Cognitive behavioural therapy (CBT) delivered by respiratory healthcare professionals does not improve the mental health of people with COPD and anxiety and/or depression, a study confirms.

The multi-centre randomised TANDEM trial of 425 patients with moderate to severe COPD found that at six months, the tailored CBT intervention did not improve anxiety as measured on the Hospital Anxiety and Depression Scale (HADS) HADS-A mean difference, 95% CI, -0.60, -1.40 to 0.21) or depression (HADS-D -0.66, -1.39 to 0.07) compared to usual care.  

The intervention also failed to improve disease-related quality-of-life or uptake or completion of pulmonary rehabilitation, reported the authors in their paper published in the  European Respiratory Journal. 

Reasons for the intervention’s ineffectiveness may include the difficulty of any relatively brief cognitive behavioural intervention to influence psychological co-morbidities that have developed alongside a multicomponent condition such as COPD, the British and Australian researchers led by Professor Stephanie Taylor of Queen Mary University of London, speculated.

“Ultimately our carefully designed intervention may have been “too little, too late” for TANDEM participants experiencing all the attendant difficulties of living with a disabling long-term condition and comorbidity,” they wrote. 

Despite their negative findings, the researchers noted that their study underlined a ‘very high unmet need’, with 42 percent of those screened for trial eligibility exhibiting symptoms of mild to moderate anxiety or depression.

Their findings also highlighted an ongoing issue with pulmonary rehabilitation uptake, with only 50% of those eligible for referral to PR actually referred, and only 30% of those who attended completed a course. 

“There is an urgent need to identify why patients are not being referred to PR. Alongside this we need more research around supporting individuals to take up and complete a course of PR, and we need to identify effective, alternative interventions for those individuals who will never be able to attend conventional PR,” they wrote.

The TANDEM intervention focused on physical symptoms, thoughts, feelings, and behaviours associated with living with COPD, particularly breathlessness. It was delivered while participants waited to participate in a pulmonary rehabilitation programme. Support was initially offered face to face, with weekly telephone support for up to two weeks after PR completion.