Cognitive behavioral therapy (CBT) interventions were statistically and clinically superior to self-help leaflets in the treatment of anxiety in patients with chronic obstructive pulmonary disease (COPD), according to study results published in European Respiratory Journal Open Research. The higher initial costs associated with CBT were offset by savings resulting from fewer hospital admissions and emergency department visits in the subsequent 12 months. 

Researchers designed a sufficiently powered, pragmatic, randomized controlled trial to test the effectiveness of one-on-one CBT sessions in patients with COPD and a Hospital Anxiety and Depression Scale (HADS)-Anxiety Subscale score of ≥8. Patients were randomly assigned to an active control of self-help leaflets addressing anxiety management (n=140) or to a brief CBT intervention delivered by respiratory nurses, plus self-help leaflets (n=139). HADS scores were taken at baseline, 3 months, 6 months, and 12 months. Four CBT-trained respiratory nurses administered an average of 4 half-hour sessions to the latter group either in the treatment facility or at home, within the recommendations for brief intervention.

Significant differences were reported between the leaflet and CBT groups in mean improvement from baseline in HADS-anxiety subscale scores at 3 months (1.52; 95% CI, 0.49-2.54; =.003), 6 months (1.05; 95% CI, –0.04 to –2.14; =.05), and 12 months (1.43; 95% CI, 0.28-2.66; =.016). The CBT group had mean HADS-Depression Subscale scores that were significantly better than the leaflet group at 3 and 6 months but without reaching the minimal clinically important differences.

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The investigators acknowledged limitations in data collection resources, inability to blind participants or researchers in the delivery of the intervention, and in the interpretation of the HADS questionnaire in determining the effectiveness of the intervention. Further studies are warranted for identifying how to incorporate CBT into routine clinical care for patients with COPD who have comorbid symptoms of anxiety and depression.

“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 researchers concluded. 

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Disclosures: Several authors acknowledge competing interests; please see the reference for a complete list of disclosures.


Heslop-Marshall K, Baker C, Carrick-Sen D, et al. Randomised controlled trial of cognitive behavioural therapy in COPD [published online November 22, 2018]. ERJ Open Res. doi:10.1183/23120541.00094-2018