1
|
Norweg A, Hofferber B, Maguire S, Oh C, Raveis VH, Simon NM. Breathing on the mind: Treating dyspnea and anxiety symptoms with biofeedback in chronic lung disease - A qualitative analysis. Respir Med 2024; 221:107505. [PMID: 38141864 PMCID: PMC10897906 DOI: 10.1016/j.rmed.2023.107505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) is characterized by dysfunctional breathing patterns that contribute to impaired lung function and symptoms of dyspnea, anxiety, and abnormal carbon dioxide (CO2) levels. OBJECTIVE The study objective was to measure the acceptability of a new mind-body intervention we developed called Capnography-Assisted, Learned Monitored (CALM) Breathing, implemented before pulmonary rehabilitation. METHODS CALM Breathing is a 4-week (8-session) intervention designed to treat dyspnea and anxiety in adults with COPD by targeting dysfunctional breathing behaviors (guided by end-tidal CO2 levels). CALM Breathing consists of ten core breathing exercises, CO2 biofeedback, and motivational interviewing. Using qualitative methods and semi-structured interviews immediately post-intervention, we evaluated the acceptability and participation process of CALM Breathing. Themes were identified using constant comparative analysis. RESULTS Sixteen participants were interviewed after receiving CALM Breathing. Three main themes of CALM Breathing were identified: (1) Process of learning self-regulated breathing, (2) Mechanisms of a mind-body intervention, (3) Clinical and implementation outcomes. CONCLUSIONS Positive themes supported the acceptability of CALM Breathing and described participants' process of learning more self-regulated breathing to manage their dyspnea and anxiety. Positive signals from qualitative participant feedback provided support for CALM Breathing as an intervention for COPD, but larger scale efficacy trials are needed.
Collapse
Affiliation(s)
- Anna Norweg
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Brittany Hofferber
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sophia Maguire
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Cheongeun Oh
- Department of Population Health (Biostatistics), New York University Grossman School of Medicine, New York, NY, USA
| | - Victoria H Raveis
- Department of Cariology and Comprehensive Care, College of Dentistry, New York University, New York, NY, USA
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
2
|
Hill K, Hug S, Smith A, O’Sullivan P. The Role of Illness Perceptions in Dyspnoea-Related Fear in Chronic Obstructive Pulmonary Disease. J Clin Med 2023; 13:200. [PMID: 38202207 PMCID: PMC10780095 DOI: 10.3390/jcm13010200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Dyspnoea is often the most distressing symptom described by people with a chronic respiratory condition. The traditional biomedical model of neuromechanical uncoupling that explains the physiological basis for dyspnoea is well accepted. However, in people with chronic obstructive pulmonary disease (COPD), measures that are linked with neuromechanical uncoupling are poorly related to the restriction in activity during daily life attributed to dyspnoea. This suggests that activity restriction that results from dyspnoea is influenced by factors other than expiratory airflow limitation and dynamic pulmonary hyperinflation, such as the ways people perceive, interpret and respond to this sensation. This review introduces the common-sense model as a framework to understand the way an individual's lay beliefs surrounding sensations can lead to these sensations being perceived as a health threat and how this impacts their emotional and behavioural responses. The aim is to provide insight into the nuances that can shape an individual's personal construct of dyspnoea and offer practical suggestions to challenge unhelpful beliefs and facilitate cognitive re-structuring as a pathway to reduce distress and optimise health behaviours and outcomes.
Collapse
Affiliation(s)
- Kylie Hill
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
| | - Sarah Hug
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
- Physiotherapy Department, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia
| | - Anne Smith
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
| | - Peter O’Sullivan
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia; (S.H.); (A.S.); (P.O.)
| |
Collapse
|
3
|
Christiansen CF, Løkke A, Bregnballe V, Prior TS, Farver-Vestergaard I. COPD-Related Anxiety: A Systematic Review of Patient Perspectives. Int J Chron Obstruct Pulmon Dis 2023; 18:1031-1046. [PMID: 37304765 PMCID: PMC10257401 DOI: 10.2147/copd.s404701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background Anxiety in patients with chronic obstructive pulmonary disease (COPD) is prevalent but often unidentified and therefore not adequately managed. Clinicians find it difficult to detect anxiety symptoms and to differentiate subclinical anxiety from anxiety disorders, because of the considerable overlap between symptoms of COPD and anxiety. Purpose We synthesized existing qualitative research on patients' experiences of COPD-related anxiety with the purpose of gaining a richer understanding and proposing a model of the construct. Methods Searches for qualitative studies of patients' experiences of COPD-related anxiety were conducted independently by two authors in the databases of PubMed (MEDLINE), CINAHL (EBSCO), and PsycInfo (APA). English-language studies including patients diagnosed with COPD were reviewed, and data were analyzed using thematic analysis. Results A total of 41 studies were included in the review. Four themes related to COPD-related anxiety were identified: initial events; internal maintaining factors; external maintaining factors; and behavioral maintaining factors. Based on the identified four themes, a conceptual model of COPD-related anxiety from the patient perspective was developed. Conclusion A conceptual model of COPD-related anxiety from the patient perspective is now available, with the potential to inform future attempts at improving identification and management of COPD-related anxiety. Future research should focus on the development of a COPD-specific anxiety questionnaire containing domains that are relevant from the patient perspective.
Collapse
Affiliation(s)
- Camilla F Christiansen
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Asthma and early smoking associated with high risk of panic disorder in adolescents and young adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:583-594. [PMID: 34279695 DOI: 10.1007/s00127-021-02146-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Studies have reported a strong link between asthma and panic disorder. We conducted a 17-year community-based large cohort study to examine the relationship between asthma, early smoking initiation, and panic disorder during adolescence and early adulthood. METHODS A total of 162,766 participants aged 11-16 years were categorized into asthma and nonasthma groups at baseline and compared within the observation period. Covariates during late childhood or adolescence included parental education, cigarette smoking by family members of participants, and participant's gender, age, alcohol consumption, smoking, and exercise habits. Data for urbanicity, prednisone use, allergic comorbidity, and Charlson comorbidity index were acquired from the National Health Insurance Research Database. The Cox proportional-hazards model was used to evaluate the association between asthma and panic disorder. RESULTS Our findings revealed that asthma increased the risk of panic disorder after adjustment for key confounders in the Cox proportional hazard regression model (adjusted HR: 1.70, 95% CI 1.28-2.26). Hospitalizations or visits to the emergency department for asthma exhibited a dose-response effect on the panic disorder (adjusted HR: 2.07, 95% CI 1.30-3.29). Patients with asthma with onset before 20 years of age who smoked during late childhood or adolescence had the greatest risk for panic disorder (adjusted HR: 4.95, 95% CI 1.23-19.90). CONCLUSIONS Patients newly diagnosed with asthma had a 1.7-times higher risk of developing panic disorder. Smoking during late childhood or adolescence increased the risk for developing the panic disorder in patients with asthma.
Collapse
|
5
|
Witcraft SM, Dixon LJ, Leukel P, Lee AA. Anxiety sensitivity and respiratory disease outcomes among individuals with chronic obstructive pulmonary disease. Gen Hosp Psychiatry 2021; 69:1-6. [PMID: 33444938 DOI: 10.1016/j.genhosppsych.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Depression and anxiety worsen COPD and lead to greater respiratory symptom severity and health care utilization. Fear of physical sensations of anxiety (AS-P) is known to exacerbate respiratory symptoms. The current study investigated the unique contribution of AS-P in respiratory symptom exacerbations, emergency department visits, hospitalizations, and COPD-related functional health status, controlling for medical characteristics, depression, and anxiety. METHOD The sample included 535 adults with COPD (Mage = 56.57; 58.1% male). Participants were recruited from a web-based panel of adults with chronic respiratory disease and completed an online battery of self-report measures. RESULTS Consistent with hypotheses, AS-P significantly increased the likelihood of acute symptom exacerbations by 12% and respiratory-related emergency department visits and hospitalizations by 7% during the prior 12 month period. Additionally, AS-P demonstrated a unique, large effect (f2 = 0.37) on COPD-related functional health status. CONCLUSION Fear of physical sensations contributed to worse respiratory outcomes and health care utilization among adults with COPD. Screening for AS-P may effectively identify at-risk COPD patients, while reducing AS-P through targeted interventions may result in decreased symptom severity, functional limitations, and burden on the health care system.
Collapse
Affiliation(s)
- Sara M Witcraft
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Patric Leukel
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Aaron A Lee
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| |
Collapse
|
6
|
XIE L, ZHU X, LIU M, LIU Y. Effectiveness of Cognitive Behavioral Therapy on Health Outcomes in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2020. [DOI: 10.24193/jebp.2020.2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"The incidence of psychological distress (such as anxiety and depression) is high in COPD patients. CBT has been proved to reduce depression and anxiety and enhance quality of life. This meta-analysis evaluated the effectiveness of cognitive behavioral therapy(CBT) on patients with chronic obstructive pulmonary disease(COPD). The following electronic databases were searched from inception to March
2020: PubMed, EMBase, Cochrane Library, Web of Science, Medline, OVID, CINAHL, Chinese Biomedical Literature Database (CBM), China
National Knowledge Infrastructure (CNKI), Wangfang Database (WF), PsycARTICLES, VIP database. The Scopus and Google scholar database that we did not use. Randomized controlled trials (RCTs) that compared CBT with routine methods of care in COPD were retrieved in electronic databases. The Cochrane Risk of Bias Tool and Review Manager version 5.3 were used for risk of bias assessment and meta-analysis, respectively. Both data synthesis and descriptive analysis were used for outcome assessment. A total of 10 RCTs involving 1173 patients were included. Data synthesis showed that CBT was statistically significant in improving short- and medium-term depression and treatment compliance. Mediumterm anxiety and quality of life were improved among COPD patients receiving CBT, although no significant effect was found for short-term quality of life and anxiety. Descriptive analysis showed that CBT could reduce dyspnea. No clear evidence supports the effectiveness on improving self-efficacy in COPD patients with the use of CBT (P > 0.05).
CBT can be a useful strategy to improve the symptoms of depression, dyspnea and treatment compliance in patients with COPD. It can also improve patients’ quality of life and anxiety to some extent, but there is still lack of strong evidence in improving patients’ self-efficacy."
Collapse
Affiliation(s)
- Lin XIE
- The Second Hospital of Jingzhou, Hubei, China
| | | | - Miao LIU
- School of Nursing, Yangtze University, Hubei, China
| | - Yang LIU
- "Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hubei, China"
| |
Collapse
|
7
|
Mathew AR, Yount SE, Kalhan R, Hitsman B. Psychological Functioning in Patients With Chronic Obstructive Pulmonary Disease: A Preliminary Study of Relations With Smoking Status and Disease Impact. Nicotine Tob Res 2020; 21:686-690. [PMID: 29788395 DOI: 10.1093/ntr/nty102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/16/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a tobacco-related disease associated with several comorbid conditions, including elevated rates of depression and anxiety. Psychological factors that commonly underlie nicotine dependence, depression, and anxiety may represent novel treatment targets, but have not yet been examined among patientswith COPD. We assessed three psychological factors-anxiety sensitivity (AS; fear of anxiety-related sensations), distress intolerance (DI; inability to withstand distressing states), and anhedonia (Anh; diminished sense of pleasure or interest)-in relation to smoking status, COPD symptom impact, and negative response to COPD symptoms. METHODS We conducted a single-session laboratory assessment with 37 patients with COPD (17 current daily smokers and 20 former smokers). All participants completed self-report measures of psychological factors, COPD symptom impact, response to COPD symptoms, and anxiety and depression symptoms. RESULTS Current versus former smokers with COPD reported higher levels of AS, DI, and Anh. In univariate regression models, AS, DI, and Anh were each associated with greater COPD symptom impact and breathlessness catastrophizing. Only AS remained a significant predictor of COPD symptom impact and breathlessness catastrophizing after adjusting for general depression and anxiety symptoms. CONCLUSIONS Our preliminary study is the first to assess AS, DI, and Anh among patients with COPD. These psychological factors were elevated among current smokers and associated with more negative disease impact, suggesting their potential utility as treatment targets within this clinical population. IMPLICATIONS While elevated rates of anxiety and depression among patients with COPD have been wellcharacterized, few studies have specifically addressed the causal, modifiable psychological factors that may underlie these disorders. Our preliminary findings demonstrate associations of three psychological factors-AS, DI, and Anh-with smoking status, COPD symptom impact, and negative reaction to symptoms. Cognitive-behavioral interventions targeted to these psychological factors may improve smoking cessation outcomes and disease adjustment among patients with COPD.
Collapse
Affiliation(s)
- Amanda R Mathew
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Susan E Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ravi Kalhan
- Department of Preventive Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
8
|
Heslop-Marshall K, Burns G. The role of cognitive behavioural therapy in living well with COPD. Breathe (Sheff) 2019; 15:95-97. [PMID: 31191716 PMCID: PMC6544791 DOI: 10.1183/20734735.0119-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Psychological ill health is very common in COPD; CBT may be a key step towards improving the care of COPD patients http://ow.ly/fb8j30onfPj.
Collapse
Affiliation(s)
- Karen Heslop-Marshall
- Dept of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Health and Society, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Graham Burns
- Dept of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| |
Collapse
|
9
|
Yohannes AM. Nurse-led cognitive behavioural therapy for treatment of anxiety in COPD. ERJ Open Res 2018; 4:00221-2018. [PMID: 30568966 PMCID: PMC6293040 DOI: 10.1183/23120541.00221-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 02/01/2023] Open
Abstract
Anxiety disorders are common and debilitating conditions that significantly impair the physical functioning and quality of life (QoL) of patients with chronic obstructive pulmonary disease (COPD). A recent systematic review identified the high prevalence of these disorders in patients with COPD, ranging 6–33% for generalised anxiety, 0–44% for panic disorder, 10–27% for specific phobias, and 5–11% for social phobias [1]. Furthermore, under-recognised or untreated anxiety disorders in COPD patients may reduce the QoL of their caregivers and increase emergency care visits and hospital admissions [1–5]. In 2004, in the European Union, the estimated direct (e.g. hospital admissions and medications) and indirect (e.g. loss of productivity due to absence from work) cost of anxiety disorders exceeded €41 billion per annum [2]. Nurse-led cognitive behavioural therapy is feasible and cost-effective for the treatment of anxiety in patients with chronic obstructive pulmonary disease.http://ow.ly/QZJT30mJdXU
Collapse
Affiliation(s)
- Abebaw Mengistu Yohannes
- School of Behavioral and Applied Sciences, Dept of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
| |
Collapse
|
10
|
Maras D, Balfour L, Tasca GA, Gaudet E, Aaron SD, Cameron WD, Pakhale S. Breathlessness catastrophizing relates to poorer quality of life in adults with cystic fibrosis. J Cyst Fibros 2018; 18:150-157. [PMID: 30197031 DOI: 10.1016/j.jcf.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cystic Fibrosis (CF) is the most common genetic disease affecting children and young adults in Canada. It is a multi-system disease, however lung disease is largely responsible for mortality. Treatment advances have resulted in increased life expectancy and a subsequent need to better understand psychosocial issues associated with quality of life in adults living with CF. Emerging research suggests that anxiety and depression are related to poorer health-related quality of life (HRQoL) in CF patients, but there is little research examining cognitive processes, such as breathlessness catastrophizing. The present study addresses this gap in the literature. METHODS Participants in this study are based on a convenience sample of patients recruited during their regular CF clinic appointments at a tertiary care center. Forty-five adults (Mage = 30.73 years) completed measures of lung function, depression, anxiety, pain, breathlessness catastrophizing, and HRQoL at one time point. RESULTS Results of a hierarchical multiple regression indicate that increased breathlessness catastrophizing was related to poorer HRQoL, after controlling for lung function, depression, anxiety, and pain (p < .05). Depression, pain, and breathlessness catastrophizing all emerged as significant unique predictors of HRQoL. CONCLUSIONS Breathlessness catastrophizing is a potential target for clinical intervention and might impact HRQoL. Further research on breathlessness catastrophizing in CF is warranted including longitudinal studies to examine the mechanisms by which breathlessness catastrophizing relates to HRQoL and treatment outcomes in CF.
Collapse
Affiliation(s)
- Danijela Maras
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada.
| | - Louise Balfour
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada; Psychology, The Ottawa Hospital, Canada; Faculty of Medicine, University of Ottawa, Canada
| | - Giorgio A Tasca
- School of Psychology, University of Ottawa, Canada; The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada
| | - Ena Gaudet
- The Ottawa Hospital Research Institute, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
| | - William D Cameron
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
| | - Smita Pakhale
- The Ottawa Hospital Research Institute, Canada; Faculty of Medicine, University of Ottawa, Canada; Respirology, The Ottawa Hospital, Canada
| |
Collapse
|
11
|
Dixon LJ, Witcraft SM, Perry MM. How Does Anxiety Affect Adults with Skin Disease? Examining the Indirect Effect of Anxiety Symptoms on Impairment Through Anxiety Sensitivity. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9942-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
12
|
Horenstein A, Potter CM, Heimberg RG. How does anxiety sensitivity increase risk of chronic medical conditions? CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arielle Horenstein
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
| | - Carrie M. Potter
- Department of Psychiatry of Cambridge Health Alliance; Harvard Medical School; Boston Massachusetts
| | - Richard G. Heimberg
- Adult Anxiety Clinic of Temple; Department of Psychology; Temple University; Philadelphia Pennsylvania
| |
Collapse
|
13
|
Farver-Vestergaard I, O'Toole MS, O'Connor M, Løkke A, Bendstrup E, Basdeo SA, Cox DJ, Dunne PJ, Ruggeri K, Early F, Zachariae R. Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial. Eur Respir J 2018; 51:51/2/1702082. [DOI: 10.1183/13993003.02082-2017] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/31/2017] [Indexed: 11/05/2022]
Abstract
A considerable proportion of patients with chronic obstructive pulmonary disease (COPD) entering pulmonary rehabilitation (PR) report psychological distress, which is often accompanied by poor physical health status. Mindfulness-based cognitive therapy (MBCT) has been shown to improve psychological and physical outcomes in other chronic diseases. We therefore evaluated the efficacy of MBCT as an add-on to a standard PR programme in COPD.COPD patients eligible for PR were cluster randomised to receive either an 8-week, group-based MBCT programme as an add-on to an 8-week PR programme (n=39), or PR alone (n=45). The primary outcomes of psychological distress and physical health status impairment were measured with the Hospital Anxiety and Depression Scale (HADS) and the COPD Assessment Test (CAT) before randomisation (T1), mid- (T2) and post-intervention (T3), and at 3 (T4) and 6 (T5) months’ follow-up .A statistically significant time×arm effect was found for the HADS (Cohen'sd=0.62, 95% CIs (d)=0.18–1.06, p=0.010). The treatment effect on the CAT failed to reach statistical significance (d=0.42, 95% CIs (d)=−0.06–0.90, p=0.061).MBCT showed a statistically significant and durable effect on psychological distress, indicating that MBCT may be an efficacious add-on to standard PR programmes in COPD.
Collapse
|
14
|
Stoeckel MC, Esser RW, Gamer M, Büchel C, von Leupoldt A. Dyspnea catastrophizing and neural activations during the anticipation and perception of dyspnea. Psychophysiology 2017; 55. [DOI: 10.1111/psyp.13004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/19/2022]
Affiliation(s)
- M. Cornelia Stoeckel
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Roland W. Esser
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Matthias Gamer
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Psychology 1; University of Würzburg; Würzburg Germany
| | - Christian Büchel
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Andreas von Leupoldt
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Health Psychology; University of Leuven; Leuven Belgium
| |
Collapse
|
15
|
Holas P, Michałowski J, Gawęda Ł, Domagała-Kulawik J. Agoraphobic avoidance predicts emotional distress and increased physical concerns in chronic obstructive pulmonary disease. Respir Med 2017; 128:7-12. [PMID: 28610672 DOI: 10.1016/j.rmed.2017.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/03/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anxiety and panic attacks are more common in chronic obstructive pulmonary disease (COPD) than in the overall population. Individuals with panic attacks often attempt to avoid situations perceived as at risk of eliciting bodily sensations such as dyspnea, which paradoxically may lead to anxiety-related responsivity. Although there is some evidence that COPD individuals restrict their participation in various life activities because they fear that these may trigger breathlessness, little is known about agoraphobic avoidance and its impact on cognitions and emotional distress in this population. It was thus our aim to investigate the degree of agoraphobic avoidance in COPD individuals, its clinical concomitants and consequences. METHODS A total of 48 patients with COPD and 48 matched controlled subjects completed measures of anxiety sensitivity, agoraphobic avoidance, anxiety and depression. Objective COPD severity was measured using forced expiratory volume in the first second. RESULTS Patients showed significant impairment in respiratory functioning and psychological distress. Relative to the control, the COPD group exhibited greater depression, anxiety, physical symptom concerns and avoidance (alone and accompanied), irrespective of whether they were panickers or not. Patients with high avoidance showed more intense physical concerns when compared to those with low avoidance. Importantly, the level of avoidance predicted emotional distress and increased physical concerns in COPD. CONCLUSIONS Physical concerns scores in COPD patients are partially explained by avoidance in this group. The results of the study provide evidence for the importance of evaluating avoidance in COPD patients and implicate targeting this behavior in therapeutic interventions.
Collapse
Affiliation(s)
- Pawel Holas
- Faculty of Psychology, University of Warsaw, Krakowskie Przedmieście 26/28, 00 927 Warsaw, Poland.
| | - Jaroslaw Michałowski
- SWPS University of Social Sciences and Humanities, Faculty of Social Sciences and Design in Poznan, Department of Psychology, Poznan, Poland
| | - Łukasz Gawęda
- II Department of Psychiatry, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw, Poland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joanna Domagała-Kulawik
- Department of Internal Medicine, Pneumonology and Allergology, Medical University of Warsaw, Poland
| |
Collapse
|
16
|
von Leupoldt A, Janssens T. Could targeting disease specific fear and anxiety improve COPD outcomes? Expert Rev Respir Med 2016; 10:835-7. [DOI: 10.1080/17476348.2016.1198697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
17
|
Solomon BK, Wilson KG, Henderson PR, Poulin PA, Kowal J, McKim DA. Loss of Dignity in Severe Chronic Obstructive Pulmonary Disease. J Pain Symptom Manage 2016; 51:529-37. [PMID: 26620235 DOI: 10.1016/j.jpainsymman.2015.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 02/02/2023]
Abstract
CONTEXT The maintenance of dignity is an important concept in palliative care, and the loss of dignity is a significant concern among patients with advanced cancer. OBJECTIVES The goals of this study were to examine whether loss of dignity is also a concern for patients receiving interdisciplinary rehabilitation for Stage III or IV chronic obstructive pulmonary disease. We examined the prevalence and correlates of loss of dignity and determined whether it improves with treatment. METHODS Inpatients underwent a structured interview inquiry around their sense of dignity and completed measures of pulmonary, physical, and psychological function at admission (n = 195) and discharge (n = 162). RESULTS Loss of dignity was identified as a prominent ongoing concern for 13% of patients. It was correlated with measures of depression and anxiety sensitivity, but not with pulmonary capacity or functional performance. A robust improvement in loss of dignity was demonstrated, with 88% of those who reported a significant problem at admission no longer reporting one at discharge. CONCLUSION The prevalence of a problematic loss of dignity among patients with severe chronic obstructive pulmonary disease is at least as high as among those receiving palliative cancer care. Loss of dignity may represent a concern among people with medical illnesses more broadly, and not just in the context of "death with dignity" at the end of life. Furthermore, interdisciplinary care may help to restore a sense of dignity to those individuals who are able to participate in rehabilitation.
Collapse
Affiliation(s)
- Brahm K Solomon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
| | - Keith G Wilson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
| | - Peter R Henderson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
| | - Patricia A Poulin
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Kowal
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
| | - Douglas A McKim
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
18
|
Solomon BK, Wilson KG, Henderson PR, Poulin PA, Kowal J, McKim DA. A Breathlessness Catastrophizing Scale for chronic obstructive pulmonary disease. J Psychosom Res 2015; 79:62-8. [PMID: 25498317 DOI: 10.1016/j.jpsychores.2014.11.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/22/2014] [Accepted: 11/25/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Catastrophizing about breathlessness may be related to disability in patients with chronic obstructive pulmonary disease (COPD), but assessment options are limited. This study reports the initial validation of a 13-item Breathlessness Catastrophizing Scale (BCS). METHOD Pulmonary rehabilitation inpatients completed spirometric, functional performance and questionnaire assessments at admission (N=242) and discharge (n=186). RESULTS The BCS comprised a unifactorial scale that demonstrated excellent internal consistency (Cronbach's alpha=.96) and correlated with measures of anxiety sensitivity, depression, and self-efficacy, but not with performance on walk and stair-climbing tests. BCS scores improved robustly with rehabilitation, approaching a medium effect size (d=.43), and demonstrated a modest association with enhanced performance in a stair-climbing test of exercise tolerance. CONCLUSION The BCS is a reliable measure of catastrophizing in severe COPD that has good convergent validity and sensitivity to change. Its association with functional performance requires further investigation. However, it appears that a high level of catastrophizing about breathlessness is not a barrier to functional improvement with inpatient pulmonary rehabilitation.
Collapse
Affiliation(s)
| | - Keith G Wilson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Canada
| | - Peter R Henderson
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Canada
| | | | - John Kowal
- Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Canada
| | | |
Collapse
|
19
|
Cognitive behaviour therapy reduces dyspnoea ratings in patients with chronic obstructive pulmonary disease (COPD). Respir Physiol Neurobiol 2015; 216:35-42. [PMID: 26049126 DOI: 10.1016/j.resp.2015.05.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/21/2022]
Abstract
There is evidence that psychological factors contribute to the perception of increased difficulty of breathing in patients with chronic obstructive pulmonary disease (COPD), and increase morbidity. We tested the hypothesis that cognitive behaviour therapy (CBT) decreases ratings of perceived dyspnoea in response to resistive loading in patients with COPD. From 31 patients with COPD, 18 were randomised to four sessions of specifically targeted CBT and 13 to routine care. Prior to randomisation, participants were tested with an inspiratory external resistive load protocol (loads between 5 and 45cmH2O/L/s). Six months later, we re-measured perceived dyspnoea in response to the same inspiratory resistive loads and compared results to measurements prior to randomisation. There was a significant 17% reduction in dyspnoea ratings across the loads for the CBT group, and no reduction for the routine care group. The decrease in ratings of dyspnoea suggests that CBT to alleviate breathing discomfort may have a role in the routine treatment of people with COPD.
Collapse
|
20
|
Hauzer R, Verheul W, Griez E, Wesseling G, van Duinen M. Medically unexplained dyspnoea and panic. Respirology 2015; 20:828-30. [DOI: 10.1111/resp.12516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/10/2014] [Accepted: 01/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Rose Hauzer
- Department of Psychiatry and Neuropsychology; Maastricht University; Maastricht The Netherlands
| | - Willeke Verheul
- Department of Psychiatry; Medisch Spectrum Twente; Enschede The Netherlands
| | - Eric Griez
- Department of Psychiatry and Neuropsychology; Maastricht University; Maastricht The Netherlands
| | - Geertjan Wesseling
- Department of Respiratory Medicine; Maastricht University; Maastricht The Netherlands
| | - Marlies van Duinen
- Department of Psychiatry and Neuropsychology; Maastricht University; Maastricht The Netherlands
| |
Collapse
|
21
|
Schüz N, Walters JAE, Cameron-Tucker H, Scott J, Wood-Baker R, Walters EH. Patient Anxiety and Depression Moderate the Effects of Increased Self-management Knowledge on Physical Activity: A Secondary Analysis of a Randomised Controlled Trial on Health-Mentoring in COPD. COPD 2015; 12:502-9. [PMID: 25774660 DOI: 10.3109/15412555.2014.995289] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Anxiety and depression are common comorbidities in people with chronic obstructive pulmonary disease (COPD). While these comorbidities could potentially lead to a higher motivation to learn about self-management, they could also inhibit patients from translating this knowledge into appropriate self-management behaviours. This paper explores the moderating effects of anxiety and depression on a health-mentoring intervention, focusing on mechanisms of change (mediation). METHODS 182 COPD patients participated in an RCT, with anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS), self-management knowledge by the Partners in Health Scale, and spontaneous physical activity using accelerometers, all measured at baseline, 6 and 12 months. The moderated mediation model tested the intervention's effect on physical activity, mediated via changes in self-management knowledge, at different levels of anxiety and depression. RESULTS Knowledge mediated the effect of the intervention on changes in physical activity only for participants reporting low levels of anxiety or depression. Both acted as moderators: Increased knowledge led to more physical activity among participants reporting low anxiety or depression and to less activity among highly anxious or depressed participants. CONCLUSION Although health-mentoring interventions can be an effective tool to increase knowledge and physical activity among COPD patients, it is essential to take anxiety and depression into account, as increased knowledge may have detrimental effects in highly anxious or depressed participants. This suggests that patients with elevated anxiety or depression may need to be treated appropriately before engaging in chronic disease self-management interventions.
Collapse
Affiliation(s)
- Natalie Schüz
- a School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
| | - Julia A E Walters
- a School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
| | - Helen Cameron-Tucker
- a School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
| | - Jenn Scott
- a School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
| | - Richard Wood-Baker
- a School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
| | - E Haydn Walters
- a School of Medicine, Faculty of Health , University of Tasmania , Hobart , Australia
| |
Collapse
|
22
|
A Review of Cognitive Behavioral Therapy for Panic Disorder in Patients with Chronic Obstructive Pulmonary Disease: The Rationale for Interoceptive Exposure. J Clin Psychol Med Settings 2014; 21:144-54. [DOI: 10.1007/s10880-014-9393-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is associated with significant individual and socioeconomic burden. Recent research has begun to acknowledge the important role of psychological factors in the course and management of the disease. Therefore, the present review provides an overview on recent findings on psychological factors in COPD with a specific focus on anxiety and depression. RECENT FINDINGS Recent findings demonstrate high levels of anxiety and depression in COPD patients which are related to a considerably worse course of the disease. The exact causes for these findings are widely unknown, but several potential mechanisms have been suggested. Moreover, anxiety and depression often remain undetected and untreated in COPD patients. Although some beneficial effects of respective psychotropic and psychotherapeutic treatments have been reported, future well-controlled studies regarding their efficacy are mandatory. SUMMARY Comorbid anxiety and depression in patients with COPD are a major health problem requiring intensified research activities. Future studies need to examine the exact links between COPD and these psychological comorbidities, and how their detection and treatment can be improved in the clinical setting.
Collapse
|