <.05），并且仅对女性的抑郁症状和 SF-36 心理成分综合评分的改善显著更大（p <.01）。在随访期间，两种治疗方法之间在 ICD 治疗方面没有差异。
针对 ICD 适应问题的 CBT 干预在植入后第一年增强了心理功能。
