You are considered a nationally recognized expert on the topic of psychological care and quality of life outcomes of ICD patients; your research in this area is quite extensive. When in your career did you first begin to study the effects of ICDs in patients? What interests you about this area of research? For example, was there a particular case that affected you?

Approximately 12 years ago, I was a new assistant professor in clinical health psychology at the University of Florida Health Science Center and served on the cardiac transplantation team. My responsibilities included performing psychosocial evaluations of candidates to examine their relative strengths and weaknesses related to undergoing transplantation. In the course of these evaluations, I inquired about anxiety and depressive symptoms and current quality of life. At that time, a sizeable minority of patients began presenting with ICDs that tended to be active in terms of shock exposure. In fact, exposure to multiple shocks often triggered an acute need for consideration of all treatment options, including transplantation. The patients and the families were terrified of the shock experience. Their anxieties seemed somewhat reasonable for the situation but still problematic.

These clinical presentations prompted me to work more closely with the University of Florida s EP service. Over time, my colleagues and I compiled some case studies and published a comprehensive review of the literature with some new ideas. We initiated a series of investigations into the point prevalence and the predictive validity of psychological factors in outcomes that have kept us busy ever since. The cardiology journals and community have been very receptive to this research, and we have attempted to lead the way in examining and communicating the patient experience of ICD therapy.

Describe the purpose of the study (including number of patients, age range, etc.). Why was it important to study this population of patients?

The ICD has succeeded in clinical trials to be the treatment of choice for the termination of potentially life-threatening arrhythmias. This is a significant scientific and clinical feat. However, the patient experience of being shocked is notoriously difficult. EP clinics confidently manage the clinical phenomenon of shock, but are often unsure if they have met the patient s other needs related to fear/anxiety about the shock experience.

The ICD Shock and Stress Management Program (ICD-SSMP) was a pilot study designed to examine whether a psychosocial intervention would affect psychological and quality of life functioning in shocked ICD patients. We had a good idea from our clinical practice what seemed to help, but we did not have good data to convince a scientific audience.

How was the ICD shock and stress management program designed? What are some important components to include in such a stress management program?

The ICD-SSMP involved a few key components:

a) ICD-Specific Education: To help patients understand why they have an ICD and why it protects them (e.g., debunking myths about the causes of ICD shocks);

b) Relaxation/Stress Management Training: To assist patients in reducing their ongoing arousal levels post shock (e.g., hypervigilance to shock);