Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online

Abstract

There is an established relationship between anxiety and asthma, which is associated with poor health outcomes. Most previous cognitive behavior therapies (CBT) have focused on comorbid panic disorder whereas anxiety related to asthma may rather be illness-specific. The feasibility of an online CBT targeting avoidance behavior in anxiety related to asthma was evaluated, using a pretest-posttest design. Thirty participants with self-reported anxiety related to asthma were offered an eight-week treatment with therapist support. Mean adherence was good (80% of content), and most participants (89%) reported adequate relief after treatment. Catastrophizing about asthma (CAS), assessed at 2 months after treatment, improved significantly with a large effect size (Cohen's d = 1.52). All secondary outcomes, including asthma control, avoidance behavior, fear of asthma symptoms and quality of life, improved significantly with moderate to large effect sizes ( d : 0.40–1.44). All improvements were stable at 4 months follow up. Weekly ratings showed that a decrease in avoidance behavior predicted a decrease in CAS the following week throughout the treatment period. We conclude that CBT targeting avoidance behavior is a feasible treatment for anxiety related to asthma. The results justify investigation of efficacy and mechanisms of change in a randomized controlled trial. ClinicalTrials.gov , ID: NCT03486756 .

A unified Internet-delivered exposure treatment for undifferentiated somatic symptom disorder: single-group prospective feasibility trial

“…Though this small feasibility trial does not allow us to make distinctions between participants based on their somatic diagnoses or syndromes, in larger samples, the transdiagnostic nature of this sort of intervention may serve as a strength precisely because it allows for the direct comparison of outcomes over different patient groups that report a high degree of distress related to their physical symptoms. Overall, results were similar to exposure-based therapies for more restricted populations with distress related to physical symptoms with regard to treatment credibility [ 26 , 29 , 34 , 40 ], working alliance [ 34 , 40 ], satisfaction [ 11 , 21 , 22 , 26 , 29 , 34 ] and adverse events [ 21 , 22 , 24 , 26 , 29 , 34 , 40 ]. Tentatively, within-group effects on somatic symptoms and symptom preoccupation were slightly smaller, possibly owing to the transdiagnostic approach, the relatively short duration of 8 weeks, or the fact that this study of exposure-based treatment was conducted during the covid-19 pandemic.…”

“…This exposure-based treatment was also unusual in that it incorporated no additional treatment components over and above the psychoeducation and self-monitoring necessary for exposure. It may be beneficial to add acceptance strategies [ 79 ], behavioural activation [ 80 ], mindfulness exercises [ 36 ], the naming of emotions [ 11 ] or emotional regulation techniques [ 26 ] to the treatment.…”

“…Therapies with an emphasis on this type of conventional exposure exercises have been found to be efficacious in several conditions where patients commonly report distress related to somatic symptoms. In anxiety in asthma, within-group effects have been large on asthma control ( d = 1.27), large on catastrophising, fear and avoidance ( d = 0.90–1.52), and small to moderate on quality of life ( d = 0.40) [ 11 ]. In atopic dermatitis, superiority has been seen on subjective somatic symptoms versus rudimentary education (between-group d = 0.75) and within-group effects have been large on subjective somatic symptoms ( d = 0.93–1.09) and moderate to large on quality of life ( d = 0.65–0.83) [ 21 ].…”

Paediatric asthma and non‐allergic comorbidities: A review of current risk and proposed mechanisms

“…In addition to informing healthcare practice and asthma management guidelines, further understanding of the mechanisms for comorbidity can lead to targeted intervention studies for comorbidities, for example, cognitive behaviour‐based therapy has been shown to improve anxiety‐induced asthma 144,145 …”

“…In addition to informing healthcare practice and asthma management guidelines, further understanding of the mechanisms for comorbidity can lead to targeted intervention studies for comorbidities, for example, cognitive behaviour-based therapy has been shown to improve anxiety-induced asthma. 144,145 In conclusion, further research is warranted to understand the comorbidity with a range of diseases as well as to better understand the underlying mechanisms in general. Clinical consequences of comorbidity in terms of management, severity/complications, medication, hospitalizations, healthcare cost and quality of life for individuals and families are of greatest importance.…”