Harnessing Evidence-based Psychotherapies to Develop an Integrated Intervention Targeting Key Psychological Mechanisms of PTSD in Cardiac Patients

About This Grant

Project Summary Sudden, life-threatening cardiac events can be terrifying experiences that can trigger the onset of posttraumatic stress disorder (PTSD). PTSD symptoms are common after cardiac events, with over 1 in 5 patients receiving implantable cardioverter defibrillators (ICDs) for prevention of life-threatening arrhythmias and sudden cardiac arrest exhibiting elevated PTSD symptoms. Cardiac disease-induced PTSD symptoms are associated not only with worse mental health but a worse clinical prognosis, including poorer quality of life (QoL), greater disability, and greater risk of event recurrence and/or all-cause mortality. Further, cardiac-focused anxiety sensitivity—a unique aspect of cardiac disease-induced PTSD—is linked to worse health, medical reassurance seeking, and greater healthcare utilization. However, evidence-based interventions for these cardiac-induced psychological presentations are lacking. This R34 proposal will draw from existing, evidence-based psychotherapies to develop a streamlined intervention that addresses cardiac trauma-related fear and cardiac-focused anxiety sensitivity— two key manifestations of PTSD after cardiac events that relate to adverse outcomes and are direct targets of gold standard, exposure-based interventions for PTSD and panic disorder. Trauma-focused exposure reduces trauma-related fear and interoceptive exposure reduces anxiety sensitivity, but neither intervention has been tested in patients with cardiac trauma. After initial intervention development (Stage Ia), a pilot randomized controlled trial (RCT) will be conducted (Stage Ib), in which patients with ICDs (N=70) from the UCLA Cardiac Arrhythmia Center will be randomized to 1) the trauma and anxiety sensitivity exposure-based treatment, called Cardiac Fears Treatment (CFT), or 2) standard supportive therapy (treatment as usual [TAU]). Participants will be assessed at pre-treatment, several periods throughout treatment, post-treatment, and a 6-month follow-up. In Aim 1, we will develop the CFT intervention using an iterative approach, guided by prior research and qualitative interviews with key stakeholders (e.g., cardiology experts), and pilot testing in a small (N=8) open trial of patients with ICDs will yield initial feasibility and acceptability data. Subsequent aims will analyze data from the pilot RCT, generating additional feasibility and acceptability data, along with preliminary efficacy information. In Aim 2, we will compare CFT to TAU on psychological responses (self-report and behavioral task measures of cardiac trauma-related fear and cardiac-focused anxiety sensitivity). Aim 3 will compare CFT to TAU on health- related outcomes (health-related QoL and healthcare utilization). Finally, in Aim 4, we will explore whether key psychological processes targeted in the intervention (cardiac trauma-related fear and cardiac-focused anxiety sensitivity) mediate change in health-related outcomes. By targeting key psychological processes associated with adverse outcomes after a cardiac trauma, this mechanism-focused study has the potential to improve the emotional and physical health of cardiac patients and will generate critical feasibility, acceptability, and preliminary efficacy data needed to inform a grant proposal to test a refined version of CFT in a larger RCT.