Cognitive Behavioral Therapy: the unsung hero behind improving COPD?

COPD is a chronic, progressive disease, affecting millions of people worldwide. As clinicians, we are quite familiar with how to treat many of the physical symptoms of COPD: breathing techniques, energy conservation, strength and endurance building- but, have you ever considered including working on your patient’s mental health?

Studies show that up to 60% of people with COPD have a concomitant mental health disorder: most commonly anxiety, depression, or both. Prevalence of panic disorder is up to 10 times higher in COPD compared to the general population. This makes sense, as the feeling pf breathlessness can leave one feeling panicked, and the impact of the COPD on your life and activities can cause depression.  However, there is a lot of recent research to suggest that teaching your patients cognitive behavioral therapy techniques (CBT), can have extremely positive impacts on your patient’s health status, and can be more effective than Pulmonary Rehabilitation alone.

The health effects of anxiety and depression on those with COPD are worrisome. Those with untreated mental health conditions will be less likely to: attend pulmonary rehabilitation sessions, decrease risky/detrimental behaviors such as smoking, and develop good coping strategies that will help them maximize the QOL with COPD. Untreated mental health conditions are also well known to impact physical health over the long term and may result in a disimprovement in health and function.

Apart from the ethical imperative to help people with COPD have the best QOL possible, there is also a massive societal impact. We want to help people return to the workforce and have productive lives. Increased hospitalizations and lengthier hospital stays are also costly to the patient and to society.

Breathlessness is a highly distressing, defining feature of both COPD and panic attacks. From a cognitive-behavioral perspective, panic stems from escalating fear and sympathetic nervous system activity and is heightened through the reactions of carers who may be equally frightened. Subsequently, an over reliance on medications, over monitoring of symptoms, mistaken avoidance of activities due to fearful beliefs, and a lack of motivation for self-management can develop. This of course is going to impact the persons engagement in pulmonary rehab and community support.

Adjusting to a chronic physical condition, rapid symptom relief, realistic goals and beliefs, and decreased fear and misunderstanding of the condition are all other reasons that those with COPD benefit from the inclusion of CBT in their rehabilitation. However, access to psychologists and other mental health professionals can be hard to come by and may not be covered under a patient’s insurance. Dr. Heslop-Marshall, a nurse consultant in the UK has done much research into training respiratory nurses in the techniques of CBT, with very impressive results.  Studies have shown that by providing patient with a simple manual that coaches them in some of the techniques of CBT, hospital and Emergency Room admissions were decreased significantly over the course of the following months. Patients also reported deceased anxiety and depression symptoms. These research findings have been echoed across several research projects, and could have a huge impact on the way that we manage the millions of people living with COPD in the most holistic and evidence-based manner.

As therapists and nurses, we are uniquely positioned to include CBT techniques into our plan of care. These simple and straightforward behavioral changes could have a huge impact on your patients outcomes!

Have you incorporated CBT techniques into your treatment or therapy sessions? We would love to hear more! Check out our video on teaching your patients diaphragmatic breathing here, and to get some great articles and free resources to enhance your clinical practice, join our mailing list below!