The effect of psychological intervention on patients' long-term adjustment to the ICD: a prospective study.

This study prospectively examined the role of cognitive behavioral therapy (CBT) in (1) alleviating psychological and somatic distress, and (2) lowering arrhythmic events requiring shocks. Forty-nine of 61 consecutive patients were randomized into therapy (CBT, n = 25) or no therapy (NT, n = 24) and completed a battery of self-report questionnaires at baseline and at 9-month follow-up. CBT was administered at preimplant, predischarge, and at seven routine follow-up visits. Patients were 65 +/- 10 years old, 65% were men, and 92% Caucasian. Eighteen (72%) CBT patients and 18 (75%) NT patients were retained at follow-up. Compared to CBT patients, NT patients reported higher levels of depression (P = 0.046), more anxiety (P = 0.013), more psychological distress (P = 0.015), poorer overall adjustment (P = 0.009), and poorer sexual functioning (P = 0.003). Mean number of shocks did not differ between the CBT and NT groups (2.85 vs 2.30, respectively); however, more patients in the CBT group (61%) than the NT group (33%) received shocks (P = 0.070). At follow-up, a subgroup analysis revealed that the significant differences observed between the CBT and NT groups were attributable to the patients who received shocks in both groups. In conclusion, CBT was associated with decreased depression, decreased anxiety, and increased adjustment for ICD recipients, particularly among those patients receiving shocks. CBT can be administered effectively at routine follow-up visits or transtelephonically with little added inconvenience to the ICD recipient.

Prevention of marital dysfunction: behavioral approaches and beyond.

Marital dysfunction is a significant problem in the U.S., with far-ranging effects on the mental health, physical health, and economic well-being of people who experience it. In addition, marital discord and divorce appear to have adverse effects on children. This review describes the historical roots of current prevention programs and critically reviews marriage preparation programs that have been examined in the peer-reviewed literature. The results of 13 studies suggest that behaviorally oriented, skills-based marriage preparation programs can lead to behavioral changes that may help prevent the emergence of marital dysfunction. Whereas there has been modest improvement in the methodology of the program evaluations, suggestions for continued improvements are made. Ways to enhance the effectiveness of marriage preparation programs using the principles of prevention are described.