Cognitive behaviour therapy reduces dyspnoea ratings in patients with chronic obstructive pulmonary disease (COPD).

There is evidence that psychological factors contribute to the perception of increased difficulty of breathing in patients with chronic obstructive pulmonary disease (COPD), and increase morbidity. We tested the hypothesis that cognitive behaviour therapy (CBT) decreases ratings of perceived dyspnoea in response to resistive loading in patients with COPD. From 31 patients with COPD, 18 were randomised to four sessions of specifically targeted CBT and 13 to routine care. Prior to randomisation, participants were tested with an inspiratory external resistive load protocol (loads between 5 and 45cmH2O/L/s). Six months later, we re-measured perceived dyspnoea in response to the same inspiratory resistive loads and compared results to measurements prior to randomisation. There was a significant 17% reduction in dyspnoea ratings across the loads for the CBT group, and no reduction for the routine care group. The decrease in ratings of dyspnoea suggests that CBT to alleviate breathing discomfort may have a role in the routine treatment of people with COPD.

Catastrophic interpretations and anxiety sensitivity as predictors of panic-spectrum psychopathology in chronic obstructive pulmonary disease.

OBJECTIVE: Panic-spectrum psychopathology (denoting panic attacks and panic disorder) is highly prevalent in chronic obstructive pulmonary disease (COPD), and the cognitive model of panic has been proposed as an explanation of this high prevalence. In the current cross-sectional study we investigated factors predicting panic-spectrum psychopathology in COPD, and hypothesized that, consistent with the cognitive model, both the catastrophic interpretation of shortness of breath and elevated anxiety sensitivity would be significant predictors when variance shared with confounding variables was controlled. METHODS: Sixty-two participants with COPD were interviewed with the Anxiety Disorders Interview Schedule for DSM-IV, Panic Disorder section, and completed measures of interpretation of breathing difficulty, anxiety sensitivity, anxiety, depression, disease-specific quality of life, and stressful life events. Objective disease severity was measured using forced expiratory volume in the first second. RESULTS: Direct logistic regression was performed, and worse depressive symptoms, more catastrophic interpretations of shortness of breath, higher anxiety sensitivity, higher magnitude of recent stressful life events, and worse disease severity were each found to be significant unique predictors of panic-spectrum psychopathology in COPD after shared variance was controlled. CONCLUSIONS: The results of the study provide support for the cognitive model of panic, and also suggest a diathesis-stress explanation of the development of panic-spectrum psychopathology in COPD. The findings have implications for future preventative psychological interventions.

Panic attacks and panic disorder in chronic obstructive pulmonary disease: a cognitive behavioral perspective.

The prevalence of panic disorder in patients with chronic obstructive pulmonary disease (COPD) is up to 10 times greater than the overall population prevalence of 1.5-3.5%, and panic attacks are commonly experienced. When present, clinically significant anxiety decreases quality of life for COPD patients, and also increases health care costs. Therefore, understanding why COPD patients have such high rates of panic attacks and panic disorder is important for optimal management of COPD. The cognitive model of panic anxiety is the most widely accepted theory of panic attacks and panic disorder in physically healthy adults. According to this model, panic attacks occur when catastrophic misinterpretations of ambiguous physical sensations (such as shortness of breath or increased heart rate) increase arousal, creating a positive feedback loop that results in panic. As the major symptom of a terminal illness that threatens our most basic physical requirement, dyspnea in COPD is open to catastrophic misinterpretation. There is some experimental and clinical evidence for the applicability of the cognitive model of panic anxiety in COPD, and of the utility of cognitive behavior therapy (CBT), based on this model, for treating anxiety symptoms and panic attacks in COPD patients. However, there is much need for further studies. Evidence is increasing that mental health professionals, in collaboration with multi-disciplinary pulmonary teams, potentially have key roles to play in preventing and treating panic attacks and panic disorder in COPD patients. This review addresses diagnosis, epidemiology, theoretical conceptualizations, treatment, and recommendations for future research.

Panic attacks and perception of inspiratory resistive loads in chronic obstructive pulmonary disease.

RATIONALE: Panic attacks are common in chronic obstructive pulmonary disease (COPD), and the prevalence of panic disorder is at least 10 times higher than in the general population. In the current study, we examined resistive load perception in patients with COPD with and without panic attacks. OBJECTIVES: We tested competing hypotheses, based on conflicting results of earlier studies, that those patients with COPD with panic attacks or panic disorder would show either heightened or blunted perception of dyspnea as the magnitude of inspiratory resistive loads increased. METHODS: We compared 20 patients with COPD with panic attacks or panic disorder, 20 patients without panic, and 20 healthy, age-matched subjects using an inspiratory resistive load-testing protocol. MEASUREMENTS AND MAIN RESULTS: We administered a diagnostic interview for panic attacks and panic disorder. We measured perceived dyspnea in response to increasing inspiratory resistive loads (modified Borg scale) and several respiratory variables. Dyspnea ratings increased linearly for all groups as the size of resistive loads increased. No significant differences were found between groups on the respiratory variables. Patients with COPD with panic attacks or panic disorder rated their level of dyspnea significantly higher than did other subjects. CONCLUSIONS: Patients with COPD with panic attacks showed heightened sensitivity to inspiratory loads. The result reinforces the influence of psychological factors on symptom perception in this disease.