Psychological aspects in the perception of dyspnea in obstructive pulmonary diseases

Abstract

Dyspnea is an impairing symptom in obstructive pulmonary diseases. Besides multiple physiological pathways contributing to this sensation recent research has demonstrated an important role of psychological factors in the perception of dyspnea. The present review article synthesizes the research literature with regard to psychological aspects of the perception of dyspnea as well as other dyspnea-related issues such as course of disease, neuropsychological correlates and interventions that focus on psychological or behavioural changes. The available data show that inaccurate perception of dyspnea is related to poorer treatment outcome in obstructive pulmonary diseases and is impacted upon by emotional, attentional and learning processes. Neuropsychological deficits might further contribute to this association. Different psychological and behavioural interventions might reduce comorbid psychological disorders and thus improve the perception of dyspnea. However, future research is clearly required to substantiate current findings.

Cognitive Behavioral Therapy for Management of Dyspnea: A Pilot Study

“…Both stages may be modulated by cognitive processes (memory, learning, and schemata) and personality (affectivity). 3 The findings of this pilot study appear to be consistent with this model if the feedback provided by BREVE program subjects (increased endurance, better breathlessness management, and reduced anxiety associated with exercise-related breathlessness) reflects a change in affective awareness facilitating an ability to increase their exercise capacity. A heavy emphasis on cognitive restructuring and repeated exposure to potentially aversive sensations (in this case, breathlessness) can be an effective way of reducing the fear associated with physical sensations, 23 may facilitate more effective exercise training, and potentially could lead to larger or longer-lasting changes in activity levels.…”

“…1 Interventions that target the central processes for perception or cognition associated with dyspnea have been recognized as potential therapeutic strategies. [2][3][4] To date, controlled trials of psychological interventions (including cognitive behavioral therapy [CBT]) in subjects with COPD have targeted generalized anxiety, panic, and depression rather than specifically focusing on the sensation of breathlessness. 2,5,6 In subjects with COPD, when psychological interventions for generalized anxiety and depression are used without exercise training or education, small effects (effect size of Ϫ0.27, 95% CI Ϫ0.42 to Ϫ0.14) that are not significantly different from controls are reported.…”

Patients With COPD With Higher Levels of Anxiety Are More Physically Active

“…These fi ndings are especially interesting, since published data suggest a positive relationship between anxiety and dyspnea, 26,38 which are presumed to bear negative consequences on PA in patients with COPD. 39 Increased dyspnea and low levels of anxiety were associated with decreased daily step counts (data not shown), but found no indication of an interaction.…”

Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD

“…In an attempt to better understand the psychological aspect of dyspnea, a number of studies have investigated the relationship between anxiety and levels of dyspnea [36][37][38][39][40] . Indeed, patient descriptors of breathlessness vary depending on the intensity of the dyspnea experience [39] .…”

“…Indeed, patient descriptors of breathlessness vary depending on the intensity of the dyspnea experience [39] . Often the presenting symptom of acute dyspnea is anxiety [40] . Nurses may focus on anxiety to the exclusion of dyspnea and associated physiological changes [41] rather than recognizing anxiety as an important and initial sign of invisible dyspnea for individuals with acute respiratory distress [42] .…”