Cognitive behavioral therapy for management of dyspnea: A pilot study

Marie T. Williams, Paul Cafarella, Catherine Paquet, Peter Frith

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: In patients with COPD, psychological interventions usually target generalized anxiety and depression rather than the sensation of breathlessness. The objectives of this pilot study were to develop and implement a cognitive behavioral therapy (CBT) program specific to the perceptual experience of breathlessness, identify practical issues in the study protocol, and estimate beneficial effects of combining the CBT program with comprehensive pulmonary rehabilitation. METHODS: The CBT program for the sensation of breathlessness (Breathing: Recognize sensations, Explore thoughts and beliefs, Validate thoughts as useful or harmful, Evolve and change behavior [BREVE]) was developed as a sequential series of 8 modules enabling it to be embedded within an 8-week comprehensive pulmonary rehabilitation program. When appropriate, outcomes from the pilot group (comprehensive pulmonary rehabilitation program + BREVE) were compared with those from a retrospective control group (comprehensive pulmonary rehabilitation program only). Outcomes included feedback provided by pilot study subjects, sensation of breathlessness (volunteered and endorsed descriptors of breathlessness), 6-min walk distance (6MWD), and St George Respiratory Questionnaire (SGRQ) total score. Within-group analyses were undertaken for descriptors of breathlessness (the McNemar test), whereas between-group analyses (repeated- measures analysis of variance, effect-size comparison) were conducted for the 6MWD and SGRQ total score. RESULTS: Pilot (n = 11) and control (n = 58) groups were not significantly different at baseline. Feedback indicated that the program structure and content were positively received. No significant changes were evident for the sensation of breathlessness or the SGRQ score (< 4 points). The 6MWD improved significantly in both groups, with the pilot group demonstrating greater gains compared with the control group (mean change of 57 m and effect size of 0.73 vs mean change of 27 m and effect size of 0.23; between groups, P =.03, effect size of 0.69). CONCLUSION: The CBT program for the perceptual experience of breathlessness was feasible and well accepted by subjects, although the protocol raised a number of methodological limitations warranting modification. A larger randomized controlled trial is needed to determine the effectiveness and longerterm outcomes.

LanguageEnglish
Pages1303-1313
Number of pages11
JournalRespiratory Care
Volume60
Issue number9
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Breathlessness
  • Chronic obstructive pulmonary disease
  • Cognitive behavioural therapy
  • Exercise capacity
  • Psychological intervention

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Williams, Marie T. ; Cafarella, Paul ; Paquet, Catherine ; Frith, Peter. / Cognitive behavioral therapy for management of dyspnea : A pilot study. In: Respiratory Care. 2015 ; Vol. 60, No. 9. pp. 1303-1313.
@article{93a33692ad9d4262a7165c521fb615e8,
title = "Cognitive behavioral therapy for management of dyspnea: A pilot study",
abstract = "BACKGROUND: In patients with COPD, psychological interventions usually target generalized anxiety and depression rather than the sensation of breathlessness. The objectives of this pilot study were to develop and implement a cognitive behavioral therapy (CBT) program specific to the perceptual experience of breathlessness, identify practical issues in the study protocol, and estimate beneficial effects of combining the CBT program with comprehensive pulmonary rehabilitation. METHODS: The CBT program for the sensation of breathlessness (Breathing: Recognize sensations, Explore thoughts and beliefs, Validate thoughts as useful or harmful, Evolve and change behavior [BREVE]) was developed as a sequential series of 8 modules enabling it to be embedded within an 8-week comprehensive pulmonary rehabilitation program. When appropriate, outcomes from the pilot group (comprehensive pulmonary rehabilitation program + BREVE) were compared with those from a retrospective control group (comprehensive pulmonary rehabilitation program only). Outcomes included feedback provided by pilot study subjects, sensation of breathlessness (volunteered and endorsed descriptors of breathlessness), 6-min walk distance (6MWD), and St George Respiratory Questionnaire (SGRQ) total score. Within-group analyses were undertaken for descriptors of breathlessness (the McNemar test), whereas between-group analyses (repeated- measures analysis of variance, effect-size comparison) were conducted for the 6MWD and SGRQ total score. RESULTS: Pilot (n = 11) and control (n = 58) groups were not significantly different at baseline. Feedback indicated that the program structure and content were positively received. No significant changes were evident for the sensation of breathlessness or the SGRQ score (< 4 points). The 6MWD improved significantly in both groups, with the pilot group demonstrating greater gains compared with the control group (mean change of 57 m and effect size of 0.73 vs mean change of 27 m and effect size of 0.23; between groups, P =.03, effect size of 0.69). CONCLUSION: The CBT program for the perceptual experience of breathlessness was feasible and well accepted by subjects, although the protocol raised a number of methodological limitations warranting modification. A larger randomized controlled trial is needed to determine the effectiveness and longerterm outcomes.",
keywords = "Breathlessness, Chronic obstructive pulmonary disease, Cognitive behavioural therapy, Exercise capacity, Psychological intervention",
author = "Williams, {Marie T.} and Paul Cafarella and Catherine Paquet and Peter Frith",
year = "2015",
month = "1",
day = "1",
doi = "10.4187/respcare.03764",
language = "English",
volume = "60",
pages = "1303--1313",
journal = "Respiratory Care",
issn = "0020-1324",
number = "9",

}

Cognitive behavioral therapy for management of dyspnea : A pilot study. / Williams, Marie T.; Cafarella, Paul; Paquet, Catherine; Frith, Peter.

In: Respiratory Care, Vol. 60, No. 9, 01.01.2015, p. 1303-1313.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cognitive behavioral therapy for management of dyspnea

T2 - Respiratory Care

AU - Williams, Marie T.

AU - Cafarella, Paul

AU - Paquet, Catherine

AU - Frith, Peter

PY - 2015/1/1

Y1 - 2015/1/1

N2 - BACKGROUND: In patients with COPD, psychological interventions usually target generalized anxiety and depression rather than the sensation of breathlessness. The objectives of this pilot study were to develop and implement a cognitive behavioral therapy (CBT) program specific to the perceptual experience of breathlessness, identify practical issues in the study protocol, and estimate beneficial effects of combining the CBT program with comprehensive pulmonary rehabilitation. METHODS: The CBT program for the sensation of breathlessness (Breathing: Recognize sensations, Explore thoughts and beliefs, Validate thoughts as useful or harmful, Evolve and change behavior [BREVE]) was developed as a sequential series of 8 modules enabling it to be embedded within an 8-week comprehensive pulmonary rehabilitation program. When appropriate, outcomes from the pilot group (comprehensive pulmonary rehabilitation program + BREVE) were compared with those from a retrospective control group (comprehensive pulmonary rehabilitation program only). Outcomes included feedback provided by pilot study subjects, sensation of breathlessness (volunteered and endorsed descriptors of breathlessness), 6-min walk distance (6MWD), and St George Respiratory Questionnaire (SGRQ) total score. Within-group analyses were undertaken for descriptors of breathlessness (the McNemar test), whereas between-group analyses (repeated- measures analysis of variance, effect-size comparison) were conducted for the 6MWD and SGRQ total score. RESULTS: Pilot (n = 11) and control (n = 58) groups were not significantly different at baseline. Feedback indicated that the program structure and content were positively received. No significant changes were evident for the sensation of breathlessness or the SGRQ score (< 4 points). The 6MWD improved significantly in both groups, with the pilot group demonstrating greater gains compared with the control group (mean change of 57 m and effect size of 0.73 vs mean change of 27 m and effect size of 0.23; between groups, P =.03, effect size of 0.69). CONCLUSION: The CBT program for the perceptual experience of breathlessness was feasible and well accepted by subjects, although the protocol raised a number of methodological limitations warranting modification. A larger randomized controlled trial is needed to determine the effectiveness and longerterm outcomes.

AB - BACKGROUND: In patients with COPD, psychological interventions usually target generalized anxiety and depression rather than the sensation of breathlessness. The objectives of this pilot study were to develop and implement a cognitive behavioral therapy (CBT) program specific to the perceptual experience of breathlessness, identify practical issues in the study protocol, and estimate beneficial effects of combining the CBT program with comprehensive pulmonary rehabilitation. METHODS: The CBT program for the sensation of breathlessness (Breathing: Recognize sensations, Explore thoughts and beliefs, Validate thoughts as useful or harmful, Evolve and change behavior [BREVE]) was developed as a sequential series of 8 modules enabling it to be embedded within an 8-week comprehensive pulmonary rehabilitation program. When appropriate, outcomes from the pilot group (comprehensive pulmonary rehabilitation program + BREVE) were compared with those from a retrospective control group (comprehensive pulmonary rehabilitation program only). Outcomes included feedback provided by pilot study subjects, sensation of breathlessness (volunteered and endorsed descriptors of breathlessness), 6-min walk distance (6MWD), and St George Respiratory Questionnaire (SGRQ) total score. Within-group analyses were undertaken for descriptors of breathlessness (the McNemar test), whereas between-group analyses (repeated- measures analysis of variance, effect-size comparison) were conducted for the 6MWD and SGRQ total score. RESULTS: Pilot (n = 11) and control (n = 58) groups were not significantly different at baseline. Feedback indicated that the program structure and content were positively received. No significant changes were evident for the sensation of breathlessness or the SGRQ score (< 4 points). The 6MWD improved significantly in both groups, with the pilot group demonstrating greater gains compared with the control group (mean change of 57 m and effect size of 0.73 vs mean change of 27 m and effect size of 0.23; between groups, P =.03, effect size of 0.69). CONCLUSION: The CBT program for the perceptual experience of breathlessness was feasible and well accepted by subjects, although the protocol raised a number of methodological limitations warranting modification. A larger randomized controlled trial is needed to determine the effectiveness and longerterm outcomes.

KW - Breathlessness

KW - Chronic obstructive pulmonary disease

KW - Cognitive behavioural therapy

KW - Exercise capacity

KW - Psychological intervention

UR - http://www.scopus.com/inward/record.url?scp=84944750952&partnerID=8YFLogxK

U2 - 10.4187/respcare.03764

DO - 10.4187/respcare.03764

M3 - Article

VL - 60

SP - 1303

EP - 1313

JO - Respiratory Care

JF - Respiratory Care

SN - 0020-1324

IS - 9

ER -