Figures
- 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.
Tables
- TABLE 1
Nonpharmacological management options and their effects on symptoms of depression and anxiety in people with COPD
Treatment options Anxiety Depression Category of treatment Specific kind of treatment Effect References of reviews/systematic reviews/meta-analysis Effect References of reviews/systematic reviews/meta-analysis Psychotherapy Cognitive behavioural therapy + [102] + [102] Mindfulness-based intervention − [103] − [103] Self-management interventions ++ [104] ++ [104] Relaxation therapy Relaxation therapy + [105] + [105] Progressive muscle relaxation + [106] + [106] Mind–body exercise Qigong + [107, 108] + [107, 108] Tai chi − [109] − [109] Yoga − [110, 111] − [110, 111] Music therapy Music therapy + [112] − [112] Singing − [113, 114] − [113, 114] Integrated disease management − [115, 116] − [115, 116] Collaborative care model − [117] − [117] Pulmonary rehabilitation ++ [118] +++ [118] Telemonitoring − [119, 120] − [119, 120] +++: Strong evidence for beneficial effect; ++: moderate evidence for beneficial effect; +: small/promising evidence for beneficial effect; −: no consistent evidence for beneficial effect.
