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Living and Loving Life:Living and Loving Life:A.er Cardiac ArrestA.er Cardiac Arrest
Eva R. Serber, Ph.D.Eva R. Serber, Ph.D.
Centers for Behavioral & Preven9ve Medicine,Centers for Behavioral & Preven9ve Medicine,The Miriam HospitalThe Miriam Hospital
Department of Psychiatry & Human Behavior,Department of Psychiatry & Human Behavior,Warren Alpert Brown Medical SchoolWarren Alpert Brown Medical School
ΨΨ© 2010 Serber
Disclosures
• Medtronic, Inc – Speaker Honoraria
• NIH/NHLBI – R21 HL092340 (CARE-‐E Trial)
ΨΨ© 2010 Serber
FULL par:cipa:on in a FULL lifeFULL par:cipa:on in a FULL life
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Survivors Survivors livingliving not simply not simplysurvivingsurviving
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Today’s discussion:
• Resiliency• Behavioral Health• Preven9on of poor adjustment• Emo9ons and cardiovascular disease• What to look for in yourself and loved ones• Ways to improve mood and return to life
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The Ini:al Reac:on
• Gra9tude• Surprised and confused
– “Why me?” “How could this happen?”– Clean bill of health– Pinnacle of my [career, sport]– Peak fitness– Top of my game
• Sense of loss– Func9oning/ac9vi9es– Independence
• Anger / Sadness
ΨΨ© 2010 Serber
Your sen:ments:
“I thank God” “blessed”“live life” “empowerment”
“appreciate rela9onships”“new life / second chance”
“reinvent myself” “embracing life”“changed my outlook”
“pay it forward” “return to [life]”“gra9tude”
“advocate for change”
ΨΨ© 2010 Serber
Resiliency
• The ability to recover quickly from illness, change,or misfortune
• Being able to “bounce back”• The process of adap9ng well• Involves behaviors, thoughts, and ac9ons that canbe learned
• Is not without difficulty or distress
American Psychological Associa1on, 2010;The American Heritage® Dic1onary, Fourth Edi1on, rev 2009.
ΨΨ© 2010 Serber
Living with Resiliency
• Benefit-‐finding / Posbrauma9c growth• Faith• Social Support• Posi9vity and op9mism• Humor• Flexibility• Sedng Goals• Hope
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Resilience Factors & Health
• ↓ risk of coronary heart disease• ↓ cardiovascular events• ↓ mortality• ↓ rehospitaliza9on afer CABG• ↓ CVD progression• ↑ recovery from event• ↑ mental health and social func9oning• ↑ general healthCohen & Pressman, 2006; Giltay et al., 2006; Kubzansky et al., 2001;Middleton & Byrd, 1996; Scheier et al., 1989, 1999; Sears, Serber, et al., 2004;Tindle et al., 2009
ΨΨ© 2010 Serber
Cardiac Health is Behavioral Health
• Minimize stress• Work less hours• Stop smoking
– & abusing other substances
• Physical ac9vity• Ea9ng healthy• Watching your weight• Enjoying life• Adequate sleep
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Post-‐SCA Concerns
• Vulnerability & mortality– Vs. new lease on life
• Search for coherence• Search for meaning• Iden9ty• Control• Acceptance
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ICD-‐Specific Concerns
• Dependence on the box– life-‐threatening vs. life-‐saving
• Device func9on and malfunc9oning• Shock• Daily func9oning• Body Image
ΨΨ© 2010 Serber
How will shock affect me?
• “Swif kick in the chest”• Rated as a “6” on a 0 -‐ 10 pain scale.• ICD shock is ofen the primary culprit to poor QOL• Anxiety or depression ~ 13-‐38%• Avoidance• Hypervigilance• No changes
Sears et al., 2005
ΨΨ© 2010 Serber
The Struggle (Growth vs. Stress)
• Mental recovery alongside physical recovery• Apprecia9on vs. apprehension• Return to occupa9onal and recrea9onal ac9vi9es• Fear and avoidance of ac9vi9es• Rose or grey colored glasses
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What does surviving a cardiacWhat does surviving a cardiacarrest mean to you?arrest mean to you?
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Coping Strategies
DO –• Keep doing what you love doing• Set (new) goals and accomplish them• Unless otherwise directed, you do not need tochange how you enjoy living life
• Engage in heart healthy behaviors– Physical ac9vity – good for body and mind– Eat right– Relax and rest
ΨΨ© 2010 Serber
Coping Strategies
EDUCATE YOURSELF• Knowledge is power!
– Disease state and “normal” progression– About your ICD and how it works– How to respond to a cardiac event /shock
• Seek informa9on:– Health care providers– Mental health/behavioral professionals– Other SCA survivors– Support group– www.icdsupportgroup.org
ΨΨ© 2010 Serber
Coping Strategies
BE PREPARED –• Keep the following informa9on with you at all9mes.– ICD Iden9fica9on card– Medical jewelry– Current list of medica9ons/allergies– Physician’s name and phone number
This informa9on will help health care providerstake care of you in an emergency.
Sears et al., 2005
ΨΨ© 2010 Serber
Shock Plan
• Ac9on plan with your physicians and family toprepare for an ICD shock– Write it down and spread the word!
• What to do medically– When to call in or receive medical care
• What to do psychologically– Stay or find calm:
• Breathe, talk, surround self with loved ones, carry on withac9vi9es
• Carry it with you
Sears et al., 2005
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Why is your emo:onal health soWhy is your emo:onal health soimportant?important?
Not only for your well-‐being, but alsoyour health
ΨΨ© 2010 Serber
Nega:ve Emo:on, Distress, & CVD
• Poor self-‐care and health behaviors• Cardiac events
– Ischemia– Infarc9on– Arrhythmias and cardiac arrest
• Provoke 20% of life-‐threatening arrhythmias or SCD• Provoke ischemia in 50% of chronic IHDAhern et al., 1990; Burg et al., 1993; Dimsdale, 2008; Dunbar et al., 2001; Jain,2008; Lampert et al., 2002; Lampert et al., 2009; MiVleman et al., 1995;Muller et al., 1999; Ramachandruni et al., 2006; Rozanski & Blumenthal,2005; Shedd et al., 2004; Smith & Ruiz, 2002; Ziegelstein, 2007
ΨΨ© 2010 Serber
This is to encourage you to hold ontowhat is good
“The future’s so bright, [you] go[a wear shades.”
ΨΨ© 2010 Serber
If you start to struggle, you may feellike this:
• Feeling depressed, down, “blah,” or hopeless• ↓ interest, pleasure in enjoyable ac9vi9es• ↓ mo9va9on to engage in ac9vi9es• Feeling “wound up,” nervous, on edge, orworrying a lot
ΨΨ© 2010 Serber
Other symptoms of distress arephysical:
• Difficult to dis9nguish from cardiac symptoms:
– ↑ heart rate – Fa9gue– ↑ respiratory rate – Change in sleep– SOB – Chest pain
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Distress also affects what you do:
• Avoid ac9vi9es• Avoid people• Reduced self-‐care• Change in ea9ng/ appe9te• Change in sleep
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Stress-‐Management TechniquesStress-‐Management Techniques
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Diaphragma@c / Belly Breathing
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Guided Imagery
•• Take yourself to a peaceful, safe place (place youTake yourself to a peaceful, safe place (place youknow or imagine)know or imagine)
•• Ac9vate all 5 senses: sight, smell, taste, touch,Ac9vate all 5 senses: sight, smell, taste, touch,hearhear
ΨΨ© 2010 Serber
Thought Management
• Iden9fy automa9c nega9ve thoughts
• Iden9fy possible “cogni9ve distor9ons”
• Challenge and replace nega9ve thoughts
• Find a “posi9ve”– In the situa9on or another area of your life– Blessings, affirma9ons, accomplishments
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Thought Management
• E.g., “I am never going for a walk in the park again.” “The walk or the park did not cause the SCA/shock.”– “I have been treated and encouraged to be ac9ve.” and/or “This
device allows me to do what I want!”– Can take it further: “Next 9me I will pay aben9on to how I am
feeling and will also have my cell phone with me.”
• E.g., Shock episode – “I am going to die.” “the shockwas painful and disrup9ve, but it just saved my life.”
ΨΨ© 2010 Serber
Know When to Get Help
• Change in mood or temperament• Change in sleep• Change in appe9te• Low tolerance for people or ac9vi9es• Feel confused, lost, helpless, hopeless• “Can’t be bothered” to take care of yourself• Reduced interest in ac9vi9es you usually enjoy
When your own strategies aren’t working…
ΨΨ© 2010 Serber
Benefits of Psychological/ BehavioralInterven:ons
• ↑ psychological well-‐being and QOL• ↑ exercise capacity and physical fitness• ↑ physiology• ↓ physical symptoms
Chevalier et al., 2006; FitcheV et al., 2003; Frizelle et al., 2004;Pedersen et al., 2007; Sears et al., 2009
ΨΨ© 2010 Serber
Thank youThank you
Ques9ons?Ques9ons?
