Cognitive behavioral therapy (CBT) delivered by respiratory nurses is associated with reduced anxiety symptoms and is cost-effective for patients with chronic obstructive pulmonary disease (COPD), according to a study recently published in ERJ Open Research.

Guidelines for the treatment of anxiety and depression recommend psychological treatment (cognitive behavioral therapy (CBT), counseling and self-help approaches) and pharmacological treatment, or a combination of both. CBT is a “talking” treatment, which explores the link between a patient's situation, physical symptoms, thoughts, emotions, and behavior.

Traditionally, treatment for anxiety and depression is provided by mental health professionals, but this may not encompass the needs of COPD patients where complex physical health problems and mental health issues are interrelated.

There are also barriers to accessing mental health support including perceived stigma and unwillingness to engage with mental health services, lack of prioritisation compared with physical healthcare, increasing demand, and limited resources

Chronic obstructive pulmonary disease (COPD) is one of the most important chronic diseases affecting over 210 million people worldwide. Anxiety and depression are major comorbidities in COPD associated with high morbidity, disability, healthcare expenditure, and mortality.

The underdiagnosis and undertreatment of anxiety and depression in COPD are common and can adversely affect patient outcomes. Anxiety and depression have a significant impact on physical functioning, breathlessness, quality of life, exacerbation rates, use of healthcare resources, length of hospital stay, readmission rates and mortality.

Chronic respiratory conditions

Patients with psychological difficulties are less able to manage symptoms and are less likely to be physically active or attend pulmonary rehabilitation, an evidence-based intervention, which is a key strategy for people with chronic respiratory conditions.

Karen Heslop-Marshall, Ph.D., from Newcastle upon Tyne Hospitals NHS Foundation Trust in the United Kingdom, and colleagues randomly assigned 279 patients with COPD and anxiety to CBT or self-help leaflets. The authors measured anxiety, depression, and quality of life at baseline and at three, six, and 12 months.

The researchers found that the group mean change from baseline to three months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% confidence interval [CI], 2.62 to 4.17) in the CBT group and 1.88 (95% CI, 1.19 to 2.55) in the leaflet group (mean difference of 1.52; 95% CI, 0.49 to 2.54). At 12 months, the CBT intervention was more cost-effective than leaflets and reduced hospital admissions and attendance at emergency departments.

"This study shows that a brief CBT intervention, uniquely delivered by respiratory nurses, was clinically effective at reducing anxiety symptoms and was cost-effective," the authors write. "CBT should be incorporated into routine clinical care pathways." Several authors disclosed financial ties to the pharmaceutical industry.