Psychological Medicine

Original Articles

COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial

M. E. Kunika1a2a3a4a5 c1, C. Veazeya6, J. A. Cullya1a2a3a5, J. Soucheka1a2a4, D. P. Grahama1a2a3a5, D. Hopkoa7, R. Cartera8, A. Sharafkhaneha2a4, E. J. Goepferta3, N. Wraya1a2a4 and M. A. Stanleya1a2a3a5

a1 Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Houston, TX, USA

a2 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

a3 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

a4 Department of Medicine, Baylor College of Medicine, Houston, TX, USA

a5 Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, USA

a6 Northwestern State University of Louisiana, Natchitoches, LA, USA

a7 The University of Tennessee, Department of Psychology, Knoxville, TN, USA

a8 Texas Tech University, Health, Exercise and Sport Sciences, Lubbock, TX, USA


Background Chronic obstructive pulmonary disease (COPD) affects 14 to 20 million Americans and is associated with increased prevalence of affective disorders, contributing significantly to disability. This study compared cognitive behavioral therapy (CBT) group treatment for anxiety and depression with COPD education for COPD patients with moderate-to-severe anxiety and/or depressive symptoms.

Method A randomized controlled trial (RCT) was conducted between 11 July 2002 and 30 April 2005 at the Michael E. DeBakey VA Medical Center, Houston, TX. Participants were 238 patients treated for COPD the year before, with forced expiratory value in 1 second (FEV)1/forced vital capacity (FVC)<70% and FEV1<70% predicted, and symptoms of moderate anxiety and/or moderate depression, who were being treated by a primary care provider or pulmonologist. Participants attended eight sessions of CBT or COPD education. Assessments were at baseline, at 4 and 8 weeks, and 4, 8 and 12 months. Primary outcomes were disease-specific and generic quality of life (QoL) [Chronic Respiratory Questionnaire (CRQ) and Medical Outcomes Survey Short Form-36 (SF-36) respectively]. Secondary outcomes were anxiety [Beck Anxiety Inventory (BAI)], depressive symptoms [Beck Depression Inventory-II (BDI-II)], 6-minute walk distance (6MWD) and use of health services.

Results Both treatments significantly improved QoL, anxiety and depression (p<0.005) over 8 weeks; the rate of change did not differ between groups. Improvements were maintained with no significant change during follow-up. Ratios of post- to pretreatment use of health services were equal to 1 for both groups.

Conclusions CBT group treatment and COPD education can achieve sustainable improvements in QoL for COPD patients experiencing moderate-to-severe symptoms of depression or anxiety.

(Received December 11 2006)

(Revised July 17 2007)

(Accepted July 23 2007)

(Online publication October 09 2007)


c1 Address for correspondence: M. E. Kunik, M.D., M.P.H., Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VAMC (152), 2002 Holcombe, Houston, TX 77030, USA. (Email: