The implantable cardioverter defibrillator (ICD) is an effective treatment device for potentially malignant arrhythmias, including those leading to sudden cardiac death. However, some patients develop a variety of adjustment problems to the ICD. Clinical behavioral scientists have conceptualized ICD adjustment problems using principles of classical conditioning (i.e., cardiophobia), the learned helplessness paradigm of depression, and cognitive-behavioral models of panic. This case study likens ICD adjustment problems to a cognitive-behavioral model of panic and chest pain illustrating the limits of thesemodels in terms of howType I/Type II threat appraisal by the patient serves as a significant barrier to full symptomresolution. This case study supports the need formodifications in suchmodels and related interventions as they relate to the presence of real comorbid risk factors.
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