Cognitive behavioural therapy (CBT) for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation

Abstract

Background: The study aimed to determine the effects of adding cognitive behavioural therapy (CBT) to pulmonary rehabilitation to treat patients with chronic lung disease and comorbid anxiety and/or depression symptoms.Methods: An open, parallel group, randomised controlled trial (RCT) was conducted, with longitudinal follow-up of 12 months. CBT was delivered in 2 face-to-face sessions and 4 phone sessions to patients with depression or anxiety undergoing pulmonary rehabilitation. The main outcome measures were change in Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI); secondary outcomes were St.Georges Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT) and pulmonary rehabilitation attendance.Results: A total of 65 patients were randomized to Intervention (n=24) and Control (n=41) groups. Of the 24 patients in the Intervention group, 6 patients (25%) withdrew and 4 patients (12.5%) failed to attend more than 2 CBT sessions, which was significantly more than the Control group. The majority of patients (75.4%) had chronic obstructive pulmonary disease. Fourteen (21.5%) had symptoms of depression only, 12 (18.4%) had symptoms of anxiety only, and 39 (60.0%) had symptoms of both anxiety and depression. In the Intervention group, GDS significantly improved at the end of pulmonary rehabilitation (mean difference −3.1, 95% CI: −4.39 to −1.70; P=0.0001), 3 months follow-up (mean difference −1.5, 95% CI: −4.17 to −0.75; P=0.008), and at 12 months follow-up (mean difference −1.6, 95% CI: −3.29 to −0.03, P=0.04), compared to baseline. The Control group demonstrated improvement in GDS by the end of pulmonary rehabilitation (mean difference −1.3, 95% CI: −2.4 to −0.27; P=0.01) which was not maintained at 3 months (P=0.14) and 12 months (P=0.25). GAI significantly improved by the end of rehabilitation in both the Intervention (mean difference −2.6, 95% −4.69 to −0.57; P=0.01) and Control groups (mean difference −2.6, 95% −4.16 to −1.14; P=0.001) and there was no significant improvement at 3 and 12 months. No statistically significant differences in changes in GDS or GAI were observed between the Intervention and Control groups at any time point. There was no significant improvement in SGRQ or 6MWT. There was a significant increase in attended pulmonary rehabilitation sessions in the Intervention group, compared to the Control group (mean difference 1.59; 95% CI: 0.11 to 3.07; P=0.03). Conclusions: In this RCT of patients with chronic lung diseases attending pulmonary rehabilitation, there was no evidence found for improved symptoms of anxiety or depression or health-related quality of life with the addition of CBT given in a mixed face-to-face and telephone format, compared to usual care. Slower

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

“…The majority of studies were controlled trials (ie, CCT or RCT n= 24). [13][14][15][16][17][18][19][20][21][22][35][36][37][38][39][40][41][42][43][44][45][46][47][48] In addition, there were six single group cohort designs, [49][50][51][52][53][54] two papers reported case exemplars 55,56 and one a phenomenological study. 57 Eight studies were not included as they reported the sub-analysis of a parent study.…”

“…[58][59][60][61][62][63][64][65] The majority of studies exclusively recruited people with COPD (78.7%, n=26). With the exception of Blumenthal et al 48 where 42% of participants had COPD, in the remaining seven studies, at least half the sample analyzed were categorized as COPD (Cully et al (75%), 41 Pumar et al (75%), 38 Cully et al (74%), 52 Cully et al (66%), 56 Jonker et al (51%), 45 Malpass et al (50%) 57 ). In studies reporting threshold criteria as an eligibility requirement (n=15, 45%), these ranged between including people with at least mild-to-moderate anxiety or depression (HADs-A ≥ 8, Beck Anxiety Inventory (BAI) scores 10-18, Beck Depression Inventory (BDI) ≥13) or clinically significant symptoms (State-Trait Anxiety Inventory STAI-STAIT ≥39, Patient Health Questionnaire PHQ-9 ≥10).…”

“…78,79 While PR is recommended as usual care, poor referral, access and uptake rates suggest that for many people living with COPD, it continues to be "best or recommended practice" or "not quite usual practice." 80 The second most frequent intervention-comparator dyad in this review were high-intensity interventions vs high-intensity comparators (n=9), the most frequent of which concerned PR with or without CBT 15,16,35,36,38 or mindfulness-based cognitive therapy (MBCT 39 ).…”

Does the 6-minute walk test in hospitalized COPD patients exclusively correlate with lung function parameters or should psychological factors also be taken into account?

“…clinically stable settings [48], or with much different 6-minute walking distances. Further studies should clarify the effects of factors leading to a reduction in depression, including medical and psychotherapeutic interventions [56], as well as physical activity, exercise and rehabilitation [57][58][59][60], which may also influence test results and may in parallel improve the quality of life and possibly the outcome of COPD patients [47].…”

Interstitial Lung Disease and Depression – A Questionnaire Based Study

“…The course of illness profoundly affects patient's physical, vocational and mental functioning, usually persistent, correlated with increased exacerbation rates, poor compliance and sometimes increased mortality thereby management of pulmonary conditions becomes even challenging. [10][11][12][13] Depression is not associated with survival in patients of interstitial lung disease, but is regarded as a major determinant of health related quality of life in patients with interstitial pulmonary fibrosis (IPF). 14,15 There may be both psychological and physical explanations to it, one hypothesis being; hypoxia renders brain damage that may lead to depression and suicide.…”