Self-help for
breathlessness and
anxiety
Dr Jane Hutton
Consultant Clinical Psychologist
SLaM and King’s College Hospital
Overview
• COPD, breathlessness and anxiety
• Aims and development of self-help
material
• Content and current applications
• Next steps
COPD
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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
Management
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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 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 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
dangerous
• 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 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 booklet
• 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
Development
• Input from service leads in respiratory
nursing and physiotherapy
• Pilotting with respiratory nurses and
physiotherapists, and patients in a
pulmonary rehabilitation class
Part 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 Awareness
• 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 Confidence
• 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 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 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)
References
http://www.kcl.ac.uk/iop/depts/pm/research/imparts/K
-quick-links/Breathlessness-and-anxiety.pdf
Arnold, 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 cognitivebehavioural 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.
Any questions?