Efficacy of cognitive behavioural therapy and/or simulation-based learning resources on the mental health of chronic obstructive pulmonary disease patients.

INTERVENTION: 1) Group cognitive behavioural therapy (CBT) CBT was conducted by a clinical psychologist in groups of 3–7 people. CBT involves a structured program that recognises the way people think affects the way they feel. It teaches people to think rationally about common difficulties, helping to change their thought patterns and the way they react to certain situations. CBT can be as effective as medication to treat depression and anxiety. Our CBT program consisted of two half‐day sessions (totalling 9 hours) a fortnight apart and a one‐hour telephone booster session four weeks later. The sessions were semi‐structured in nature and included both CBT global concepts and those that were specific to people with COPD. A manual was provided to participants for referral to CBT concepts. The topics covered during the sessions and provided in the manual included: 1. Background information ‐ how to recognise anxiety and panic attacks, depression and the link between mental health and COPD. 2. Automatic thoughts 3. Cognitive distortions 4. Relaxation 5. Reclaiming your confidence (catastrophising and self‐talk) 6. The influence activities have on your mood (e.g. increase the 'beautifuls') 7. Assertiveness training. 2) ‘Breathing New Life’ self‐management cognitive behavioural therapy resource (DVD) The ‘Breathing New Life’ self‐management simulation‐based CBT learning resource (DVD) contained the same concepts covered by the CBT group. The DVD included 7 chapters (including an introduction) which involved 6 vignettes presenting various scenarios likely to be encountered by the participants. The same clinical psychologist who conducted the group sessions was part of the DVD and provided CBT concepts on how individuals could change their behaviour and thoughts to improve their mental health. There was also an accompanying manual provided to the participants which reinforced concepts within the DVD. The DVD/manual covered the same topics as outlined in the group CBT intervention. Participants were asked to watch one DVD chapter per week (approximately 10 mins) and complete the accompanying section of the manual (approximately 10‐20 mins). In total, participants were given 6 weeks for the DVD to be completed. A researcher telephoned each participant once a week to monitor compliance. Each call lasted <5 minutes on average and telephone coaching was deliberately avoided. If any queries arose, participants were referred to a clinical psychologist. CONDITION: Anxiety Chronic obstructive pulmonary disease Depression PRIMARY OUTCOME: Beck Anxiety Inventory (BAI) Beck Depression Inventory (BDI‐II) SECONDARY OUTCOME: All cause hospitalisations by data linkage to medical records (this was decided during the trial) Cost effectiveness of intervention by economic analysis. This will be completed from data linkage to hospital records and Western Australian costs for emergency presentation and hospital admissions at the time of the hospital utilisation. Hospital and Anxiety Depression Scale (HAD‐S) Hospital utilisation by self report (this was decided prospectivelyl) St George's Respiratory Questionnaire ‐ quality of life INCLUSION CRITERIA: 1) A confirmed diagnosis of COPD by respiratory physicians 2) A positive screen for anxiety and/or depression on the BAI and BDI‐II, respectively.