CBT effective for anxiety in COPD

A respiratory nurse-led cognitive behavioural therapy (CBT) intervention to help patients with COPD manage anxiety is both clinically and cost effective, UK research shows.

Results published in ERJ Open Research showed that at three months patients with mild to very severe COPD and anxiety receiving one-on-one CBT sessions with a respiratory nurse had significantly reduced anxiety levels compared to those given only self-help leaflets.

Patients receiving CBT also had significantly fewer hospital admissions and emergency department (ED) visits over 12 months, possibly due to better self-management of frightening physical symptoms such as breathlessness, amplified by anxiety.

The brief intervention was found to be cost-effective, as the initial costs for training and supervision were offset by lower resource use from fewer respiratory admissions and a reduction in ED attendances.

The study is the largest randomised trial of CBT in COPD, according to lead investigator Dr Karen Heslop-Marshall, a nurse consultant from Newcastle University, who developed the bespoke CBT programme for respiratory patients. The trial is also the first to show that respiratory nurses can be trained to undertake and effectively deliver a cost-effective brief CBT intervention to reduce symptoms of anxiety in COPD patients, which are intrinsically linked with breathlessness, she said.

The researchers were unable to determine which specific element of the CBT intervention, such as the coping strategies to address frightening thoughts, pacing, breathing control, distraction or encouraging physical activity, was most effective at reducing anxiety symptoms.

Even so, Dr Heslop-Marshall believes the brief intervention should be incorporated into routine clinical care for COPD patients, for several reasons, not least to address the current lack of resources to meet mental health needs.

“We found a significant number of patients screened, 59%, had symptoms of anxiety, suggesting anxiety is very common in COPD,” she told the limbic.

Training respiratory staff could lead to better recognition and treatment of breathlessness and anxiety symptoms in patients who otherwise may not have engaged with mental health services, she added.

CBT trained respiratory nurses also had the ability to distinguish and manage physical and psychological causes of symptoms and are in a position to offer a multi-faceted service as part of one clinic.

Dr Heslop-Marshall told the limbic she believed the intervention should also be replicated for COPD patients treated in primary care, noting that in the study there was no correlation between lung function and anxiety, suggesting patients with milder COPD may benefit from CBT.

“What we need to do is get this intervention way down the line for patients with mild COPD so they learn about breathlessness and how to deal with it using simple management strategies from early on,” she said.

“The challenge is implementing it in practice because it’ll take a long time to train all the respiratory nurses and all the practice nurses; it’s a massive task.”

“The next logical step, and the quickest way to role this out in primary care, would be to develop a digital platform of the intervention for patients, as well as train respiratory nurses.”

Dr Heslop-Marshall is now involved in two studies looking at using CBT to optimise the benefits of routine pulmonary rehabilitation.

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