COPD patients who have anxiety and are unable to exercise may benefit from cognitive behavioural therapy, TSANZSRS 2018 delegates were told.
CBT, an umbrella term for a group of psychological interventions that facilitate people to reframe their thinking, is recommended for treating anxiety, depression and phobias.
Now a growing body of evidence suggests it’s effective for treating anxiety in COPD patients, in whom the condition is prevalent with one systematic review putting it as high as 36%.
Dr Marie Williams, Associate Head of Research in the School of Health Sciences at the University of South Australia, told the conference there were about 20 randomised controlled trials exploring the use of CBT in COPD.
The studies show CBT gives consistent improvements in anxiety – and less consistent results for depression – when compared to standard medical treatment.
But results are less clear cut when CBT is compared to an active intervention, such as education or exercise programs.
In this case “about half show improvement in anxiety or depression for the CBT intervention compared to the other intervention,” Dr Williams told the limbic.
Very few of the CBT interventions showed significant impact on breathlessness.
There was also a “very mixed picture” for studies which compare a CBT intervention against an exercise training or pulmonary rehabilitation program which includes ‘exposure’ to the sensation of breathlessness.
Exposure therapy is an element of CBT in which a patient is progressively exposed to the thing they are scared of while in a supported environment.
Dr Williams said the body of research is still very small and “we have a fair way to go to unpick what’s going on”.
However, the evidence suggests that physicians could do well to consider referring those patients with anxiety and depression who can’t access, or decline, another active intervention, to a psychologist for CBT, she said.
“We know the referral rates for pulmonary rehabilitation are low, we know that people drop out and have trouble getting to centres so there will be a sub group of people who are either unable to access pulmonary rehab or actually are just so immobile. It might be that CBT could be a very useful thing for these people”.