Background:

The literature and our preliminary studies find that in COPD patients anxiety and depression affect quality of life and functioning over and above what would be expected given disease severity. Thus, in order to improve quality of life and functioning in the 20% of COPD patients with significant anxiety and/or depression symptoms, interventions are needed to help manage psychological symptoms. Considering the wealth of research that has documented the utility of cognitive behavioral therapy (CBT) in treating anxiety and depression, CBT shows promise as a self-management intervention to improve quality of life in this population.

Objectives:

This proposal is a randomized control trial designed to examine the efficacy of manual based CBT.

Methods:

Subjects were recruited from the MEDVAMC through direct recruitment and use of administrative databases. Two hundred and forty-three COPD patients with comorbid anxiety and/or depression symptoms were randomized to either eight weeks of CBT/usual care or eight weeks of COPD Education/usual care. We hypothesized that COPD patients receiving CBT/usual care will show greater improvement when compared to COPD patients receiving COPD Education/usual care. Improvement is defined as increased disease specific quality of life (QOL), generic QOL, and six-minute walk distance; and decreased depression, anxiety, and health service use. Outcomes will be examined pre-treatment, mid-treatment, post-treatment and at 4, 8 and 12 months.

Status:

Follow-up assessments ended June 2005. Data cleaning is complete and preliminary statistical analyses are being conducted. Two papers have been published and five papers are accepted or in press. One paper has been submitted for publication (under review) with an additional five papers in varying stages of planning and preparation. The study was scheduled to officially end December 31, 2005. However, the study was granted a no-cost extension by HSR&D to complete data analyses and prepare final papers. The extension was granted through June 30, 2006.