For patients with serious heart conditions, an implanted cardiac defibrillator can mean the difference between life and death. Unfortunately for some, it can also mean living in a constant state of anxiety, awaiting the next shock. Thanks to a new feasibility study conducted by Elena Salmoirago-Blotcher, MD, PhD, such patients may soon be able to get relief from anxiety with a mindfulness intervention delivered by phone.
Mindfulness-based interventions have been effective in treating depression and anxiety in a number of chronic medical conditions. Dr. Salmoirago-Blotcher, assistant professor of medicine in the Division of Cardiovascular Medicine, in collaboration with colleagues in the Divisions of Cardiovascular Medicine and Preventive & Behavioral Medicine, received funding from the National Institutes of Health National Center for Complementary and Alternative Medicine to conduct a pilot study examining the feasibility of delivering mindfulness training by phone to patients who had recently had cardiac defibrillators implanted. Overall, about one in four patients who have implanted cardiac defibrillators (ICD) develop anxiety, either because they are fearful of the shock it might deliver or due to the severity of their underlying cardiac condition.
The study, Phone-Delivered Mindfulness Training for Patients with Implantable Cardioverter Defibrillators: Results of a Pilot Randomized Controlled Trial, was published in Annals of Behavioral Medicine (2013).
Many ICD patients have driving limitations and severe underlying cardiac conditions that limit their ability to attend group-delivered mindfulness training. Salmoirago-Blotcher was interested in testing an intervention that incorporated mindfulness without requiring vulnerable patients to drive to classes. Delivering the intervention by phone eliminated the transportation burden and any additional related anxiety.
“Our group designed a phone-delivered mindfulness intervention that adapted the basic elements of traditional mindfulness training to the needs of these patients,” said Salmoirago-Blotcher.
The intervention included the basic elements of mindfulness training such as the body scan, (a technique in which participants are trained to bring attention to bodily sensations and cognitions) and the awareness of breath technique (in which participants are trained to bring awareness to the sensation of breathing as a means of focusing their attention) to the needs of ICD patients. Participants were also gradually encouraged to bring their awareness to the activities of daily life that normally go unnoticed such as eating and drinking, sounds, visual objects, thoughts and emotions.
The study enrolled 45 patients from the ICD clinic at UMass Memorial Medical Center and randomized them into two groups, one of which received the mindfulness intervention, and the other, the control group, received a weekly scripted phone call. The mindfulness training comprised weekly 30-minute, scripted, mindfulness training sessions delivered over eight weeks by an expert mindfulness instructor. The control group received a weekly 10-minute scripted phone call addressing possible concerns regarding the defibrillators.
“Thanks to this novel delivery method, we were able to provide mindfulness training to a population at high risk of severe clinical events, with low socioeconomic status and transportation problems,” said Salmoirago-Blotcher. A strong indicator of the feasibility of delivering mindfulness training by phone was the high retention rate of patients in the study (93 percent) as well as the high attendance (90 percent of participants attended all training sessions).
While the primary goal of the study was to determine the feasibility of the intervention, a secondary objective was to see if the intervention was acceptable. Overall, 86 percent of participants reported that the study intervention was helpful in coping with the defibrillator procedure and 90 percent reported that the intervention had moderate to great impact on their overall wellbeing.
Since this study was designed to test the feasibility of the intervention, and not its efficacy, and because the sample size was small, no hard conclusions can be drawn as to whether the intervention was effective in reducing anxiety, although the results point in that direction. Salmoirago-Blotcher said, “As the number of patients receiving ICD implantations for the primary prevention of sudden cardiac death increases, it is important to find interventions that may improve psychological distress and thus the quality of life of these patients. Mindfulness training holds great promise and may reduce anxiety in these patients. However our pilot findings need to be reproduced in a large randomized clinical trial. I am planning to seek funding for a larger study that will assess the efficacy of the intervention.”