A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD
Open accessAbstract
Background Previous research indicates a high prevalence of untreated anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). The current study examined the effect of cognitive behavioral therapy (CBT) in groups for co-morbid, clinically significant anxiety and depression in COPD outpatients of both sexes.Methods In a randomized, controlled trial, CBT (n = 25) was compared with enhanced standard care (n = 26). Participants in both conditions were followed up at 2 and 8 months from baseline. Main outcome measures comprised the Beck Anxiety Inventory and the Beck Depression Inventory-II. Measures of health status and sleep were included as secondary outcomes. The effects of sex and age were also investigated.Results CBT resulted in improvement in symptoms of anxiety and depression, with effect sizes of 1.1 and 0.9 at post-treatment, respectively. The improvement was maintained at the 8-month follow-up, with effect sizes of 1.4 and 0.9. In the control group, there was no significant change. Compared to men, women had higher symptom levels throughout the whole study period. Younger patients had more anxiety and depression, age had also differential effects in the two groups on change in depressive symptoms. Changes in sleep and health status were small in both groups.Conclusions The findings indicate that CBT may provide rapid symptom relief for COPD patients with clinically significant anxiety and depression, and underline the need for integrating mental health care into the overall medical regimen for COPD.
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Psychological therapies compared with co-intervention do not significantly improve quality of life emotional composite in people with COPD (SMD -0.30, 95% CI -1.03 to 0.44, P = 0.43).
“Subtotal *** 143 146 100% -0.3[-1.03,0.44]Heterogeneity: Tau =0.24; Chi =5.68, df=1(P=0.02);I =82.39%Test for overall effect: Z=0.79(P=0.43)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, allocation concealment was at low risk of selection bias because numbered containers identical in appearance were used.
“Allocation concealment (selection bias) Low risk Allocation concealment was implemented using numbered containers that were identical in appearance for the two groups”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In the short term (0 to 3 months), psychological therapies compared with co-intervention do not significantly improve quality of life physical composite in people with COPD (SMD -0.30, 95% CI -0.73 to 0.13, P = 0.17).
“Subtotal *** 143 146 100% -0.3[-0.73,0.13]Heterogeneity: Tau =0.06; Chi =2.14, df=1(P=0.14);I =53.22%Test for overall effect: Z=1.37(P=0.17)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, random sequence generation was at unclear risk of selection bias because randomisation was reported but methods were not described.
“Random sequence generation (selection bias) Unclear risk Randomisation reported however methods not described”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In the short term (0 to 3 months), psychological therapies compared with co-intervention reduce anxiety in people with COPD (MD -3.86, 95% CI -6.63 to -1.10, P = 0.01).
“Subtotal *** 157 162 100% -3.86[-6.63,-1.1]Heterogeneity: Tau =1.16; Chi =2.47, df=2(P=0.29);I =19.09%Test for overall effect: Z=2.74(P=0.01)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
Psychological therapies compared with co-intervention do not significantly improve quality of life physical composite in people with COPD (SMD -0.40, 95% CI -0.88 to 0.08, P = 0.1).
“Subtotal *** 143 146 100% -0.4[-0.88,0.08]Heterogeneity: Tau =0.08; Chi =2.56, df=1(P=0.11);I =60.97%Test for overall effect: Z=1.63(P=0.1)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In the short term (0 to 3 months), psychological therapies compared with co-intervention do not significantly improve quality of life emotional composite in people with COPD (SMD -0.17, 95% CI -0.93 to 0.60, P = 0.67).
“Subtotal *** 143 146 100% -0.17[-0.93,0.6]Heterogeneity: Tau =0.26; Chi =6.25, df=1(P=0.01);I =84% Test for overall effect: Z=0.42(P=0.67)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
Psychological therapies compared with co-intervention reduce anxiety in people with COPD (mean difference -4.41, 95% CI -8.28 to -0.53, P = 0.03).
“Total *** 157 162 100% -4.41[-8.28,-0.53]Heterogeneity: Tau =7.21; Chi =5.2, df=2(P=0.07);I =61.51%Test for overall effect: Z=2.23(P=0.03)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In the long term (6 to 12 months), psychological therapies compared with co-intervention do not significantly reduce anxiety in people with COPD (MD -4.30, 95% CI -10.57 to 1.97, P = 0.18).
“Subtotal *** 143 146 100% -4.3[-10.57,1.97]Heterogeneity: Tau =16.37;Chi =4.92, df=1(P=0.03);I =79.66%Test for overall effect: Z=1.34(P=0.18)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, blinding of outcome assessment was at unclear risk of detection bias because there was no mention of blinding for outcome assessors.
“Blinding of outcome assessment (detection bias) All outcomes Unclear risk No mention of blinding for outcome assessors”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, blinding of participants and personnel was at high risk of performance bias because neither participants nor therapists were blinded.
“Blinding of participants and personnel (performance bias) All outcomes High risk Neither participants nor therapists were blinded to the intervention”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, there was low risk of other bias because no other biases were identified.
“Other bias Low risk No other biases identified”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, selective reporting was at low risk of reporting bias because a prespecified protocol was available and no selective reporting was identified.
“Selective reporting (reporting bias) Low risk Prespecified protocol available and no selective reporting identified”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, incomplete outcome data was at low risk of attrition bias because reasons for attrition were reported and intention-to-treat analysis was used.
“Incomplete outcome data (attrition bias) All outcomes Low risk Reasons for attrition reported in participant flow chart.Missing outcome data at one measurement point did not preclude analysis as mixed models with random effect was used for analysis; Intention-to-treat analysis occurred”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
In Hynninen 2010, the target sample size from the power analysis (33 per arm) was not reached (25 in the intervention arm and 26 in the control arm).
“the target sample size identified as being necessary in the power analysis (33 in each arm) was not reached by the end of the study period (25 in the intervention arm and 26 in the control arm)”
From Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease (2017) · cites this paper as Hynninen 2010
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- Authors
- Hynninen, M. J., Bjerke, N., Pallesen, S., Bakke, P. S., & Nordhus, I. H.
- Affiliations
- University of Bergen (NO)
- Haukeland University Hospital (NO)
- Corresponding author
- Hynninen, Minna J.
- Venue
- Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 104
- Issue
- 7
- Pages
- 986-994
- ISSN
- 0954-6111 (ISSN-L)
- OpenAlex
- W2141347382
- Cited by
- 152
- References
- 44
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 6 · 2023: 13 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 16 · 2016: 11 · 2015: 10 · 2014: 21 · 2013: 6 · 2012: 12
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, chronic obstructive pulmonary disease, anxiety, depression, comorbidities, group therapy, sex differences, age differences, sleep, health status, mental health integration
- MeSH terms
- Adult, Aged, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Norway, Quality of Life, Surveys and Questionnaires, Cognitive Behavioral Therapy, Treatment Outcome, Pulmonary Disease, Chronic Obstructive
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