Skip to main content

A Pilot Study of a Mindfulness Based Stress Reduction Program in Adolescents with Implantable Cardioverter Defibrillators or Pacemakers

Abstract

Adolescents with implantable cardioverter defibrillators (ICDs) or pacemakers (PMs) face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could potentially impact adolescents’ adjustment to these devices. Mindfulness Based Stress Reduction (MBSR) is a structured psycho-educational program that includes meditation, yoga, and group support and has been studied extensively among adults. This study examined the feasibility of the MBSR program for adolescents with ICDs/PMs, a population previously unexamined in the research literature. The participants completed measures of anxiety and depression (Hospital Anxiety and Depression Scale) and coping (Responses to Stress Questionnaire) at baseline and after the six-session MBSR intervention. Mean age of the cohort (n = 10) was 15 ± 3 years, 6 were male, 6 had a PM, and 4 had an ICD. Feasibility was demonstrated by successful recruitment of 10 participants, 100 % participation and completion. Anxiety decreased significantly following the intervention, with a large effect size, t[9] = 3.67, p < .01, ŋ 2 = .59. Anxiety frequency decreased from baseline to post-intervention (Fisher’s exact test p = .024), and 90 % of participants reported decreased anxiety scores post-intervention. Coping skills related negatively to anxiety (r = −.65, p = .04) and depression (r = −.88, p = .001). Post-intervention, the group independently formed their own Facebook group and requested to continue meeting monthly. Although generalizability is limited due to the small sample size, this successful pilot study paves the way for larger studies to examine the efficacy of MBSR interventions in adolescents with high-risk cardiac diagnoses.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Beauchemin J, Hutchins TL, Patterson F (2008) Mindfulness meditation may lessen anxiety, promote social skills, and improve academic performance among adolescents with learning disabilities. Complement Health Pract Rev 13(1):34–45

    Google Scholar 

  2. Berul CI, Van Hare G, Kertsz N et al (2008) Results of a multicenter retrospective implantable cardioverter defibrillator registry of pediatric and congenital heart disease patients. J Am Coll Cardiol 51:1685–1691

    Article  PubMed  Google Scholar 

  3. Biegel GM, Brown KW, Shapiro SL, Schubert CM (2009) Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: a randomized clinical trial. J Consult Clin Psychol 77(5):855

    Article  PubMed  Google Scholar 

  4. Bilge AK, Ozben B, Demircan S et al (2006) Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors. Pacing Clin Electrophysiol 29(6):619–626

    Article  PubMed  Google Scholar 

  5. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 52(2):69–77

    Article  PubMed  Google Scholar 

  6. Bögels S, Hoogstad B, van Dun L et al (2008) Mindfulness training for adolescents with externalizing disorders and their parents. Behav Cogn Psychother 36(02):193–209

    Article  Google Scholar 

  7. Bootzin RR, Stevens SJ (2005) Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clin Psychol Rev 25(5):629–644

    Article  PubMed  Google Scholar 

  8. Burke CA (2010) Mindfulness-based approaches with children and adolescents: a preliminary review of current research in an emergent field. J Child Fam Stud 19(2):133–144

    Article  Google Scholar 

  9. Cohen J (1988) Statistical power analysis for the behavioral sciences. Psychology Press, Hove

    Google Scholar 

  10. Compas BE, Boyer MC, Stanger C et al (2006) Latent variable analysis of coping, anxiety/depression, and somatic symptoms in adolescents with chronic pain. J Consult Clin Psychol 74(6):1132

    Article  PubMed  Google Scholar 

  11. Connor-Smith JK, Compas BE, Wadsworth ME (2000) Responses to stress in adolescence: measurement of coping and involuntary stress responses. J Consult Clin Psychol 68:976–992

    Article  CAS  PubMed  Google Scholar 

  12. Cowan MJ, Pike KC, Budzynski HK (2001) Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival. Nurs Res 50(2):68–76

    Article  CAS  PubMed  Google Scholar 

  13. DeMaso DR, Lauretti A, Spieth L, Van Der Feen JR, Jay K, Gauvreau K et al (2004) Psychosocial factors and quality of life in children and adolescents with implantable cardioverter-defibrillators. Am J Cardiol 93:582–587

    Article  PubMed  Google Scholar 

  14. DeMaso DR, Neto LB, Hirshberg J (2009) Psychological and quality-of-life issues in the young patient with an implantable cardioverter-defibrillator. Heart Rhythm 6(1):130–132

    Article  PubMed  Google Scholar 

  15. Dougherty CM, Thompson EA, Lewis F (2005) Long-term outcomes of a telephone intervention after an ICD. Pacing Clin Electrophysiol 28(11):1157–1167

    Article  PubMed  Google Scholar 

  16. Dunbar SB, Langberg JJ, Reilly CM et al (2009) Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients. Pacing Clin Electrophysiol 32(10):1259–1271

    Article  PubMed Central  PubMed  Google Scholar 

  17. Dunbar S, Dougherty C, Sears S et al (2012) Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families: a scientific statement from the American Heart Association. Circulation 126:2146–2172

    Article  PubMed  Google Scholar 

  18. Duru F, Buchi S, Klaghofer R et al (2001) How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life? Heart 85(4):375–379

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Freedenberg V, Thomas SA, Friedmann E (2011) Anxiety and depression in implanted cardioverter-defibrillator recipients and heart failure: a review. Heart Fail Clin 7(1):59–68

    Article  PubMed  Google Scholar 

  20. Friedmann E, Thomas SA, Liu F et al (2006) Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality. Am Heart J 152(5):940 e1,940. e8

    Article  PubMed  Google Scholar 

  21. Gradaus R, Wollmann C, Kobe J et al (2004) Potential benefit from implantable cardioverter-defibrillator therapy in children and young adolescents. Heart 90(3):328–329

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Graue M, Wentzel-Larsen T, Bru E et al (2004) The coping styles of adolescents with type 1 diabetes are associated with degree of metabolic control. Diabetes Care 27(6):1313–1317

    Article  PubMed  Google Scholar 

  23. Greenberg MT, Domitrovich C, Bumbarger B (2001) The prevention of mental disorders in school-aged children: current state of the field. Prev Treat 4(1):1a

    Google Scholar 

  24. Grossman P, Niemann L, Schmidt S, Walach H (2004) Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res 57(1):35–43

    Article  PubMed  Google Scholar 

  25. Irving JA, Dobkin PL, Park J (2009) Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR). Complement Ther Clin Pract 15(2):61–66

    Article  PubMed  Google Scholar 

  26. Jaser SS, White LE (2011) Coping and resilience in adolescents with type I diabetes. Child Care Health Dev 37(3):335–342

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Kabat-Zinn J, Hanh TN (2009) Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. Random House LLC, New York

    Google Scholar 

  28. Karsdorp P, Everaerd W, Kindt M (2007) Psychological and cognitive functioning in children and adolescents with congenital heart disease: a meta-analysis. J Pediatr Psychol 32(5):527–541

    Article  PubMed  Google Scholar 

  29. Kohn CS, Petrucci RJ, Baessler C et al (2000) The effect of psychological intervention on patients’ long-term adjustment to the ICD: a prospective study. Pacing Clin Electrophysiol 23(4):450–456

    Article  CAS  PubMed  Google Scholar 

  30. Lane DA, Millane TA, Lip GY (2013) Psychological interventions for depression in adolescent and adult congenital heart disease. Cochrane Database Syst Rev. doi:10.1002/14651858.CD004372.pub2

    Google Scholar 

  31. Lee J, Semple RJ, Rosa D, Miller L (2008) Mindfulness-based cognitive therapy for children: results of a pilot study. J Cogn Psychother 22(1):15–28

    Article  Google Scholar 

  32. Lloyd-Jones D, Adams RJ, Brown TM et al (2010) Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation 121(7):948–954

    Article  PubMed  Google Scholar 

  33. Maryniak A, Szumowski Ł, Orczykowski M, Przybylski A, Walczak F (2009) Anxiety and depression among the patients with frequent implantable cardioverter–defibrillator discharges. Int J Cardiol 132(2):e80–e81

    Article  PubMed  Google Scholar 

  34. Newall EG, Lever NA, Prasad S et al (2007) Psychological implications of ICD implantation in a new zealand population. Europace 9(1):20–24

    Article  CAS  PubMed  Google Scholar 

  35. Nichol G, Thomas E, Callaway CW et al (2008) Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 300(12):1423–1431

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Schreier H, Chen E (2008) Prospective associations between coping and health among youth with asthma. J Consult Clin Psychol 76(5):790

    Article  PubMed  Google Scholar 

  37. Sears SF, Conti JB (2002) Quality of life and psychological functioning of ICD patients. Heart 87(5):488–493

    Article  PubMed Central  PubMed  Google Scholar 

  38. Sears SF, Conti JB (2006) Psychological aspects of cardiac devices and recalls in patients with implantable cardioverter defibrillators. Am J Cardiol 98:565–567

    Article  PubMed  Google Scholar 

  39. Sears S, Eads A, Marhefka S (1999) The US national survey of ICD recipients: examining the global and specific aspects of quality of life. Eur Heart J 20:232

    Article  Google Scholar 

  40. Semple RJ, Reid EF, Miller L (2005) Treating anxiety with mindfulness: an open trial of mindfulness training for anxious children. J Cogn Psychother 19(4):379–392

    Article  Google Scholar 

  41. Singh NN, Lancioni GE, Joy SDS, Winton AS, Sabaawi M, Wahler RG et al (2007) Adolescents with conduct disorder can be mindful of their aggressive behavior. J Emot Behav Disord 15(1):56–63

    Article  Google Scholar 

  42. Singh NN, Lancioni GE, Singh AN et al (2008) A mindfulness-based health wellness program for an adolescent with prader-willi syndrome. Behav Modif 32(2):167–181

    Article  PubMed  Google Scholar 

  43. Wang Q, Hay M, Clarke D, Menahem S (2012) The prevalence and predictors of anxiety and depression in adolescents with heart disease. J Pediatr 161(5):943–946.e1

    Article  PubMed  Google Scholar 

  44. White D, Leach C, Sims R et al (1999) Validation of the hospital anxiety and depression scale for use with adolescents. Br J Psychiatry 175:452–454

    Article  CAS  PubMed  Google Scholar 

  45. Zhan C, Baine WB, Sedrakyan A, Steiner C (2007) Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis. J Gen Intern Med 23:13–19

    Article  PubMed Central  Google Scholar 

  46. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    Article  CAS  PubMed  Google Scholar 

  47. Zylowska L, Ackerman DL, Yang MH et al (2008) Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. J Atten Disord 11(6):737–746

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Kristen Rawlett, RN, MSN, FNP-BC for her assistance during the data collection phase of the study. The authors would also like to thank Pamela Hinds, PhD, RN for her expertise and help during the editing process. This pilot study was funded in part by a Grant from the University of Maryland School of Nursing Foundation, PhD Nursing Research Fund.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vicki A. Freedenberg.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Freedenberg, V.A., Thomas, S.A. & Friedmann, E. A Pilot Study of a Mindfulness Based Stress Reduction Program in Adolescents with Implantable Cardioverter Defibrillators or Pacemakers. Pediatr Cardiol 36, 786–795 (2015). https://doi.org/10.1007/s00246-014-1081-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-014-1081-5

Keywords

  • Adolescent
  • Cardiac
  • Anxiety
  • Pacemaker
  • Implantable cardioverter defibrillator