Cognitive and behavioral processes predict anxiety and depression in patients with pulmonary hypertension

Abstract

Emotional and psychological difficulties cannot fully be explained by disease‐related factors in people with pulmonary hypertension (PH). This study examined the relationship between anxiety, depression, demographic, objective and subjective PH factors, and self‐reported cognitive and behavioral processes, which have been associated with mood in clinical and nonclinical samples. This is a secondary analysis of baseline data from 77 adults with PH who took part in a randomized controlled trial of a self‐help intervention targeting anxiety in PH. Participants completed self‐report measures including: demographic (age, gender, ethnicity, education, employment) and clinical questionnaire (PH diagnosis, functional class, years since diagnosis), depression (PHQ‐9), anxiety (GAD‐7), health‐related quality of life (emPHAsis‐10), dyspnea (D12), and cognitive and behavioral processes (CBP‐Q) scale. Data were analyzed using correlational and regression analyses. Overall, 70% and 63% of participants scored above the clinical cut off for anxiety and depression, respectively. Demographics were not associated with anxiety or depression. PH‐related factors were correlated with depression but not anxiety. A multiple regression analysis suggested dyspnea and cognitive processes significantly predicted anxiety whereas behavioral processes were not a unique predictor. In contrast, dyspnea and behavioral processes predicted depression whereas cognitive processes did not. While a body of evidence exists demonstrating people with PH are more likely to experience anxiety and depression, less is known about factors that cause and maintain these disorders. Findings highlight the significance of subjective factors that could be a target for screening and psychological treatments for emotional difficulties, such as cognitive behavioral therapy.

Can self‐compassion help us better understand the impact of pulmonary hypertension on those with the condition and their carers? A cross‐sectional analysis

“…11 Participants' cognitions and behaviors from the CBP-Q also predicted anxiety and depression, even after controlling for PH-specific factors such as functional class or self-reported dyspnea. 12 Taken together, the results suggest that individual difference variables in people with PH can help to identify those at risk of developing mood disturbance, as well as serve as a target for intervention.…”

“…Indeed, in a recent study, prospective and retrospective analyses of data collected as part of a self‐help intervention using cognitive‐behavioral therapy (CBT) for anxiety in PH, found that changes in unhelpful cognitions and behaviors (as measured by the cognitive behavioral processes questionnaire: CBP‐Q) mediated the relationship between intervention group (CBT vs. waitlist) and a reduction in anxiety and depression 11 . Participants' cognitions and behaviors from the CBP‐Q also predicted anxiety and depression, even after controlling for PH‐specific factors such as functional class or self‐reported dyspnea 12 . Taken together, the results suggest that individual difference variables in people with PH can help to identify those at risk of developing mood disturbance, as well as serve as a target for intervention.…”

Cardiovascular and Pulmonary Research: The Year (2022) in Review

“…Treadmill training was continued on the regular floor until the patient could ambulate with minimum support (FAC-score 2). In an intention to treat analysis (ITT), the median time to independent ambulation was 6 (3-9) days in the intervention group and 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) days in the UC group (P 5 .063). The authors noted that although not significant in the ITT analysis, the difference in time to independent ambulation was considerable between the intervention and UC group, because of the large hazard ratio (1.97) and Kaplan-Meier curve.…”

“…Promising results of cognitive therapies on dyspnea have also been reported in other cardiovascular and pulmonary diagnoses such as asthma, interstitial lung disease, pulmonary hypertension, and HF. [20][21][22][23]…”

Relationship between quality of life, fear of disease progression, and coping styles in patients with pulmonary hypertension: A network analysis

“…In other words, PH patients will constantly experience a life of sudden exacerbation of symptoms, complex and repeated treatments, and serious complications (Aguirre‐Camacho & Moreno‐Jiménez, 2018). These will undoubtedly place patients in a perpetual state of chronic psychological stress, especially fear/panic (Rawlings et al, 2022a), which is completely different from the traditional psychological disorders of anxiety and depression that can occur in people without the disease (Liu et al, 2021). Olsson et al (2021) reported a 15.2% prevalence of panic disorder in patients with PAH, approximately eight times that of the general population.…”