Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management

Rosser, Rachel; Denford, John; Heslop, A; Kinston, Warren; Macklin, David B.; Minty, K.; Moynihan, Clare; Muir, B.; Rein, Lisa; Guz, A.

doi:10.1017/s0033291700050108

Cited by 70 publications

(40 citation statements)

References 36 publications

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“…Finally, 7 of 9 (77.8%) reported significant (n = 6) or possible (n = 1) reductions in healthcare utilization. An outcome possibly worse than the control was reported in only the bronchitis/emphysema study [22] on some of the symptom measures. In this study, more STPP patients had stopped smoking, perhaps leading to withdrawal, anxiety or depressive symptoms.…”

Section: Resultsmentioning

confidence: 97%

Short-Term Psychodynamic Psychotherapy for Somatic Disorders

Abbass¹,

Kisely

Kroenke

2009

Psychother Psychosom

239

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Background: Somatic symptom disorders are common, disabling and costly. Individually provided short-term psychodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for somatic symptom disorders has not been reviewed. Methods: We undertook a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation. Results: A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symptoms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls. Conclusion: STPP may be effective for a range of medical and physical conditions underscoring the role of patients’ emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and costs.

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Section: Resultsmentioning

confidence: 97%

Short-Term Psychodynamic Psychotherapy for Somatic Disorders

Abbass¹,

Kisely

Kroenke

2009

Psychother Psychosom

239

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“…However, Piper et al (1986) found that transference interpretations were uncorrelated with outcome. Furthermore, Rosser et al (1983), in a study of 32 patients with respiratory disease randomised to eight sessions of psycho analytic psychotherapy in which the analyst was instructed either to make free use of transference interpretations or to withhold such inter pretations, found that change in psychiatric symp toms was significantly greater in the latter group. Other studies have shown that higher 'doses' of transference interpretations (frequency per session) were associated with poorer therapeutic alliance, increased levels of defensiveness in the patients and poorer outcomes (Piper 1991;Høglend 1993;Connolly 1999;Ogrodniczuk 1999).…”

Section: Transferencementioning

confidence: 99%

Psychodynamic psychotherapy: developing the evidence base

Yakeley¹

2014

Adv. psychiatr. treat

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SummaryPsychodynamic psychotherapy has been criticised as being based on outdated principles of psychoanalysis and lacking an adequate evidence base to convincingly demonstrate its efficacy. This article summarises the recent evidence from high-quality outcome studies to show that psychodynamic psychotherapy is as effective in the treatment of a range of mental disorders as other psychological treatment modalities such as cognitive-behavioural therapy, as well as reviewing process-outcome research aiming to elucidate mechanisms of therapeutic change. A paradigm for psychodynamic psychotherapy research based on attachment theory is introduced, which may inform the development of psychodynamic therapeutic modalities tailored for specific conditions.LEARNING OBJECTIVESUnderstand the basic principles and techniques of psychodynamic psychotherapy.Be able to summarise the recent evidence base for the efficacy of psychodynamic psychotherapy.Appreciate process-outcome research that elucidates therapeutic mechanisms underpinning psychodynamic psychotherapy.

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“…Anxiety is closely associated with dyspnoea, and may be one of the most important factors determining quality of life in patients with severe COPD [4,5]. Attempts at improving dyspnoea, by means of psychotherapy, relaxation and retraining of breathing patterns, have met with varying success [6][7][8][9].The aim of the present study was to assess the effect of general cognitive and behavioural psychotherapy, directed by a psychiatrist, on the level of anxiety, quality of life, dyspnoea and exercise tolerance in patients with moderately severe COPD. …”

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confidence: 99%

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confidence: 99%

Effects of psychotherapy in moderately severe COPD: a pilot study

Eiser

West²,

Evans³

et al. 1997

Eur Respir J

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Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life.Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)=1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy.Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02).In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers". Eur Respir J 1997; 10: 1581-1584 In patients with chronic obstructive pulmonary disease (COPD), dyspnoea often correlates poorly with physiological impairment [1][2][3]. Anxiety is closely associated with dyspnoea, and may be one of the most important factors determining quality of life in patients with severe COPD [4,5]. Attempts at improving dyspnoea, by means of psychotherapy, relaxation and retraining of breathing patterns, have met with varying success [6][7][8][9].The aim of the present study was to assess the effect of general cognitive and behavioural psychotherapy, directed by a psychiatrist, on the level of anxiety, quality of life, dyspnoea and exercise tolerance in patients with moderately severe COPD. Methods PatientsHospital Anxiety and Depression Scale (HADS) questionnaires were completed by patients attending the monthly COPD clinic at Lewisham Hospital over a 3 month period. The HADS [10] is a self-administered questionnaire, comprising 14 questions, seven of which are aimed to detect anxiety. Questions are based on psychic symptoms only, without r...

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Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management

Cited by 70 publications

References 36 publications

Short-Term Psychodynamic Psychotherapy for Somatic Disorders

Short-Term Psychodynamic Psychotherapy for Somatic Disorders

Psychodynamic psychotherapy: developing the evidence base

Effects of psychotherapy in moderately severe COPD: a pilot study

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