Nonpharmacological management of psychological distress in people with COPD

Abstract

Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.

FIGURE 1

Psychological distress as an umbrella term for different levels of psychological suffering in COPD. This broader view of psychological distress reflects a more inclusive model of psychological suffering in COPD. It includes “normal”, passing psychological reactions to living with COPD (e.g. experiencing anxiety when there is an acute worsening of COPD; experiencing lowered mood when not being able to attend important family events; experiencing guilt when discussing smoking with the physician, etc.). Moreover, it includes more persistent, but still subclinical psychological symptoms, where anxiety, depression, self-blame, etc. do not meet the criteria for a mental disorder as well as pathological forms such as anxiety and depressive disorders. All of these levels of psychological distress can impact mental well-being, behaviour and quality of life negatively and result in nonoptimal self-management and course of COPD. The model does not attempt to make all psychological reactions pathological, but serves to make the clinician aware of the spectrum of reactions that should be assessed with the purpose of targeting management accordingly. If “normal” psychological reactions are noticed and met with appropriate support from healthcare professionals and psycho-educated family caregivers at an early stage, the spiralling effects of psychological suffering and maladaptive behaviour over time may be prevented. Thereby, psychological distress in the form of “normal” psychological reactions to COPD will be less likely to develop into anxiety and/or depressive disorders.

FIGURE 2

Future directions.