Cognitive behavioral therapy can help people with COPD deal with the anxiety associated with breathing difficulties.

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Relaxation techniques are among the therapies people with COPD can use for anxiety. Getty Images

Imagine not being able to breathe easily. You’d probably be a little anxious.

That’s what happens to many of the 12 million adults in the United States suffering from chronic obstructive pulmonary disease (COPD).

COPD obstructs airflow to the lungs and in the process can cause anxiety in many patients, which only makes breathing more difficult.

“It causes a spiral,” said Bill Clark, who has COPD and leads community engagement at the COPD Foundation. “The stress and anxiety causes the breathing to get worse, which causes more stress and anxiety, and gets worse again, and creates cycles of shortness of breath.”

Treating that anxiety may lead to reduced suffering by COPD patients — and reduced costs for treatment and hospitalization.

And a new study has found a better method for treating the problem.

It calls for using cognitive behavior therapy in settings that take into account the unique difficulties of COPD patients.

What the study revealed

In the recent study, Karen Heslop-Marshall, PhD, a nurse consultant at Newcastle-upon-Tyne NHS Foundation Trust hospital in England, and her team screened COPD patients for anxiety.

Of 1,500 patients, 59 percent had anxiety symptoms.

Some of those with COPD and anxiety symptoms were given cognitive behavioral sessions with nurses specializing in respiratory issues.

Others were just given self-help literature on anxiety management.

Researchers found the cognitive behavioral therapy patients’ management of their anxiety improved considerably more than the other study participants.

The group receiving the therapy also had significantly reduced hospital admissions.

That wasn’t surprising to Clark.

The behavioral therapy works primarily by helping patients work on ways of coping with and managing anxiety, in order to keep it from spinning out of control.

Clark said he was diagnosed with COPD 17 years ago and was given 6 years to live.

He has 20 percent lung function, which he says feels like you’ve just had the wind knocked out of you pretty much all the time.

“I remember the terror of not being able to get enough breath,” he told Healthline.

To cope, he talked with others and learned what he could about coping with that stress.

“The most important thing for a patient to do is to become educated,” he said.

How to cope with anxiety

Heslop-Marshall had an idea for addressing that terror through education.

“A lot of patients don’t get the link between breathlessness and feeling frightened and anxiety,” she told Healthline. “They just think it’s part of COPD.”

It’s not, although it is related.

When you’re frightened — like, say, because you’re struggling to breathe — that makes breathing worse, she explained.

But there are things you can to do control those fears.

Counting backward from 107, Heslop-Marshall suggested.

Or counting how many red cars you see.

“Anything to take your mind off your breathing,” she said.

Getting professional help

It’s a lot easier to master these coping mechanisms with a little help from a professional.

And if that professional also has expertise in lung conditions such as COPD, Heslop-Marshall figured, then they’d be better able to tell whether there was a real breathing problem or whether it was just anxiety.

“If your lungs are at 80 percent and you have a lot of anxiety, then we’d need to push you a bit because it might be in your head more than your lungs,” she said.

That’s why her study relied on cognitive behavioral therapy from respiratory nurses rather than psychologists.

“Because we can bear in mind patients’ lung health, so we can gauge whether the goals they’re setting for themselves are realistic or not,” she said.

She did add it’s important for nurses to check in with psychologists periodically.

In the study, COPD patients saw nurses for behavioral therapy training for an average of about four visits.

Heslop-Marshall said the National Health Service, the United Kingdom’s publicly funded countrywide healthcare system, has asked for the data behind her report and expressed interest in using her recommendations to help lower the hospitalizations of COPD patients — and associated costs.

Getting away from drugs

In the United States, a greater reliance on treatments such as behavioral therapy could potentially decrease reliance on drugs to help control anxiety, which patient advocates say have limited benefits.

“A lot of people with COPD seem to think that they need medications for anxiety or depression,” John Linnell, a COPD advocate who was diagnosed with the disease in 2005, told Healthline. “But a lot of these medications are to correct a chemical imbalance in the brain.”

What COPD patients are suffering from isn’t a chemical imbalance but panic caused by an inability to breathe.

So, at least for many COPD patients, drugs aren’t going to help, Linnell told Healthline. And, he added, many of these meds can lower respiration rates so might end up hurting breathing in the long run.

Linnell also recommended calming techniques, such as mindful awareness.

He and Clark recommended non-pharmacological methods instead, such as pursed-lip breathing, which can help empty lungs of carbon dioxide and refill them.

Talking to other patients to get tips — whether in patient support groups or online boards such as the COPD Foundation’s copd360social.org — can also help patients find coping strategies that work.

To better share such strategies, Heslop-Marshall hopes more nurses working on lung conditions get training in cognitive behavioral therapy.

More behavioral therapy work by nurses could save millions of pounds in COPD drugs and hospitalizations, she said, “but it’s not going to be easy because we would need to train people.”

“We’re trying to train as many people as we can,” she said, “and one day, a digital version would be the goal.”

The bottom line

People with the lung disease COPD often have trouble breathing, which can lead to anxiety.

Cognitive behavior therapy, which helps patients develop strategies for coping with anxiety and similar conditions, can help lower that anxiety and reduce the chances COPD patients will end up in the hospital.

That’s especially true when the behavioral therapy is done by nurses with expertise in lung conditions, a new study finds.