Behavioral Interventions in Patients with an Implantable Cardioverter Defibrillator: Lessons Learned and Where to Go from Here?



    1. CoRPS – Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
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    1. Columbia University Medical Center, New York, New York
    2. Yale University Medical School, New Haven, Connecticut
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    Corresponding author
    1. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
    • CoRPS – Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
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  • This work was in part supported by the Dutch Heart Foundation, a VIDI grant (91710393) from the Netherlands Organisation for Health Research and Development (ZonMW), The Hague, The Netherlands to Dr. Susanne S. Pedersen, and by a grant to Dr. M.M. Burg from the National Heart, Lung, and Blood Institute (R01HL084438).

  • Conflict of interest: None declared.

Address for reprints: Susanne S. Pedersen, Ph.D., CoRPS, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. Fax: 31 13 466 2067; e-mail:



The implantable cardioverter defibrillator (ICD) is the first-line treatment for primary and secondary prevention of sudden cardiac death. A subgroup of patients experience psychological distress postimplant, and no clear evidence base exists regarding how best to address patients’ needs. The aim of this critical review is to provide an overview of behavioral interventions in ICD patients to date, and to delineate directions for future research using lessons learned from the ongoing RISTA and WEBCARE trials.


We searched the PubMed and PsycInfo databases to identify reports of behavioral trials targeting distress and related factors in ICD patients published between 1980 and April 2012.


We identified 17 trials for the review. Generally, compared to usual care, behavioral interventions were associated with reduced anxiety and depression and improved physical functioning, with effect sizes ranging from small to moderate-large (0.10–1.79 for anxiety; 0.23–1.20 for depression). Important limitations were small sample sizes and potential selection bias, hampering generalizability of the results. In addition to a need for larger trials, experiences from the RISTA and WEBCARE trials suggest that intervention trials tailored to the individual patient may be the way forward.


Behavioral interventions show promise with respect to reducing distress in ICD patients. Large-scale intervention trials targeted to the individual needs and preferences of patients are warranted, as a “one size fits all” approach is unlikely to work for all ICD patients.