Cognitive Behavioral Therapy Reduces COPD-related Anxiety and Hospital Visits, Study Shows

Cognitive behavioral therapy (CBT) intervention can alleviate anxiety in people with chronic obstructive pulmonary disease (COPD), and reduce long-term hospital costs, a study shows.

The results were published in the journal ERJ Open Research, in an article titled “Randomised controlled trial of cognitive behavioural therapy in COPD.”

Anxiety and depression are known comorbidities among people with COPD, and can have a negative effect on their physical condition and quality of life.

Guidelines for the treatment of anxiety and depression recommend pharmacological treatment and/or psychological treatment, including CBT.

“CBT is a ‘talking’ treatment, which explores the link between a patient’s situation, physical symptoms, thoughts, emotions, and behavior,” the research team said. However, the effectiveness of CBT in the context of COPD is unclear.

The study looked at whether one-on-one CBT sessions by trained respiratory nurses could ease COPD-related anxiety, and reduce hospital costs by lowering the number of hospital admissions.

The 279 COPD patients with anxiety in the study were randomized to receive either a self-help leaflet addressing anxiety management (control group), or a self-help leaflet together with brief CBT interventions (on average four sessions). CBT sessions offered participants coping strategies for COPD symptom-related anxiety, breathing control, and physical improvement.

All participants had mild to severe COPD symptoms, and received standard medical care apart from the study intervention.

Researchers assessed anxiety and depression at baseline and at three, six, and 12 months follow-up using the Hospital Anxiety and Depression Scale (HADS) questionnaire. HADS measures a person’s perceived feelings of anxiety and depression. A score of 8-10 score indicates mild symptoms, 11-14 moderate symptoms, and 15 or higher severe symptoms.

Results showed that 59% of the participants scored an 8 or higher in HADS at baseline, indicating that anxiety is a common feature in COPD patients. Of these, 236 patients (121 controls and 115 receiving CBT) completed the questionnaire at baseline and follow-up timepoints.

COPD patients receiving CBT showed a significant reduction in mean HADS score after three months compared with the controls — the HADS score improved by 1.9 on average in control patients, and by 3.4 in CBT-treated patients.

CBT treatment of COPD patients also showed to be cost-effective at 12 months compared with the self-help leaflet intervention. On average, patients attending CBT sessions saved £1,089 (about $1,407) on hospital admission costs, and £63 (about $81.40) on emergency room costs.

“We found that one-to-one CBT sessions delivered by respiratory nurses could reduce symptoms of anxiety and that this could be a cost-effective intervention,” Karen Heslop-Marshall, lead author of the study, said in a news release.

“Although the CBT intervention initially resulted in added costs, as respiratory nurses required training in CBT skills, this was balanced by the savings made thanks to less frequent need of hospital and [accident and emergency] services,” Heslop-Marshall said.

Overall, the researchers observed no association between anxiety levels and lung function, measured by forced expiratory volume in one second (FEV₁). Consequently, the team suggested that CBT treatment may benefit COPD patients irrespective of disease severity.

“Reducing the levels of anxiety patients experience has a significant impact on their quality of life as well as their ability to keep physically active and may improve survival in the long term,” Heslop-Marshall said. “Our research shows that front-line respiratory staff can deliver this intervention efficiently and effectively.”

Thierry Troosters, PhD, President-Elect of the European Respiratory Society, did not participate in the study, but said of the findings: “This research highlights how using a multidisciplinary approach in the treatment of COPD can reduce the burden on patients and healthcare services.

“Treating patients for coexisting conditions such as anxiety contributes greatly to improving their overall health, and these methods can be cost-effective. Care provided by dedicated and properly trained healthcare professionals also allows for early referral of patients with more serious mental health conditions to even more specialized care tracks.”