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ECCU Survivor Workshop: Serber.ppt


Living and Loving Life: After Cardiac Arrest

Living and Loving Life: After Cardiac Arrest

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  • 1. Living  and  Loving  Life:  Cardiac  Arrest Eva  R.  Serber,  Ph.D.Centers  for  Behavioral  &  Preven9ve  Medicine, The  Miriam  HospitalDepartment  of  Psychiatry  &  Human  Behavior, Warren  Alpert  Brown  Medical  School
  • 2. Disclosures• Medtronic,  Inc  –  Speaker  Honoraria• NIH/NHLBI  –    R21  HL092340  (CARE-­‐E  Trial) Ψ © 2010 Serber
  • 3. FULL  par:cipa:on  in  a  FULL  life Ψ © 2010 Serber
  • 4. Survivors  living  not  simply living surviving Ψ © 2010 Serber
  • 5. 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 Ψ © 2010 Serber
  • 6. 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 Ψ © 2010 Serber
  • 7. 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” Ψ © 2010 Serber
  • 8. 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  can be  learned• Is  not  without  difficulty  or  distressAmerican  Psychological  Associa1on,  2010;The  American  Heritage®  Dic1onary,  Fourth  Edi1on,  rev  2009. Ψ © 2010 Serber
  • 9. Living  with  Resiliency• Benefit-­‐finding  /  Posbrauma9c  growth• Faith• Social  Support• Posi9vity  and  op9mism• Humor• Flexibility• Sedng  Goals• Hope Ψ © 2010 Serber
  • 10. 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 Ψ © 2010 Serber
  • 11. 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 Ψ © 2010 Serber
  • 12. Post-­‐SCA  Concerns• Vulnerability  &  mortality – Vs.  new  lease  on  life• Search  for  coherence• Search  for  meaning• Iden9ty• Control• Acceptance Ψ © 2010 Serber
  • 13. ICD-­‐Specific  Concerns• Dependence  on  the  box –  life-­‐threatening  vs.  life-­‐saving• Device  func9on  and  malfunc9oning• Shock• Daily  func9oning• Body  Image Ψ © 2010 Serber
  • 14. 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  changesSears  et  al.,  2005 Ψ © 2010 Serber
  • 15. 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 Ψ © 2010 Serber
  • 16. What  does  surviving  a  cardiac arrest  mean  to  you? Ψ © 2010 Serber
  • 17. Coping  StrategiesDO  –• Keep  doing  what  you  love  doing• Set  (new)  goals  and  accomplish  them• Unless  otherwise  directed,  you  do  not  need  to change  how  you  enjoy  living  life• Engage  in  heart  healthy  behaviors – Physical  ac9vity  –  good  for  body  and  mind – Eat  right – Relax  and  rest Ψ © 2010 Serber
  • 18. Coping  StrategiesEDUCATE  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 – Ψ © 2010 Serber
  • 19. Coping  StrategiesBE  PREPARED  –• Keep  the  following  informa9on  with  you  at  all 9mes. – ICD  Iden9fica9on  card – Medical  jewelry – Current  list  of  medica9ons/allergies – Physician’s  name  and  phone  number           This  informa9on  will  help  health  care  providers take  care  of  you  in  an  emergency.Sears  et  al.,  2005 Ψ © 2010 Serber
  • 20. Shock  Plan• Ac9on  plan  with  your  physicians  and  family  to prepare  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  with ac9vi9es• Carry  it  with  you ΨSears  et  al.,  2005 © 2010 Serber
  • 21. Why  is  your  emo:onal  health  so important? Not  only  for  your  well-­‐being,  but  also your  health Ψ © 2010 Serber
  • 22. 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 Ψ © 2010 Serber
  • 23. This  is  to  encourage  you  to  hold  onto what  is  good“The  future’s  so  bright,  [you]  go[a  wear  shades.” Ψ © 2010 Serber
  • 24. If  you  start  to  struggle,  you  may  feel like  this:• Feeling  depressed,  down,  “blah,”  or  hopeless• ↓  interest,  pleasure  in  enjoyable  ac9vi9es• ↓  mo9va9on  to  engage  in  ac9vi9es• Feeling  “wound  up,”  nervous,  on  edge,  or worrying  a  lot Ψ © 2010 Serber
  • 25. Other  symptoms  of  distress  are physical:• Difficult  to  dis9nguish  from  cardiac  symptoms: – ↑  heart  rate   –    Fa9gue – ↑  respiratory  rate –    Change  in  sleep –  SOB –    Chest  pain Ψ © 2010 Serber
  • 26. Distress  also  affects  what  you  do:• Avoid  ac9vi9es• Avoid  people• Reduced  self-­‐care• Change  in  ea9ng/  appe9te• Change  in  sleep Ψ © 2010 Serber
  • 27. Stress-­‐Management  Techniques Ψ © 2010 Serber
  • 28. Diaphragma@c  /  Belly  Breathing Ψ © 2010 Serber
  • 29. Guided  Imagery• Take  yourself  to  a  peaceful,  safe  place  (place  you know  or  imagine)• Ac9vate  all  5  senses:  sight,  smell,  taste,  touch, hear Ψ © 2010 Serber
  • 30. 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 Ψ © 2010 Serber
  • 31. 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  shock was  painful  and  disrup9ve,  but  it  just  saved  my  life.” Ψ © 2010 Serber
  • 32. 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  enjoyWhen  your  own  strategies  aren’t  working… Ψ © 2010 Serber
  • 33. Benefits  of  Psychological/  Behavioral Interven:ons• ↑  psychological  well-­‐being  and  QOL• ↑  exercise  capacity  and  physical  fitness• ↑  physiology• ↓  physical  symptomsChevalier  et  al.,  2006;  FitcheV  et  al.,  2003;  Frizelle  et  al.,  2004;Pedersen  et  al.,  2007;  Sears  et  al.,  2009 Ψ © 2010 Serber
  • 34. Thank  you Ques9ons? Ψ © 2010 Serber