Nonpharmacological management of psychological distress in people with COPD

Abstract

Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.

The quality of life of patients with chronic obstructive pulmonary disease: a bibliometric analysis

“…In addition, the anticipation of dyspnea itself can have a significant impact on the patient’s mood and behaviour ( 25 ), and psychological distress is prevalent in patients with COPD and is associated with a more severe course of the disease, which can also increase the burden on patients, caregivers, and the healthcare system when psychological problems are not treated ( 26 ). Therefore, more attention needs to be paid to the psychological changes caused by COPD and the impact on relatives and caregivers in the process of family rehabilitation and self-management.…”

COPD-Related Anxiety: A Systematic Review of Patient Perspectives

“…Furthermore, it is also important to differentiate COPD-related anxiety from episodic, passing experiences of anxiety that can be normal reactions to events such as diagnosis or symptom exacerbation. 84 According to the conceptual model of our study, COPD-related anxiety involves persistent anxiety symptoms that are related to an individual’s processing of COPD-related internal and external factors, as well as accompanying fear-induced behavior, such as avoidance of physical activity, social distancing, and seeking hospital intervention instead of self-management. Consequently, COPD-related anxiety should be described neither as a momentary feeling nor as a mental disorder, but as a biopsychosocial pattern that develops over time and reduces an individual’s functional capacity, quality of life, and ability to cope with the illness.…”

Editorial: The psychological challenges of respiratory disease

“…Over the last few decades, there has been a growing body of literature on the influence that psychological factors can have on chronic respiratory diseases and how these, in turn, might have major implications on the psychological distress and quality of life of those affected. Over time, a strong association between increased symptoms of anxiety and depression and chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD) (Vieira et al, 2011 ; Ohayon, 2014 ; Volpato et al, 2023 ), asthma (Verkleij et al, 2013 , 2017 ), Primary Ciliary Dyskinesia (PCD) (Verkleij et al, 2021a ), or Cystic Fibrosis (CF) (Quittner et al, 2016 ; Verkleij et al, 2018 ) has been documented Similarly, a strong relationship has been found between certain respiratory symptoms such as dyspnoea, wheezing or nocturnal problems and the onset of anxiety and depression (Leander et al, 2014 ). Nevertheless, many patients with chronic respiratory diseases do not meet all the diagnostic criteria for mental illness, but still experience high levels of some of their symptoms (e.g., worry, decreased mood, and loss of interest), difficulties in managing their lifestyle (e.g., disturbed sleep and lack of appetite), and other emotional reactions to their illness (e.g., shame, guilt, loneliness, and lower self-esteem) (Verkleij et al, 2018 ; Jerpseth et al, 2021 ; Noij et al, 2023 ; Volpato et al, 2023 ).…”

“…Over time, a strong association between increased symptoms of anxiety and depression and chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD) (Vieira et al, 2011 ; Ohayon, 2014 ; Volpato et al, 2023 ), asthma (Verkleij et al, 2013 , 2017 ), Primary Ciliary Dyskinesia (PCD) (Verkleij et al, 2021a ), or Cystic Fibrosis (CF) (Quittner et al, 2016 ; Verkleij et al, 2018 ) has been documented Similarly, a strong relationship has been found between certain respiratory symptoms such as dyspnoea, wheezing or nocturnal problems and the onset of anxiety and depression (Leander et al, 2014 ). Nevertheless, many patients with chronic respiratory diseases do not meet all the diagnostic criteria for mental illness, but still experience high levels of some of their symptoms (e.g., worry, decreased mood, and loss of interest), difficulties in managing their lifestyle (e.g., disturbed sleep and lack of appetite), and other emotional reactions to their illness (e.g., shame, guilt, loneliness, and lower self-esteem) (Verkleij et al, 2018 ; Jerpseth et al, 2021 ; Noij et al, 2023 ; Volpato et al, 2023 ). In addition, going along with polypharmacy (Ierodiakonou et al, 2021 ; Woolford et al, 2021 ), quitting smoking, using Long-Term Oxygen Therapy (LTOT) and/or Non-Invasive Ventilation (NIV) (Mehrtash et al, 2019 ; Pierucci et al, 2022 ) require changes in habits and behavior that may, in turn, contribute to the presence of distress and emotional reactions, with consequent effects on self-perception, adherence and clinical outcomes (Jerpseth et al, 2018 ; McCormick et al, 2022 ).…”