A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma

Abstract

Word Count: Abstract = 300; main paper = 4192Key words: psychological, cognitive behavioural therapy, anxiety, depression, quality of life, breathlessness 2 AbstractObjectives: Evidence for the efficacy of Cognitive Behavioural Therapy (CBT) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group. This study aimed to assess the feasibility and acceptability of Group-CBT in severe asthma.Method: This was a two-centre, randomised controlled parallel group feasibility study. Eligible participants (patients with severe asthma and a clinically significant diagnosis of anxiety and/or depression -Hospital Anxiety and Depression Scale (HAD) score greater than 8 for the anxiety or depression sub-scale) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only. Follow-up was for 16 weeks and end points were: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire, HAD, Dyspnoea-12, EuroQual-5D and EuroQuol-VAS.Results: 51 patients were randomised: 36% (51 out of 140) consent rate and 25% (13/51) attrition at week 16.Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly demands of the programme. Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health. Participants who contributed to focus group discussions reported that Group-CBT contributed to a better understanding of their illness and related approaches to anxiety management and acceptance of their asthma condition. Although weekly face-to-face sessions were challenging, this was the preferred method of delivery for these participants.Conclusions: This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma. It has been possible but not easy to recruit and retain the sample.Options for a less demanding intervention schedule, such as less frequent face-to-face visits and the use of webbased interventions, require careful consideration.3

Pulmonary Rehabilitation and Asthma

“…This approach includes the use of motivational interviewing with the support of social media and web-based applications. This method seems to improve clinical practice and allows patients to share their doubts and to practice the correct techniques for using inhalers and nebulizers (Kew et al, 2016;Yorke et al, 2017;Schuermans et al, 2018;Gesinde and Harry, 2018). Knowledge about the disease helps patients to understand, recognize, and treat the symptoms and therefore to achieve a better asthma control in daily life (Spruit et al, 2013;Boudreau et al, 2014;Levy et al, 2016;Donner et al, 2018).…”

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…Psycho-educational interventions such as cognitive behavioural therapy and relaxation techniques may improve asthma control and reduce exacerbations [143], although the evidence is based on small and heterogeneous studies. Access to a psychologist with experience in managing patients with chronic disorders may be helpful in the management of severe asthma [8].…”

Fatigue Management in Patients with Sarcoidosis Using Group CBT

“…The lowest incidence of depression is reported in studies conducted in the Netherlands: 18%, 18%, and 17%. (9,30) The relationship between depression, fatigue and anxiety is interesting. Kulberg (2014) states that patients who claim that they feel tired show depressive symptoms in 30% and increased anxiety in 40%.…”

“…In its conclusion, the study recommends group CBT as a promising option in patients with asthma. (30) Studies (1,3,12,16,22,24,29) suggest that group CBT should be considered an integral part of standard pharmacotherapy for the treatment of mental health symptoms in people with chronic diseases and disabilities, especially in depression and anxiety.…”