Improving outcomes for COPD patients with mild-to-moderate anxiety and depression: A systematic review of cognitive behavioural therapy

Purpose. Anxiety and depression are highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and are associated with lower levels of self-efficacy, impaired health status, poorer treatment outcomes and reduced survival following emergency admission. Cognitive behavioural therapy (CBT) may be effective for treating anxiety and depression in COPD patients but evidence for this is uncertain. Methods. A systematic review of controlled trials that evaluated the effectiveness of CBT for treating mild-to-moderate anxiety or depression in adults with clinically stable COPD. Ovid electronic bibliographic databases were searched from inception to May 2006; all content held by the Cochrane Library Issue 3, 2006 was also searched. Results. One small randomized controlled trial (RCT) of moderate quality showed that CBT when given with exercise training and education, was associated with large and significant treatment effects for both anxiety (-1.39 (95% Cls -2.19, -0.59)) and depression (-0.86 (95% Cls -1.61, -0.11)). Additionally, a larger RCT of higher quality demonstrated that CBT when given with exercise and education, was associated with large and significant treatment effects for depression (-0.76 (95% Cls -1.34, -0.17)), but not for anxiety. No other included study reported significant reductions in either anxiety or depression in COPD patients given CBT. Conclusion. There is only limited evidence that CBT, when used with exercise and education, can contribute to significant reductions in anxiety and depression in COPD patients. There is scope for a well-powered RCT to evaluate the effectiveness and acceptability of CBT among this patient population.