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Fearful Appraisals and Behavioral Responses of a Patient with an Implantable Cardioverter Defibrillator

Oakwood Healthcare Systems

Amy S. Janeck

University of British Columbia

Stephanie L. Deaner

Lebanon VAMedical Center

The implantable cardioverter defibrillator (ICD) is an effective treatment device for potentially malignant arrhythmias, including those leading to sudden cardiac death. However, some patients develop a variety of adjustment problems to the ICD. Clinical behavioral scientists have conceptualized ICD adjustment problems using principles of classical conditioning (i.e., cardiophobia), the learned helplessness paradigm of depression, and cognitive-behavioral models of panic. This case study likens ICD adjustment problems to a cognitive-behavioral model of panic and chest pain illustrating the limits of thesemodels in terms of howType I/Type II threat appraisal by the patient serves as a significant barrier to full symptomresolution. This case study supports the need formodifications in suchmodels and related interventions as they relate to the presence of real comorbid risk factors.

Key Words: implantable cardioverter defibrillator • sudden cardiac death • panic • cardiophobia • learned helplessness

Clinical Case Studies, Vol. 3, No. 1, 70-82 (2004)
DOI: 10.1177/1534650103258977


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