The Poorly Coping COPD Patient: A Psychotherapeutic Perspective

Abstract

An etiology of maladaptive coping in Chronic Obstructive Pulmonary Disease is proposed and a model for psychotherapeutic intervention with poorly coping COPD patients is presented. Failure in mourning, manifested by a lack of shift in patient's expectations and goals leads to: 1) difficulty in accepting illness related feelings of loss; 2) chronic anxiety; 3) attribution of responsibility for feelings and behavior to external factors; and 4) poor compliance with medical regime. Recommendations for establishing a therapeutic alliance with the poorly coping patient are discussed. Psychotherapeutic intervention aims at: 1) facilitating acceptance of losses and restructuring of life goals; 2) interrupting the cycle of alienation and social withdrawal; and 3) increasing patient's control over affective arousal and respiratory functioning. Utilization of supportive individual psychotherapy, family or marital therapy, and specific behavioral techniques is discussed. Family or marital therapy is seen as the treatment of choice. The psychotherapeutic model proposed is useful in promoting more adaptive coping in the COPD patient.

Living in negotiation: patients’experiences of being in the diagnostic process of COPD

“…The findings are in accordance with a review27 that shows that in dealing with a new COPD diagnosis, patients often experience stages of grief, denial, anger, bargaining and depression, on their way to acceptance. Decisions about smoking cessation and other self-care strategies may be complicated by these phenomena, and they may also contribute to non-adherence with therapy and poor respiratory and functional coping 50. A patient’s illness is usually defined in terms of objective and quantifiable data representing pathological and physiological conditions with specific locations in the body.…”

Current Perspectives on Management of Co-Morbid Depression in COPD

“…Depression not only increases the suffering of COPD patients but it also decreases function, impairs overall health status and rehabilitation efforts, and contributes to the ongoing use of tobacco (7,16,17).…”

“…Dudley described depressive symptoms as a mechanism by which the patient with COPD attempted to protect himself from environmental activity and exertion that might worsen respiratory symptoms (19). Post attributed the development of depressive symptoms to patients' difficulty in managing their grief responses due to their declining function across multiple arenas of life (17). Certainly COPD can impose staggering losses for COPD patients including loss of employment and occupational identity, disrupted family relationships, and declining independence and mobility.…”

Effective communication with the patient

“…They feel more comfortable attributing the cause of their illness to external factors, such as their occupation or environmental pollution [6]. They might also have problems accepting the diagnosis and perhaps prefer to say that they have asthma.…”