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Farver-Vestergaard I, Buksted EH, Sørensen D, Jonstrup S, Hansen H, Christiansen CF, Løkke A. Changes in COPD-related anxiety symptoms during pulmonary rehabilitation: a prospective quantitative and qualitative study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1428893. [PMID: 39169921 PMCID: PMC11335722 DOI: 10.3389/fresc.2024.1428893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 08/23/2024]
Abstract
Background Fear-avoidance in COPD can have detrimental effects on pulmonary rehabilitation (PR) outcomes and is therefore important to address. This prospective study examined changes in and management of COPD-related anxiety symptoms over the course of a PR program. Methods Patients with COPD referred to 9-weeks of PR in the municipality of Vejle, Denmark from January to December 2022 completed a six-minute walk test (6MWT) and the following questionnaires, both before and after PR: COPD Anxiety Questionnaire 20-item version (CAF-R), measuring COPD-related anxiety; COPD Assessment Test (CAT), measuring COPD-related disability; 12-Item Short-Form Health Survey (SF-12), measuring health-related quality of life (HR-QoL); sociodemographic and disease-related information. After PR, a subsample of the patients took part in semi-structured interviews exploring their understanding of how they managed COPD-related anxiety during PR. Pre- and post-assessment of COPD-related anxiety and other PR outcomes were analysed with t-tests and correlation analyses. Qualitative interviews were analysed using a thematic analysis approach. Results A total of 72 patients with COPD (mean ± SD age 71 ± 8, 53% female) were included in the study, and 13 took part in qualitative interviews. A significant decrease in COPD-related anxiety was observed from before to after PR, corresponding to a small effect size (Cohen's d = 0.32; p = 0.018). Reductions in COPD-related anxiety were not associated with improvements in COPD-related disability, HR-QOL, or functional exercise capacity. The qualitative findings identified four anxiety management strategies, i.e., "planning", "problem-solving", "accepting", and "confronting", which were influenced by interactions with healthcare professionals and co-patients as well as patients' own perception. Conclusions COPD-related anxiety symptoms was reduced after PR, potentially through the use of various management strategies. The strategies appeared to be influenced by interactional factors during the PR program.
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Affiliation(s)
- Ingeborg Farver-Vestergaard
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Eva Holmegaard Buksted
- VIA Research Centre for Health and Welfare Technology, Program for Rehabilitation, VIA University College, Aarhus, Denmark
| | - Dorthe Sørensen
- VIA Research Centre for Health and Welfare Technology, Program for Rehabilitation, VIA University College, Aarhus, Denmark
| | - Sune Jonstrup
- Department of Health, Vejle Municipality, Vejle, Denmark
| | - Henrik Hansen
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark
- Institute of Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
| | - Camilla Fischer 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
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2
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Clark HL, Dixon LJ, Ramachandran S, Leukel PJ, Lee AA. Psychometric Properties of the Short Scale Anxiety Sensitivity Index Among Adults with Chronic Respiratory Disease. J Clin Psychol Med Settings 2024; 31:186-196. [PMID: 37770802 DOI: 10.1007/s10880-023-09976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Approximately one-third of adults with chronic respiratory disease (CRD) have comorbid depressive and anxiety disorders; yet these disorders are often unrecognized in this patient population. Transdiagnostic processes such as anxiety sensitivity (AS) are useful for identifying mechanisms underlying psychological and heath conditions. The Short-Scale AS Index (SSASI) is a brief self-report measure of AS which has potential clinical utility among CRD populations to evaluate psychological distress and inform comprehensive care. The present study investigated the psychometric properties of the SSASI among adults with CRDs. Participants were recruited from a web-based panel of adults with CRDs (n = 768; 49.3% female; 57.8% White) including adults with asthma only (n = 230), COPD only (n = 321), or co-occurring asthma and COPD (n = 217). Participants completed a battery of self-report questionnaires assessing psychological and medical symptoms. Analyses were conducted to examine the factor structure and measurement invariance across CRD groups. Convergent validity and criterion validity of the SSASI were assessed within each group. Results supported partial measurement invariance across CRD groups. The SSASI demonstrated high reliability, convergent validity, and criterion validity with each CRD group. Findings from this study and existing work indicate that the SSASI is an effective and economical assessment tool for identifying patients CRD who may benefit from psychological interventions to reduce AS.
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Affiliation(s)
- Heather L Clark
- 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
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Patric J Leukel
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Aaron A Lee
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
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3
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Peiffer C. Puzzled by dysfunctional breathing disorder(s)? Consider the Bayesian brain hypothesis! Front Neurosci 2023; 17:1270556. [PMID: 37877012 PMCID: PMC10593455 DOI: 10.3389/fnins.2023.1270556] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 10/26/2023] Open
Abstract
There is currently growing clinical concern regarding dysfunctional breathing disorder(s) (DBD), an umbrella term for a set of multidimensional clinical conditions that are characterized by altered breathing pattern associated with a variety of intermittent or chronic symptoms, notably dyspnea, in the absence or in excess of, organic disease. However, several aspects of DBD remain poorly understood and/or open to debate, especially the inconsistent relationship between the array of experienced symptoms and their supposedly underlying mechanisms. This may be partly due to a more general problem, i.e., the prevailing way we conceptualize symptoms. In the present article, after a brief review of the different aspects of DBD from the current perspective, I submit a call for considering DBD under the innovating perspective of the Bayesian brain hypothesis, i.e., a potent and novel model that fundamentally changes our views on symptom perception.
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Affiliation(s)
- Claudine Peiffer
- Dyspnea Clinic, Department of Physiology, University Children Hospital Robert Debré (AP-HP), Paris, France
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4
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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.
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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
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5
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Farver-Vestergaard I, Rubio-Rask S, Timm S, Christiansen CF, Hilberg O, Løkke A. Disease-Specific Anxiety in Chronic Obstructive Pulmonary Disease: Translation and Initial Validation of a Questionnaire. Front Psychol 2022; 13:907939. [PMID: 35865679 PMCID: PMC9294537 DOI: 10.3389/fpsyg.2022.907939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Commonly applied measures of symptoms of anxiety are not sensitive to disease-specific anxiety in patients with chronic obstructive pulmonary disease (COPD). There is a need for validated instruments measuring COPD-specific anxiety. Therefore, we translated the COPD-Anxiety Questionnaire (CAF) into Danish (CAF-R-DK) and performed an initial validation of the psychometric properties in a sample of patients with COPD. Materials and Methods Translation procedures followed the World Health Organization guidelines. Participants with COPD completed questionnaires measuring COPD-specific anxiety (CAF-R-DK), general psychological distress (Hospital Anxiety and Depression Scale) as well as variables related to COPD (COPD Assessment Test; modified Medical Research Council dyspnea scale), quality of life (the 12-item Short Form survey, SF12), and socio-demography. Results A total of 260 patients with COPD (mean age: 65.0, 69% female) completed questionnaires. The Danish version of CAF-R-DK demonstrated acceptable Cronbach’s α values that were comparable with those of the original CAF. As expected, the CAF-R-DK showed positive correlations with convergent constructs (CAT; HADS) and negative correlations with discriminant constructs (SF-12). However, the results for specific subdomains of the CAF-R-DK indicated inconsistency in the underlying concept of disease-specific anxiety, which was also suggested based on the subsequent confirmatory and exploratory factor analyzes. Conclusion The CAF could serve as an important supplement to generic psychological distress screening of patients with COPD in somatic health care settings, and the questionnaire is now available in Danish. Translation into other languages is needed with the purpose of obtaining data for further testing the psychometric properties of the questionnaire.
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Affiliation(s)
| | | | - Signe Timm
- Research Unit, Lillebaelt Hospital, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- 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
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Carl J, Schultz K, Janssens T, von Leupoldt A, Pfeifer K, Geidl W. The "can do, do do" concept in individuals with chronic obstructive pulmonary disease: an exploration of psychological mechanisms. Respir Res 2021; 22:260. [PMID: 34615520 PMCID: PMC8493747 DOI: 10.1186/s12931-021-01854-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022] Open
Abstract
Background The “can do, do do” concept aims at identifying subgroups among persons with chronic obstructive pulmonary disease (COPD). Following a two-dimensional categorization, individuals are binarily classified with respect to their levels of physical capacity (“can’t do” or “can do”) and physical activity (“don’t do” or “do do”), resulting in four disjunct quadrants. The approach has been debated recently and the latest articles have concluded that the quadrants should be specifically examined in terms of psychological aspects of physical activity. Therefore, the goal of the present study was to explore the role of psychological variables in physical activity in the context of the “can do, do do” quadrant concept. Methods Within the scope of secondary data analyses of the “Stay Active After Rehabilitation” (STAR) randomized controlled trial, a total of 298 COPD rehabilitants of an inpatient pulmonary rehabilitation program were grouped into the suggested quadrants. We set fixed cut-offs at 70% of relative 6-min walking test performances for healthy individuals (physical capacity dimension) and 5.000 steps per day (physical activity dimension). Univariate and multivariate logistic regression analyses served to analyze whether depression scores, fear avoidance behaviors, disease-specific anxiety, self-concordance for physical activity, and five indicators of physical activity-related health competence (PAHCO) effectively discriminated between the “don’t do” and “do do” groups. Results Among persons with lower relative physical capacity, depression scores, fear avoidance behaviors, and disease-specific anxiety (univariate case) significantly differentiated between the more and the less active. Among persons with higher relative physical capacity, fear avoidance behaviors, disease-specific anxiety, as well as three PAHCO indicators (physical activity-specific self-efficacy, self-control, and affect regulation) significantly separated the more and the less active. In multivariate analyses, only fear avoidance behaviors and affect regulation discriminated among individuals with better relative physical capacity. Conclusion The findings identified important psychological and competence-oriented variables that explain discrepancies in the quadrant concept. Based on this, we discuss implications for physical activity promotion in individuals with COPD. Respiratory research can benefit from future studies complementing the quadrant concept through further behavioral analyses. Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered 17 November, 2016, https://clinicaltrials.gov/ct2/show/NCT02966561.
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Affiliation(s)
- J Carl
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058, Erlangen, Germany.
| | - K Schultz
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pneumology, Orthopaedics, Salzburger Str. 8 - 11, 83435, Bad Reichenhall, Germany
| | - T Janssens
- Research Group on Health Psychology, Katholieke Universiteit Leuven, Tiensestraat 102, Box 3726, 3000, Leuven, Belgium
| | - A von Leupoldt
- Research Group on Health Psychology, Katholieke Universiteit Leuven, Tiensestraat 102, Box 3726, 3000, Leuven, Belgium
| | - K Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058, Erlangen, Germany
| | - W Geidl
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstraße 123b, 91058, Erlangen, Germany
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7
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Rodríguez-Torres J, López-López L, Cabrera-Martos I, Torres-Sánchez I, Prados-Román E, Ortíz-Rubio A, Valenza MC. Symptom severity is associated with signs of central sensitization in patients with asthma. CLINICAL RESPIRATORY JOURNAL 2021; 15:1219-1226. [PMID: 34328269 DOI: 10.1111/crj.13429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Asthma is characterized by recurrent episodes of wheezing, dyspnoea, chest tightness and cough. In addition to respiratory symptoms, previous studies have reported the presence of pain. OBJECTIVE To analyse the nociceptive processing of young adults with well-controlled asthma. METHODS A cross-sectional case-control study was performed. Patients diagnosed with persistent well-controlled asthma were recruited from the 'Complejo Hospitalario Universitario' (Granada). Main outcomes included pain processing, measured by the pressure-pain thresholds (PPTs) and temporal summation and latency of pain; symptoms, including cough (Leicester Cough Questionnaire) and dyspnoea (Borg scale); and catastrophic cognitions about breathlessness, assessed by the Breathlessness Catastrophizing Scale (BCS). RESULTS Seven-two participants were finally recruited in our study. Patients with asthma presented lower pressure thresholds (p < 0.05) and significant differences in latency and summation tests. These patients also presented a greater cough level, with significant differences in all subscales (p < 0.05). Significant differences were also found in the BCS between groups (p < 0.001). CONCLUSION Our results show a decrease of PPTs and a greater pain intensity in latency and summation tests, suggesting an abnormal pain processing in patients with asthma.
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Affiliation(s)
- Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Esther Prados-Román
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortíz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie C Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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8
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von Leupoldt A, Ashoori M, Jelinčić V, Herzog M, Van Diest I. The impact of unpredictability of dyspnea offset on dyspnea perception, fear, and respiratory neural gating. Psychophysiology 2021; 58:e13807. [PMID: 33682134 DOI: 10.1111/psyp.13807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023]
Abstract
Dyspnea is a debilitating and threatening symptom in various diseases. Affected patients often report the unpredictability of dyspnea episodes being particularly anxiety-provoking and amplifying the perception of dyspnea. Experimental studies testing dyspnea unpredictability together with related neural processes, physiological fear responses, and dyspnea-related personality traits are sparse. Therefore, we investigated the impact of unpredictability of dyspnea offset on dyspnea perception and fear ratings, respiratory neural gating and physiological fear indices, as well as the influence of interindividual differences in fear of suffocation (FoS). Forty healthy participants underwent a task manipulating the offset predictability of resistive load-induced dyspnea including one unloaded safety condition. Respiratory variables, self-reports of dyspnea intensity, dyspnea unpleasantness, and fear were recorded. Moreover, respiratory neural gating was measured in a paired inspiratory occlusion paradigm using electroencephalography, while electrodermal activity, startle eyeblink, and startle probe N100 were assessed as physiological fear indices. Participants reported higher dyspnea unpleasantness and fear when dyspnea offset was unpredictable compared to being predictable. Individuals with high levels of FoS showed the greatest increase in fear and overall higher levels of fear and physiological arousal across all conditions. Respiratory neural gating, startle eyeblink, and startle probe N100 showed general reductions during dyspnea conditions but no difference between unpredictable and predictable dyspnea conditions. Together, the current results suggest that the unpredictable offset of dyspnea amplifies dyspnea perception and fear, especially in individuals with high levels of FoS. These effects were unrelated to respiratory neural gating or physiological fear responses, requiring future studies on underlying mechanisms.
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Affiliation(s)
| | - Minoo Ashoori
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | | | - Michaela Herzog
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
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9
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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.
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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.
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10
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Van Den Houte M, Vlemincx E, Franssen M, Van Diest I, Van Oudenhove L, Luminet O. The respiratory occlusion discrimination task: A new paradigm to measure respiratory interoceptive accuracy. Psychophysiology 2021; 58:e13760. [PMID: 33438245 DOI: 10.1111/psyp.13760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/20/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
Interoception, or the sense of the internal state of the body, is hypothesized to be essential for a wide range of psychobiological processes and the development and perpetuation of several (mental) health problems. However, the study of interoceptive accuracy, the objectively measured capacity to detect or discriminate conscious bodily signals, has been hampered by the use of tasks with questionable construct validity and is often limited to studying interoception solely in the cardiac domain. We developed a novel task to measure interoceptive accuracy in the respiratory domain, the respiratory occlusion discrimination (ROD) task. In this task, interoceptive accuracy is defined as an individual's ability to detect small differences in lengths of short respiratory occlusions, assessed by means of an adaptive staircase procedure. This article describes a validation study (N = 97) aimed at investigating the internal consistency, test-retest reliability, and discriminant validity of the ROD task. The average just noticeable difference of lengths of respiratory occlusion was 74.22 ms, with large inter-individual variability (SD = 37.1 ms). The results of the validation study indicate acceptable internal consistency (Cronbach's alpha = 0.70), 1-week test-retest reliability (r = 0.53), and discriminant validity, as indicated by a lack of correlation between the ROD task and an auditory discrimination task with identical design (r = 0.18), and a weak correlation with breathing behavior (r = -0.27). The ROD task is a promising novel paradigm to study interoceptive accuracy and its role in various psychobiological processes and disorders.
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Affiliation(s)
- Maaike Van Den Houte
- Research group on Health, Emotion, Cognition, and Memory, Research Institute for Psychological Sciences, UCLouvain, Louvain-La-Neuve, Belgium.,Laboratory for Brain-Gut Axis Studies (LaBGAS), KU Leuven, Leuven, Belgium.,Fund for Scientific Research (FRS-FNRS), Belgium
| | - Elke Vlemincx
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Ilse Van Diest
- Health Psychology Research Group, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Lab, Dartmouth College, Hanover, NH, USA
| | - Olivier Luminet
- Research group on Health, Emotion, Cognition, and Memory, Research Institute for Psychological Sciences, UCLouvain, Louvain-La-Neuve, Belgium.,Fund for Scientific Research (FRS-FNRS), Belgium
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11
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Selzler AM, Moore V, Habash R, Ellerton L, Lenton E, Goldstein R, Brooks D. The Relationship between Self-Efficacy, Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses. COPD 2020; 17:452-461. [PMID: 32633148 DOI: 10.1080/15412555.2020.1782866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Anne-Marie Selzler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Veronica Moore
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Razanne Habash
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Lauren Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
| | - Erica Lenton
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
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12
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Severe Fatigue is Highly Prevalent in Patients with IPF or Sarcoidosis. J Clin Med 2020; 9:jcm9041178. [PMID: 32325989 PMCID: PMC7230281 DOI: 10.3390/jcm9041178] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
In patients with interstitial lung disease (ILD) next to dyspnea, fatigue is expected to be the most prevalent symptom. Surprisingly, the prevalence of severe fatigue has been scarcely studied in ILD patients and limited information on its associated factors is available. This study aimed to determine the prevalence of severe fatigue in patients with idiopathic pulmonary fibrosis (IPF) or pulmonary sarcoidosis and to identify the relationship between fatigue, patient characteristics, and clinical parameters. In this cross-sectional study, fatigue (checklist individual strength-fatigue (CIS-Fat)), demographics, lung function, dyspnea (modified-Medical Research Council (mMRC)), sleepiness (Epworth Sleepiness Scale), anxiety/depression (hospital anxiety and depression scale (HADS-A/HADS-D)), catastrophizing (fatigue catastrophizing scale (FCS)), functional activity impairment (respiratory illness quality-of-life (QoL-RIQ-Activity)), and health status (EuroQol five-dimensional descriptive system (EQ-5D-5L)) were assessed in outpatients with ILD. Mean CIS-Fat scores were 34.1 (SD ± 11.2) in 59 IPF patients and 40.0 (12.3) in 58 sarcoidosis patients. Severe fatigue (SD ± ≥36 points) was present in IPF patients (47.5%) and sarcoidosis (69%). In IPF, CIS-Fat correlated strongly (ρ > 0.5; p < 0.01) with FCS, QoL-RIQ-Activity, and EQ-5D-5L-Health and moderately (0.3 < ρ < 0.5; p < 0.01) with EQ-5D-5L-Index, mMRC, and HADS-D. In sarcoidosis, CIS-Fat correlated strongly with EQ-5D-5L-Health, QoL-RIQ-Activity, EQ-5D-5L-Index, HADS-D, and mMRC and moderately with FCS and hospitalization <12 months. Severe fatigue is highly prevalent in ILD patients and is associated with dyspnea, depression, catastrophizing, functional activity impairments, and QoL.
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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.
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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
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Andreasson KH, Skou ST, Ulrik CS, Madsen H, Sidenius K, Jacobsen JS, Assing KD, Rasmussen KB, Porsbjerg C, Thomas M, Bodtger U. Protocol for a multicentre randomised controlled trial to investigate the effect on asthma-related quality of life from breathing retraining in patients with incomplete asthma control attending specialist care in Denmark. BMJ Open 2019; 9:e032984. [PMID: 31892661 PMCID: PMC6955530 DOI: 10.1136/bmjopen-2019-032984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION AND AIM Uncontrolled asthma is a global health challenge with substantial impact on quality of life (QoL) and overall healthcare costs. Unrecognised and/or unmanaged comorbidities often contribute to presence of uncontrolled asthma. Abnormalities in breathing pattern are termed dysfunctional breathing and are not only common in asthma but also lead to asthma-like symptoms and reduced QoL, and, in keeping with this, improvement with breathing normalisation. Evidence-based guidelines recommend breathing retraining interventions as an adjuvant treatment in uncontrolled asthma. Physiotherapy-based breathing pattern modification interventions incorporating relaxation have been shown to improve asthma-related QoL in primary care patients with impaired asthma control. Despite anecdotal reports, effectiveness of breathing retraining in patients referred to secondary care with incomplete asthma control has not been formally assessed in a randomised controlled trial (RCT). We aim to investigate the effect of breathing exercises on asthma-related QoL in patients with incomplete asthma control despite specialist care. METHODS AND ANALYSIS This two-armed assessor-blinded multicentre RCT will investigate the effect of physiotherapist-delivered breathing retraining on asthma QoL questionnaire (MiniAQLQ) in addition to usual specialist care, recruiting from seven outpatient departments and one specialised clinic representing all regions of Denmark during 2017-2019. We will include 190 consenting adults with incomplete asthma control, defined as Asthma Control Questionnaire 6-item score ≥0.8. Participants will randomly be allocated to either breathing exercise programme in addition to usual care (BrEX +UC) or UC alone. BrEX compiles three physiotherapy sessions and encouragement to perform home exercise daily. Both groups continue usual secondary care management. Primary outcome is between-group difference in MiniAQLQ at 6 months. Secondary outcomes include patient-reported outcome measures, spirometry and accelerometer. ETHICS AND DISSEMINATION Ethics Committee, Region Zealand (SJ-552) and Danish Data Protection Agency (REG-55-2016) approved the trial. Results will be reported in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT03127059; Pre-results.
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Affiliation(s)
- Karen Hjerrild Andreasson
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Naestved, Region Zealand, Denmark
- Department for Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Søren Thorgaard Skou
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Naestved, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Diseases, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Madsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Kirsten Sidenius
- Allergy & Lung Clinic, Elsinore, (private specialised clinic), Helsingør, Denmark
| | - Jannie Søndergaard Jacobsen
- Department of Physiotherapy and Occupational Therapy, and Pulmonary Disease Unit, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Midtjylland, Denmark
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Celeste Porsbjerg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg and Frederiksberg University Hospitals, Copenhagen, Denmark
| | - Mike Thomas
- Primary Care, Department for Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Uffe Bodtger
- Department for Regional Health Research, Naestved Hospital, University of Southern Denmark, Naestved, Denmark
- Department of Respiratory Medicine, Naestved-Slagelse-Ringsted Hospitals, Naestved, Denmark
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Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD. J Clin Med 2019; 8:jcm8091460. [PMID: 31540306 PMCID: PMC6780973 DOI: 10.3390/jcm8091460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 01/23/2023] Open
Abstract
Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.
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The presence of others reduces dyspnea and cortical neural processing of respiratory sensations. Biol Psychol 2019; 140:48-54. [DOI: 10.1016/j.biopsycho.2018.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022]
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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.
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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
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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
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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.
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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
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Geidl W, Semrau J, Streber R, Lehbert N, Wingart S, Tallner A, Wittmann M, Wagner R, Schultz K, Pfeifer K. Effects of a brief, pedometer-based behavioral intervention for individuals with COPD during inpatient pulmonary rehabilitation on 6-week and 6-month objectively measured physical activity: study protocol for a randomized controlled trial. Trials 2017; 18:396. [PMID: 28851462 PMCID: PMC5576331 DOI: 10.1186/s13063-017-2124-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary rehabilitation programs often fail to substantially enhance long-term physical activity in patients with chronic obstructive pulmonary disease (COPD). The reasons for successful physical activity changes in patients with COPD are not well understood. The need to better understand the determinants of physical activity in patients with COPD and effective rehabilitation strategies to improve physical activity is evident. Methods/design The STAR study (Stay Active after Rehabilitation) investigates, in a randomized controlled trial, the additional effect of a pedometer-based behavior-change intervention during inpatient pulmonary rehabilitation on objectively measured physical activity 6 weeks and 6 months post rehabilitation. The intervention uses the behavior-change techniques (1) instruction on how, where and when to perform the behavior, (2) prompt goal setting for physical activity, (3) prompt self-monitoring of behavior, and (4) feedback on behavior. The primary outcome of physical activity will be measured using a physical activity monitor (Actigraph wGT3X-BT) for a period of 7 days, firstly 2 weeks before rehabilitation begins (t0) as well as 6 weeks and 6 months after rehabilitation (t3, t4). Additionally, to predict physical activity progression after rehabilitation, a complex personal diagnostics battery, including questionnaires as well as functional assessments, is to be carried out at the start and end of rehabilitation (t1, t2). This battery is based on the foundational ideas of the Physical Activity-Related health Competence model. Five hundred and two patients with COPD, aged 18 years or older and admitted for an approved pulmonary rehabilitation, will be enrolled in the STAR study. Discussion The STAR study is designed as a randomized controlled trial to gain a better understanding of the personal determinants of physical activity in patients with COPD and to evaluate a pedometer-based physical activity-change intervention in the context of inpatient pulmonary rehabilitation. The results enable the future identification of patients with COPD who will find it difficult to engage in long-term physical activity after rehabilitation. Based on this, intervention strategies to promote physical activity in the content of pulmonary rehabilitation can be optimized. Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered retrospectively after the start of the recruitment in June 2016 on 22 November 2016. All protocol modifications will be registered in the trial registry. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2124-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wolfgang Geidl
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany.
| | - Jana Semrau
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - René Streber
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Nicola Lehbert
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Silke Wingart
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | | | - Michael Wittmann
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Rupert Wagner
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology and Orthopaedics, Salzburger Straße 8-11, 83435, Bad Reichenhall, Germany
| | - Klaus Pfeifer
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
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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]
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New weaning indices in chronic obstructive pulmonary disease population. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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