Key learning points

  • Psychological ill health is very common in patients with chronic obstructive pulmonary disease (COPD)
  • There is evidence that cognitive behavioural therapy (CBT) is effective in a respiratory setting
  • Psychological wellbeing affects all aspects of our lives and addressing patients’ physical and psychological needs should be a priority for both patients and healthcare professionals
  • Clinicians can develop their skills to address physical and psychological difficulties using basic CBT techniques

International guidelines recognise that good-quality, holistic care of chronic obstructive pulmonary disease (COPD) should address all of the aspects of the condition and not merely focus on treatments aimed at improving airway obstruction.1 One area that is sadly neglected in guidelines is the psychological impact of the illness. Psychological ill health is very common, with more than 50% of patients with COPD reporting symptoms of anxiety and 40% symptoms of depression.2,3 Until recently the psychological impact of COPD was barely recognised, let alone addressed.4,5

Psychological wellbeing affects all aspects of our lives and addressing patients’ physical and psychological needs should be a priority for both patients and healthcare professionals. Cognitive behavioural therapy (CBT) is a psychological treatment, with the specific goal of improving psychological wellbeing and it can effectively treat anxiety and depression. There is evidence that CBT, delivered by respiratory nurses, is effective and has a number of benefits for patients and for the wider NHS.6 However, CBT remains underused in COPD.7

Increasing the use of CBT

So why has this effective intervention not been more widely adopted and implemented? Unfortunately, there seems to be a number of barriers to addressing psychological wellbeing of respiratory patients. Firstly, there is commonly a failure to recognise the wider scale of the problem but also to recognise symptoms in individual patients. Secondly, there has been a lack of acceptance that, as clinicians looking after patients with COPD, the issue of psychological ill health is part of our remit.8 Finally, even if we recognise there is a problem to be addressed, limited resources are available to address the complex needs of respiratory patients.

We must all therefore consider how we can incorporate CBT into routine care. Ideally, clinicians need to develop their knowledge and skills to identify symptoms of anxiety and/or treat psychological distress using basic CBT approaches. CBT is an evidence-based treatment that will help clinicians provide truly patient-centred holistic care, a goal that we all should aspire to.

Resources

The Atlas of Shared Learning – Case study – Respiratory Nurse delivered Cognitive Behavioural Therapy (CBT) for Chronic Pulmonary Disease (COPD) patients

Dr Karen Heslop-Marshall, nurse consultant, Newcastle upon Tyne NHS Foundation Trust

This project was initiated and funded by Teva Respiratory. Teva have had no influence over content. Topics and content have been selected and written by independent experts.

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