EFFECTS OF PSYCHOTHERAPY IN MODERATELY SEVERE COPD - A PILOT-STUDY

Anxiety is common in the ''pink puffer'' syndrome associated with chro nic obstructive pulmonary disease (COPD). The degree of anxiety correl ates well with perceived dyspnoea. This pilot study examines the effec t of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mea n forced expiratory volume in one second (FEV1)=1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly interva ls. Patients completed the Hospital Anxiety and Depression Scale (HADS ), Medical Research Council Questionnaire (MRCQ) and St George's Respi ratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, f orced vital capacity (FVC), slow vital capacity (SVC), blood gas tensi ons and 6 min walking distance (6MWD) were measured. Eight control pat ients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise ther e were no differences in lung function, blood gas tensions, 6MWD, or t he other questionnaire scores between groups. After treatment, the phy siological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psycho therapy group only, from 351 to 423 m (p<0.001), an increase of 24%. T hree months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behaviou ral psychotherapy produced a sustained improvement in exercise toleran ce in a group of 10 anxious patients with severe chronic obstructive p ulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, inte nsive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise toleranc e in ''pink puffers''.