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

Abstract

Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/ usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from −0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from −0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resourceintensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.

Physical and affective components of dyspnoea are improved by pulmonary rehabilitation in COPD

“… 16 Cognitive–behavioural therapy combined with traditional PR seems to further extend the benefits on dyspnoea, anxiety and depressive symptoms and exercise capacity in people with COPD. 41 In addition to education and physical training, the present home-based programme offered cognitive behavioural therapy, cardiac coherence, mindfulness meditation and/or hypnosis, depending on individual’s preferences. These latest behavioural therapy techniques, although less popular, have showed encouraging results to reduce psychological distress and dyspnoea in people with COPD.…”

“…Recently, original interventions coupling traditional PR and behavioural therapies were designed to improve dyspnoea, and anxiety and depressive symptoms 16. Cognitive–behavioural therapy combined with traditional PR seems to further extend the benefits on dyspnoea, anxiety and depressive symptoms and exercise capacity in people with COPD 41. In addition to education and physical training, the present home-based programme offered cognitive behavioural therapy, cardiac coherence, mindfulness meditation and/or hypnosis, depending on individual’s preferences.…”

Fatigue in critical care survivors: multidisciplinary and self‐management strategies

“…Fourth, fatigue has well‐known associations with mental health symptoms, such as anxiety and depression. Cognitive behavioural therapy is effective in reducing these symptoms in many patient populations [17]. Resuming activity during and after critical illness can be anxiety provoking as patients frequently must re‐learn to perform some basic activities independently (e.g.…”

ERS Scientific Working Group 09.04, “Psychologists and behavioural scientists”: the next step towards multidisciplinary respiratory care

“…They are crucial to the development, implementation and evaluation of psychological interventions. These range from traditional cognitive behavioural approaches to newer acceptance-based models, which have been shown to be effective in several studies, but still need intensified further research [23,29,[35][36][37][38][39]. This includes not only delivering specialist approaches when required, but also providing supervision to support other multidisciplinary healthcare professionals and informal caregivers who provide generalist psychological support.…”

“…This includes not only delivering specialist approaches when required, but also providing supervision to support other multidisciplinary healthcare professionals and informal caregivers who provide generalist psychological support. When successfully applied, these interventions can not only reduce psychological symptoms and distress in people with chronic respiratory disease and informal caregivers, but also create positive downstream effects on self-management, functional disease outcomes, quality of life and healthcare costs [37][38][39][40].…”