Cognitive Behavioral Therapy Improves COPD Patient Anxiety

Karen Heslop-Marshall, PhD

Training respiratory nurses to provide cognitive behavioral therapy (CBT) to patients with chronic obstructive pulmonary disease (COPD) may improve their outcomes—and save costs of care in the process, according to a recent study.

Early in her career as a respiratory nurse, lead study author Karen Heslop-Marshall, PhD—now a Nurse Consultant at Newcastle-upon-Tyne National Health Service (NHS) Foundation Trust and Newcastle University, UK—interviewed patients and discovered that many were experiencing untreated anxiety and depression. The experiences motivated her to pursue a PhD in CBT, and to develop her own model for using the technique with respiratory patients.

Despite the fact that breathlessness is one of the main symptoms of COPD and a driver of anxiety in its patients, most healthcare providers don’t consider screening or treating for it alongside COPD, Heslop-Marshall noted. She based her study on the idea that training nurses to screen for anxiety, then delivering one-on-one CBT sessions to patients, would reduce the symptoms of COPD. Secondary outcomes, including the cost-effectiveness of such a program for hospitals, were also considered.

Her team screened 1518 patients diagnosed with COPD at varying severities using the Hospital Anxiety and Depression Scale (HADS)-Anxiety subscale, which scores patients on a range from 0-21. Patients who score 8 or above are considered to be experiencing symptoms of anxiety or depression. If they score 15 or above, these symptoms are likely to be severe. According to the study, 59% (898 patients) had scores indicative of raised anxiety.

With the eventual 236 designated to participate in the study, investigators randomized patients to either receive an informational leaflet on techniques for managing anxiety (121 patients), or to receive CBT (115 patients). Patients in the CBT arm received an average of 4 CBT sessions from a trained respiratory nurse.

The patients in the CBT group started with an average score of 12.3 on the scale, while those in the leaflet group had an average score of 12.0. Both scores suggested moderate symptoms of anxiety. After 3 months, patients who underwent the CBT improved their HADS-Anxiety subscale scores by 3.4 points, whereas patients who only received leaflets only improved by 1.9 points, indicating a significant difference.

At 12 months, investigators assessed hospital records of each patient for readmissions to calculate the amount of money that the therapy cost or saved the hospital. While training nurses to deliver CBT requires an upfront investment, the team found savings of £1089 for hospital admissions, and £63 for emergency room attendances.

Heslop-Marshall indicated that fulfilling the needs of patients with COPD—both physically and psychological—are unmet. Study results show they’re feasible, however.

“Respiratory health care professionals can provide cost effective high quality care very easily,” Heslop-Marshall said in a statement.

Noting that up to millions of pulmonary disease-related patients could benefit from the care delivered in CBT, Heslop-Marshall suggested the next challenge is in understanding how to scale up the intervention.

The study, “Randomised controlled trial of cognitive behavioural therapy in COPD,” was published online in the European Respiratory Society Journal.