D1.7 Clinical psychologist/psychiatrist

Anxiety and depression are common disorders in patients with COPD (Di Marco 2006, Gudmundsson 2006, Kunik 2005, Laurin 2007, Schane 2008), which worsen quality of life and add to disability (Gudmundsson 2005, Ng 2007, Xu 2008, Laurin 2009, Giardino 2010, Eisner 2010b) [evidence level III]. The prevalence of panic attacks and panic disorder in COPD are particularly high (Yellowlees 1987, Pollack 1996, Kunik 2005, Laurin 2007) [evidence level III]. There is promising evidence that anxiety and depression can be treated by clinical psychologists and psychiatrists using approaches such as cognitive behaviour therapy (Kunik 2001, de Godoy 2003Hynninen 2010, Yohannes 2017) [evidence level II]. Psychiatrists can also advise whether pharmacological treatment may be appropriate.

A systematic review of various psychological interventions in patients with COPD showed some improvements in psychological outcomes, especially with cognitive behavioural therapy (CBT). In contrast, for physical outcomes, only mind-body interventions (e.g. mindfulness-based therapy, yoga, and relaxation) revealed a statistically significant effect. These findings favour psychosocial intervention as a tool in the management of COPD (Farver-Vestergaard 2015).

A directed psychological intervention consisting of six sessions of group-based CBT delivered by a psychologist added to an eight week pulmonary rehabilitation program, showed significant improvements in the CBT group in the 6-minute walk test (6MWT), fatigue, depression and stress measures (Luk 2017).

Telephone-administered CBT can reduce depression symptoms in people with COPD. People with COPD who have mood disorders would prefer to have CBT than befriending (Doyle 2017).