Self-help for breathlessness and
anxiety
Dr Jane HuttonConsultant Clinical Psychologist
SLaM and King’s College Hospital
OverviewOverview• COPD, breathlessness and
anxiety• Aims and development of self-
help material• Content and current applications • Next steps
COPDCOPD• Broad term• Narrowing of airways• Breathlessness, cough, phlegm• ~.9m diagnosed, ~2.8m not• Smoking most common cause• Progressive, irreversible, shortens life • …but much can be done to manage
ManagementManagement• Stop smoking• Keep fit and active• Pulmonary rehabilitation• Energy conservation• Breathing and posture training• Diet, hydration, weight management• Avoid irritants and infections
Anxiety and its impactAnxiety and its impact• Under-diagnosed and under-treated• GAD and panic disorder much more
common than in general population • Anxiety symptoms even more common• 37% had panic attack in last 3 weeks• Anxiety associated with poorer
functioning and hospitalisation• Best predictor of quality of life• Anxiety triggered by symptoms predicts
catastrophic cognitions and avoidance
Anxiety and its impactAnxiety and its impact• Misinterpretations of danger, heightened
attention • Experience of panic attacks associated with
better knowledge but lower adherence for severe exacerbation
• Predicts engagement in rehabilitation• Treatment of anxiety leads to improved QoL
and probably improved functioning• Brenes, 2003; Prigatono et al, 1983; Gurney-Smith
et al, 2002; Dowson et al, 2004; Hynninen et al, 2005
Breathlessness is not Breathlessness is not dangerousdangerous
• Common, understandable misconception• Avoidance of exertion leading to
maintenance of fears, reduced fitness and low mood
• Can be challenged by behavioural experiments and pulmonary rehabilitation
• Not desirable to avoid breathlessness altogether
• Keeping active and confident will entail some degree of breathlessness
Role of CBTRole of CBT• CBT-based interventions can be very
beneficial, even in severe COPD• Significantly improved depression and
health status and depression and reduced A&E attendance (Howard et al, 2010)
• Some other studies show significant benefits in anxiety (e.g. Livermore et al (2010)
Aims of self-help Aims of self-help bookletbooklet
• To help clients understand their breathlessness
• To manage it better and be less distressed and restricted by it
• To reduce the degree to which breathlessness is exacerbated by anxiety
• Can stand alone or be guided by health professional
DevelopmentDevelopment• Input from service leads in
respiratory nursing and physiotherapy
• Pilotting with respiratory nurses and physiotherapists, and patients in a pulmonary rehabilitation class
Part 1: UnderstandingPart 1: Understanding• Acknowledge fear is understandable• Give hope and information resources • Explore integrated mind/body model
with client’s own examples• Symptom check-list• Check understanding of anxiety, how
it can make breathlessness worse, and how it changes over time
• Identify key triggers for breathlessness and use problem-solving to address one
Part 2: Thoughts and Part 2: Thoughts and AwarenessAwareness
• Explore frightening and inaccurate thoughts
• Discuss how thoughts can lead to distress and avoidance
• Discuss thought suppression, distraction and worry time
• Introduce strategies for grounding and reducing heightened awareness
• Breathing for relaxation• Monitoring anxiety
Part 3: Self-care and Part 3: Self-care and ConfidenceConfidence
• Explore ways of reducing stress levels and increasing activity• Explore ways of explaining condition and enlisting appropriate help from family and friends• Build confidence and strategies for appointments with health professionals
Current applicationsCurrent applications• Low Intensity intervention• Integrated within Lambeth/Southwark
pulmonary rehabilitation programme• General feedback: patients
responding very well to it and able to take what they need, contents understandable and valuable
• Southwark (Talk Health) and other IAPT services
Next stepsNext steps• Freely available on IMPARTS website• Feedback welcome• Evaluation by trainee health
psychologist of acceptability, impact on anxiety, cognitions and self-efficacy
• Self-efficacy mediates association between lung function and QoL and predicts physical functioning (Kohler et al, 2002; Arnold et al, 2005)
ReferencesReferenceshttp://www.kcl.ac.uk/iop/depts/pm/research/imparts/K-quick-links/Breathlessness-and-anxiety.pdfArnold, R., Ranchor, A.V., DeJongste, M.J.L., Koeter, G.H., Hacken, N.H.T.T., Aalbers, R. & Sanderman, R. (2005). The relationship between self-efficacy and self-reported physical functioning in chronic obstructive pulmonary disease and chronic heart failure. Behavioral Medicine, 31, 107-114. Brenes, G.A. (2003). Anxiety and Chronic Obstructive Pulmonary Disease: Prevalence, Impact, and Treatment. Psychosomatic Medicine, 65, 963-970. Byer, B. & Myers, L.B. (2000). Psychological correlates of adherence to medication in asthma. Psychology, Health & Medicine, 5, 389-393. Dowson, C.A., Town, G.I.., Frampton, C. & Mulder, R.T. (2004). Psychopathology and illness beliefs influence COPD self-management. Journal of Psychosomatic Research, 56, 333-340.Gurney-Smith, B., Cooper, M.J. & Wallace, L.M. (2002), Anxiety and panic in chronic obstructive pulmonary disease: The role of catastrophic thoughts. Cognitive Therapy and Research, 26, 143-155.Howard, C., Dupont, S., Haselden, B., Lynch, J. & Wills, P. (2010). The effectiveness of a group cognitive-behavioural intervention on health status, mood and hospital admissions in elderly patients with chronic obstructive pulmonary disease. Psychology, Health & Medicine, 15, 371-385.Hynninen, K.M.J., Breitve, M.H., Wiborg, A.B., Pallesen, S. & Nordhus, I.H. (2005). Psychological characteristics of patients with chronic obstructive pulmonary disease: A review. Journal of Psychosomatic Research, 59, 429-443. Kohler, C.L. Fish, L. & Greene, P.G. (2002). The relationship of perceived self-efficacy to quality of life in chronic obstructive pulmonary disease. Health Psychology, 21, 610-614. Livermore, N., Sharpe, L. & McKenzie, D. (2010). Prevention of panic attacks and panic disorder in COPD. European Respiratory Journal, 35, 557-63.Porzelius, J. Vest, M. & Nochomovitz, M. (1992). Respiratory function, cognitions, and panic in chronic obstructive pulmonary patients, Behavioural Research Therapy 30, 75–77.Prigatano, G.P., Wright, E.C. & Levin, D. (1984). Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease, Archives Internal Medicine, 144, 1613–1619.
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