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Practice comment

Nurses should consider training in CBT to support COPD patients

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Using a CBT approach with patients with chronic obstructive pulmonary disease can reduce both psychological distress and hospital admissions, says Karen Heslop

Having worked in respiratory medicine for the last 22 years, I have seen a significant change in the provision of care for patients with chronic obstructive pulmonary disease (COPD).

Breathlessness is the characteristic feature of this illness and is a most distressing and disabling symptom experienced by patients. The condition is multi-factorial in origin with interrelated physiological, psychological and sociological components.

Over the years drug treatments have improved, pulmonary rehabilitation has developed and early supported discharge schemes are now available. Community respiratory teams are also evolving to provide care closer to patients’ homes.

Unfortunately, what has not developed to the same degree is the psychological care for these patients. Anxiety and depression have been reported in 25-50% of all those presenting for treatment for COPD. Many nurses working in this area have had little or no training in psychological interventions. Some may have completed counselling courses to develop their skills but all too often training has not been undertaken.

I realised that developing my expertise in psychological care was important when I researched COPD from a patient perspective for my masters degree. The main concern patients expressed was the psychological effect of the illness. As a respiratory nurse my skills were limited in this area.

I realised that interventions that reduce anxiety and depressive symptoms may have an impact on patients’ overall wellbeing and potentially affect COPD outcomes. A significant amount of research has shown that many patients with the condition experience psychological difficulties such as anxiety or depression. So what can we do to address these needs?

There is growing evidence for the efficacy of cognitive behavioural therapy (CBT) as an adjunctive and primary treatment in managing long-term physical conditions. CBT is used to treat psychological distress and can help healthcare professionals provide holistic care to patients. The therapy is concerned with understanding how events and experiences are interpreted and focuses on the relationship between our cognitions (what we think), our emotions (how we feel) and our behaviour (what we do). It is based on addressing the interaction between thoughts, mood, behaviour and physical sensations. These are intricately linked.

Interventions that reduce anxiety and depressive symptoms may have an impact on patients’ overall wellbeing and potentially affect COPD outcomes

CBT has a number of core features and is based on collaborating with patients. All too often healthcare professionals tell patients what to do rather than working with them to identify their problems or goals. When using the CBT approach, the healthcare professional’s role is to develop a partnership with the patient to enable them to achieve a better understanding of their problems and to help them discover alternative ways of thinking and behaving. Good communication skills are essential to developing such a relationship.

Many patients decline referral for outside psychological help, but would be prepared to see a known member of the primary care respiratory team. The advantage of this is that they have an in-depth understanding of the physical and psychological treatment of long-term conditions. Clinicians working with patients with COPD can train in CBT at different levels. Even a basic understanding of the technique can aid appreciation of patients’ experience.

Our experience of using CBT in those with COPD has shown a significant reduction in patients’ psychological distress. In addition, we have also found a reduction in hospital admissions. When public sector funding is limited this may have important implications.

Karen Heslop is respiratory nurse consultant, Newcastle upon Tyne Hospitals Foundation Trust.

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