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COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial

Published online by Cambridge University Press:  09 October 2007

M. E. Kunik ,
C. Veazey ,
J. A. Cully ,
J. Souchek ,
D. P. Graham ,
D. Hopko ,
R. Carter ,
A. Sharafkhaneh ,
E. J. Goepfert  and
N. Wray
...Show all authors
M. E. Kunik*
Affiliation:
Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA Department of Medicine, Baylor College of Medicine, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, USA
C. Veazey
Affiliation:
Northwestern State University of Louisiana, Natchitoches, LA, USA
J. A. Cully
Affiliation:
Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, USA
J. Souchek
Affiliation:
Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Department of Medicine, Baylor College of Medicine, Houston, TX, USA
D. P. Graham
Affiliation:
Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, USA
D. Hopko
Affiliation:
The University of Tennessee, Department of Psychology, Knoxville, TN, USA
R. Carter
Affiliation:
Texas Tech University, Health, Exercise and Sport Sciences, Lubbock, TX, USA
A. Sharafkhaneh
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Department of Medicine, Baylor College of Medicine, Houston, TX, USA
E. J. Goepfert
Affiliation:
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
N. Wray
Affiliation:
Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Department of Medicine, Baylor College of Medicine, Houston, TX, USA
M. A. Stanley
Affiliation:
Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, USA
*
*Address for correspondence: M. E. Kunik, M.D., M.P.H., Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakeyVAMC (152), 2002 Holcombe, Houston, TX 77030, USA. (Email: mkunik@bcm.tmc.edu)
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Abstract

Background

Chronic obstructive pulmonary disease (COPD) affects 14 to 20 million Americans and is associated with increased prevalence of affective disorders, contributing significantly to disability. This study compared cognitive behavioral therapy (CBT) group treatment for anxiety and depression with COPD education for COPD patients with moderate-to-severe anxiety and/or depressive symptoms.

Method

A randomized controlled trial (RCT) was conducted between 11 July 2002 and 30 April 2005 at the Michael E. DeBakey VA Medical Center, Houston, TX. Participants were 238 patients treated for COPD the year before, with forced expiratory value in 1 second (FEV)1/forced vital capacity (FVC)<70% and FEV1<70% predicted, and symptoms of moderate anxiety and/or moderate depression, who were being treated by a primary care provider or pulmonologist. Participants attended eight sessions of CBT or COPD education. Assessments were at baseline, at 4 and 8 weeks, and 4, 8 and 12 months. Primary outcomes were disease-specific and generic quality of life (QoL) [Chronic Respiratory Questionnaire (CRQ) and Medical Outcomes Survey Short Form-36 (SF-36) respectively]. Secondary outcomes were anxiety [Beck Anxiety Inventory (BAI)], depressive symptoms [Beck Depression Inventory-II (BDI-II)], 6-minute walk distance (6MWD) and use of health services.

Results

Both treatments significantly improved QoL, anxiety and depression (p<0.005) over 8 weeks; the rate of change did not differ between groups. Improvements were maintained with no significant change during follow-up. Ratios of post- to pretreatment use of health services were equal to 1 for both groups.

Conclusions

CBT group treatment and COPD education can achieve sustainable improvements in QoL for COPD patients experiencing moderate-to-severe symptoms of depression or anxiety.

Keywords

Anxietychronic obstructive pulmonary diseasecognitive behavioral therapydepression
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 3 , March 2008 , pp. 385 - 396
Copyright
Copyright © Cambridge University Press 2007

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