Anxiety and depression are common co-morbidities of chronic obstructive pulmonary disease (COPD) and are associated with lower quality of life and worse outcomes for patients, as well as lower activity levels and medication adherence.

Anxiety and depression’s association with COPD was not recognized until recently, still today the majority of patients with COPD are not screened for anxiety and depression.

A treatment option that is becoming more frequently recommended is cognitive behavioral therapy (CBT). CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.

It's most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

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How are COPD and Anxiety Linked?

Anxiety is a natural part of the body's alert system. It's a signal that something stressful is happening. Sometimes anxiety is caused by worrisome or fearful thoughts in your head. Other times anxiety happens as the result of an external event that you feel you have no control over, such as having a chronic condition or experiencing a traumatic event.

People with COPD often develop anxiety when their disease first develops, and they begin to experience increased shortness of breath. Not being able to breathe is usually an emergency and signals that something is wrong, so feeling anxious makes sense at this time.

However, once you find out you have COPD, your shortness of breath is not an emergency, it's your baseline. At this point, your anxiety can become a problem, limiting your functioning and getting in the way of things you want to do.

People with COPD and anxiety are also more likely to lower their activity levels which can increase shortness of breath over the long term.

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Does COPD cause Anxiety?

There have been many studies that suggest a link between COPD and anxiety, but just how it happens is still not known.

It may be that symptoms such as cough, shortness of breath and chest tightness start a cycle of anxiety. You begin to feel anxious as COPD symptoms arise. As your heart rate quickens, you may start to think you can't catch your breath, so your feelings of anxiety increase, which makes your chest tight and your breathing get worse.

Because some anxiety symptoms are similar to that of COPD, it can be difficult to tell if your symptoms are caused by your condition or by anxiety. There are other factors that contribute to anxiety, including:

• Genetics
• History of trauma
• Inherent traits like shyness during childhood

Although we still have a lot to learn, there are treatments available, even with a chronic condition such as COPD.

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What is CBT?

CBT is based on the concept that your thoughts, feelings, physical sensations, and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle, this has been known to happen frequently in COPD.

CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You're shown how to change these negative patterns to improve the way you feel.

Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.

Positives of CBT

CBT can help when medication can not and the benefits of CBT can be seen in a relatively small timeframe.

CBT teaches you methods to deal with stress and worry and these can be applied in different areas of your life. You can also re-use them after you have completed the therapy.

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CBT and Chronic Conditions

CBT has been used in many other chronic conditions and has shown to be effective, particularly in mental health conditions, such as:

• Bipolar disorder
• Borderline personality disorder

It has also shown promise in some long-term health conditions such as:

• Irritable Bowel Syndrome
• Chronic fatigue syndrome

Although CBT does not cure the physical symptoms of these conditions, it can help people cope better with their symptoms.

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CBT and COPD

There has been some positive evidence recently that CBT can help reduce anxiety and depression in COPD. The study also showed that lung function and anxiety levels were not linked, showing that patients with mild COPD can still suffer from high levels of anxiety.

In the study, CBT was delivered by respiratory nurses who were trained in CBT. The evidence demonstrates a 40% reduction in hospital visits by the patients who received the CBT and a 60% reduction in emergency departments attendances for the following year. Ultimately, the study showed that CBT can be delivered to reduce the anxiety level in patients with COPD. This improvement in feelings of anxiety was still observed a year after the initial therapy.

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What does a CBT Session Look Like

If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2 weeks. The course of treatment usually lasts between 5 and 20 sessions, with each session lasting 30 to 60 minutes.

During the sessions, you'll work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings, and actions. You and your therapist will analyze these areas to work out if they're unrealistic or unhelpful and to determine the effect they have on each other and on you.

Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours. After working out what you can change, your therapist will ask you to practice these changes in your daily life and you'll discuss how you got on during the next session.

The eventual aim of therapy is to teach you to apply the skills you have learned during treatment to your daily life. This should help you manage your problems and stop them from having a negative impact on your life, even after your course of treatment finishes.

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Problems Associated with CBT

Some of the disadvantages of CBT to consider include:

• you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation

• attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time

• it may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured sessions

• it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable

• it focuses on the person's capacity to change themselves (their thoughts, feelings, and behaviours) – this does not address any wider problems in systems or families that often have a significant impact on someone's health and wellbeing

Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.

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Conclusion

If you are someone who suffers from COPD and anxiety, CBT can give you the tools to help reduce the severity of the psychological impacts of your condition.  The key to CBT therapy is to believe that the treatment will work and approach it with an open mind.

There is a very low risk with completing CBT, so we recommend it to everyone.

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A Word from Filter

The psychological symptoms associated with COPD are often overlooked but are very serious and some people actually think they are worse than the physical symptoms associated with the disease.

If you have any feelings or thoughts of harming yourself or others, please dial 911 (or the local equivalent) or go to the nearest emergency room.

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