Cognitive behavioural therapy (CBT) for adults and adolescents with asthma
Open accessAbstract
BACKGROUND: People with asthma have a higher prevalence of anxiety and depression than the general population. This is associated with poorer asthma control, medication adherence, and health outcomes. Cognitive behavioural therapy (CBT) may be a way to improve the quality of life of people with asthma by addressing associated psychological issues, which may lead to a lower risk of exacerbations and better asthma control. OBJECTIVES: To assess the efficacy of CBT for asthma compared with usual care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also searched reference lists of all primary studies and review articles and contacted authors for unpublished data. The most recent searches were conducted in August 2016. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs) comparing any cognitive behavioural intervention to usual care or no intervention. We included studies of adults or adolescents with asthma, with or without comorbid anxiety or depression. We included studies reported as full text, those published as abstract only, and unpublished data. DATA COLLECTION AND ANALYSIS: Two or more review authors independently screened the search results, extracted data, and assessed included studies for risk of bias. We analysed dichotomous data as odds ratios (ORs) and continuous data as mean differences (MDs) or standardised mean differences (SMD) where scales varied across studies, all using a random-effects model. The primary outcomes were asthma-related quality of life and exacerbations requiring at least a course of oral steroids. We rated all outcomes using GRADE and presented our confidence in the results in a 'Summary of findings' table. MAIN RESULTS: = 0%).Subgroup analyses conducted on the AQLQ outcome did not suggest a clear difference between individual and group CBT, baseline psychological status, or CBT model. The small number of studies and the variation between their designs, populations, and other intervention characteristics limited the conclusions that could be drawn about these possibly moderating factors.The inability to blind participants and investigators to group allocation introduced significant potential bias, and overall we had low confidence in the evidence. AUTHORS' CONCLUSIONS: For adults with persistent asthma, CBT may improve quality of life, asthma control, and anxiety levels compared with usual care. Risks of bias, imprecision of effects, and inconsistency between results reduced our confidence in the results to low, and evidence was lacking regarding the effect of CBT on asthma exacerbations, unscheduled contacts, depression, and medication adherence. There was much variation between studies in how CBT was delivered and what constituted usual care, meaning the most optimal method of CBT delivery, format, and target population requires further investigation. There is currently no evidence for the use of CBT in adolescents with asthma.
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Cognitive behavior therapy for anxiety related to asthma has been suggested as a promising treatment.
“Cognitive behavior therapy (CBT) for anxiety related to asthma has been suggested as a promising treatment (Kew, Nashed, Dulay & Yorke, 2016).”
From Exposure‐based cognitive behavior therapy for anxiety related to asthma: A feasibility study with multivariate baseline design. (2020) · cites this paper as Kew, Nashed, Dulay & Yorke, 2016
The ASI has previously been used to measure anxiety-sensitivity in CBT for asthma.
“The ASI has previously been used to measure anxiety-sensitivity in CBT for asthma (Kew et al., 2016).”
From Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online (2021) · cites this paper as Kew et al., 2016
The limited number of trials and methodological limitations (e.g., high variability in interventions and delivery, underpowered samples and large drop-out rates) impede conclusions on treatment efficacy.
“However, the limited number of trials and methodological limitations (e.g., high variability in interventions and delivery, underpowered samples and large drop-out rates) impedes conclusions on treatment efficacy (Kew et al., 2016;Pateraki & Morris, 2018).”
From Exposure‐based cognitive behavior therapy for anxiety related to asthma: A feasibility study with multivariate baseline design. (2020) · cites this paper as Kew et al., 2016
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- Authors
- Kew, K. M., Nashed, M., Dulay, V., & Yorke, J.
- Affiliations
- St George's, University of London (GB)
- Ain Shams University (EG)
- University of Southampton (GB)
- University of Manchester (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2016-09-21
- Volume
- 2016
- Issue
- 9
- Pages
- CD011818-CD011818
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6457695
- OpenAlex
- W2521435637
- Cited by
- 73
- References
- 89
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 9 · 2023: 8 · 2022: 7 · 2021: 12 · 2020: 9 · 2019: 11 · 2018: 4 · 2017: 1 · 2016: 1
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (13/89/14)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- cognitive behavioral therapy, asthma, anxiety, depression, asthma exacerbations, asthma control, quality of life, psychological comorbidity, medication adherence, adolescents, adults, usual care, psychological intervention, risk of bias
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