{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:46:01Z","timestamp":1791607561167,"version":"4.3.4"},"reference-count":43,"publisher":"European Respiratory Society (ERS)","issue":"4","funder":[{"DOI":"10.13039\/501100000659","name":"Research Trainees Coordinating Centre","doi-asserted-by":"publisher","award":["10-023"],"award-info":[{"award-number":["10-023"]}],"id":[{"id":"10.13039\/501100000659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2018,10,12]]},"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:p>Anxiety is an important comorbidity in chronic obstructive pulmonary disease (COPD). We investigated if cognitive behavioural therapy (CBT), delivered by respiratory nurses, reduced symptoms of anxiety and was cost-effective.<\/jats:p><jats:p>Patients with COPD and anxiety were randomised to CBT or self-help leaflets. Anxiety, depression and quality of life were measured at baseline, 3, 6 and 12\u2005months. A cost-effectiveness analysis was conducted from a National Health Service hospital perspective and quality-adjusted life-years estimated using the EuroQol-5D questionnaire.<\/jats:p><jats:p>In total, 279 patients were recruited. Group mean change from baseline to 3\u2005months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% CI 2.62\u20134.17, p&lt;0.001) for the CBT group and 1.88 (95% CI 1.19\u20132.55, p&lt;0.001) in the leaflet group. The CBT group was superior to leaflets at 3\u2005months (mean difference in the Hospital Anxiety and Depression Anxiety Subscale was 1.52, 95% CI 0.49\u20132.54, p=0.003). Importantly, the CBT intervention was more cost-effective than leaflets at 12\u2005months, significantly lowering hospital admissions and attendance at emergency departments.<\/jats:p><jats:p>CBT delivered by respiratory nurses is a clinically and cost-effective treatment for anxiety in patients with COPD relative to self-help leaflets.<\/jats:p>","DOI":"10.1183\/23120541.00094-2018","type":"journal-article","created":{"date-parts":[[2018,11,23]],"date-time":"2018-11-23T05:25:15Z","timestamp":1542950715000},"page":"00094-2018","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":76,"title":["Randomised controlled trial of cognitive behavioural therapy in COPD"],"prefix":"10.1183","volume":"4","author":[{"given":"Karen","family":"Heslop-Marshall","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Carrick-Sen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Newton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Echevarria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Stenton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Jambon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Pearce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Burns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8566-0344","authenticated-orcid":false,"given":"Anthony","family":"De Soyza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2018,11,22]]},"reference":[{"key":"2024101707124403000_4.4.00094-2018.1","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Prevention, Diagnosis and Management of COPD . 2017. www.goldcopd.org"},{"key":"2024101707124403000_4.4.00094-2018.2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0342"},{"key":"2024101707124403000_4.4.00094-2018.3","doi-asserted-by":"crossref","unstructured":"Yohannes AM , Kaplan A , Hanania NA . Anxiety and depression in chronic obstructive pulmonary disease: recognition and management. Cleve Clin J Med 2018: S11\u2013SS8.","DOI":"10.3949\/ccjm.85.s1.03"},{"key":"2024101707124403000_4.4.00094-2018.4","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00007813"},{"key":"2024101707124403000_4.4.00094-2018.5","first-page":"1615","article-title":"Anxiety and depression \u2013 important psychological comorbidities of COPD","volume":"6","author":"Pumar","year":"2014","journal-title":"J Thorac Dis"},{"key":"2024101707124403000_4.4.00094-2018.6","doi-asserted-by":"crossref","first-page":"138","DOI":"10.12968\/bjcn.2016.21.3.138","article-title":"COPD and emotional distress: not always noticed and therefore undertreated","volume":"21","author":"Dury","year":"2016","journal-title":"Br J Commun Nurs"},{"key":"2024101707124403000_4.4.00094-2018.7","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00078504"},{"key":"2024101707124403000_4.4.00094-2018.8","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-1911"},{"key":"2024101707124403000_4.4.00094-2018.9","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.1.60"},{"key":"2024101707124403000_4.4.00094-2018.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsycho.2010.02.007"},{"key":"2024101707124403000_4.4.00094-2018.11","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.resp.2015.05.013","article-title":"Cognitive behaviour therapy reduces dyspnoea ratings in patients with chronic obstructive pulmonary disease (COPD)","volume":"216","author":"Livermore","year":"2015","journal-title":"Respir Physiol Neurobiol"},{"key":"2024101707124403000_4.4.00094-2018.12","doi-asserted-by":"crossref","first-page":"E5","DOI":"10.1017\/S1754470X17000071","article-title":"Developing and evaluating psychological provision in the acute hospital setting for patients with chronic respiratory disease","volume":"10","author":"Thew","year":"2017","journal-title":"The Cognitive Behavioural Therapist"},{"key":"2024101707124403000_4.4.00094-2018.13","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203808"},{"key":"2024101707124403000_4.4.00094-2018.14","unstructured":"National Institute for Clinical Excellence. Depression in adults with a chronic physical health problem: recognition and management. Clinical guideline [CG91] . National Institute for Clinical Excellence, 2010."},{"key":"2024101707124403000_4.4.00094-2018.15","unstructured":"National Institute for Health and Clinical Excellence. Generalised Anxiety Disorder and Panic Disorder (with or without agoraphobia) in Adults: Management in Primary, Secondary and Community Care . Leicester, The British Psychological Society and The Royal College of Psychiatrists, 2011."},{"key":"2024101707124403000_4.4.00094-2018.16","unstructured":"BMA. Breaking down barriers \u2013 the challenge of improving mental health outcomes . London, British Medical Association, 2017."},{"key":"2024101707124403000_4.4.00094-2018.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2010.04.010"},{"key":"2024101707124403000_4.4.00094-2018.18","first-page":"CD010673","article-title":"Psychological therapies for the treatment of anxiety disorders in chronic obstructive pulmonary disease","volume":"3","author":"Usmani","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2024101707124403000_4.4.00094-2018.19","doi-asserted-by":"crossref","first-page":"1096.e1","DOI":"10.1016\/j.jamda.2017.09.007","article-title":"Management of dyspnea and anxiety in chronic obstructive pulmonary disease: a critical review","volume":"18","author":"Yohannes","year":"2017","journal-title":"J Am Med Dir Assoc"},{"key":"2024101707124403000_4.4.00094-2018.20","doi-asserted-by":"crossref","first-page":"315","DOI":"10.2147\/COPD.S53255","article-title":"Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review","volume":"9","author":"Pooler","year":"2014","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2024101707124403000_4.4.00094-2018.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"2024101707124403000_4.4.00094-2018.22","unstructured":"Heslop-Marshall K . Newcastle Chronic Obstructive Pulmonary Disease (COPD) cognitive behavioural therapy (CBT) Care Study: a randomised controlled trial . Newcastle, University of Newcastle, 2016."},{"key":"2024101707124403000_4.4.00094-2018.23","unstructured":"Care Services Improvement Partnership. IAPT Outline Service Specification . Institute for Mental Health England. www.uea.ac.uk\/documents\/246046\/11991919\/iapt-pathfinder-outline-service-specification.pdf\/9fc11891-ecc5-48e4-a974-9bbc8ab0c690"},{"key":"2024101707124403000_4.4.00094-2018.24","unstructured":"Maunder L , Cameron L . Depression and Low Mood. https:\/\/web.ntw.nhs.uk\/selfhelp\/leaflets\/Depression%20and%20Low%20Mood%20A4%202016%20FINAL.pdf Northumberland, Tyne & Wear Mental Health Trust, 2011."},{"key":"2024101707124403000_4.4.00094-2018.25","unstructured":"Maunder L , Cameron L . Panic. A self-help guide. https:\/\/web.ntw.nhs.uk\/selfhelp\/leaflets\/Panic%20A4%202016%20FINAL.pdf Northumberland Tyne & Wear NHS Foundation Trust, 2011."},{"key":"2024101707124403000_4.4.00094-2018.26","first-page":"18","article-title":"Using cognitive behavioural therapy to address the psychological needs of patients with COPD","volume":"105","author":"Heslop","year":"2009","journal-title":"Nurs Times"},{"key":"2024101707124403000_4.4.00094-2018.27","doi-asserted-by":"publisher","DOI":"10.1177\/0269216306071058"},{"key":"2024101707124403000_4.4.00094-2018.28","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-11-49"},{"key":"2024101707124403000_4.4.00094-2018.29","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-6-46"},{"key":"2024101707124403000_4.4.00094-2018.30","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00102509"},{"key":"2024101707124403000_4.4.00094-2018.31","unstructured":"Szende A , Williams A , eds. Measuring Self-Reported Population Health: An International Perspective based on EQ-5D . EuroQol Group, 2004. https:\/\/euroqol.org\/wp-content\/uploads\/2016\/10\/Measuring_Self-Reported_Population_Health_-_An_International_Perspective_based_on_EQ-5D.pdf"},{"key":"2024101707124403000_4.4.00094-2018.32","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S2213-2600(14)70001-3","article-title":"Minimum clinically important difference for the COPD Assessment Test: a prospective analysis","volume":"2","author":"Kon","year":"2014","journal-title":"Lancet Respir Med"},{"key":"2024101707124403000_4.4.00094-2018.33","first-page":"319","article-title":"Use of a preference-based measure of health (EQ-5D) in COPD and Asthma","volume":"102","author":"Picard","year":"2007","journal-title":"Respir Med"},{"key":"2024101707124403000_4.4.00094-2018.34","unstructured":"Bland M . An Introduction to Medical Statistics . 4th Edn. Oxford, Oxford University Press, 2015."},{"key":"2024101707124403000_4.4.00094-2018.35","doi-asserted-by":"publisher","DOI":"10.2307\/2409177"},{"key":"2024101707124403000_4.4.00094-2018.36","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2005.00045.x"},{"key":"2024101707124403000_4.4.00094-2018.37","doi-asserted-by":"publisher","DOI":"10.1002\/hec.944"},{"key":"2024101707124403000_4.4.00094-2018.38","unstructured":"National Institute for Health and Clinical Excellence. Guide to the Methods of Technology Appraisal. Process and methods [PMG9] . National Institute for Health and Clinical Excellence, 2013."},{"key":"2024101707124403000_4.4.00094-2018.39","unstructured":"Curtis L , Burns A . Unit Costs of Health and Social Care. Personal Social Services Research Unit . Canterbury, University of Kent, 2015."},{"key":"2024101707124403000_4.4.00094-2018.40","unstructured":"Department of Health. Reference Costs. 2015\u20132016. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/577083\/Reference_Costs_2015-16.pdf"},{"key":"2024101707124403000_4.4.00094-2018.41","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1037\/a0016136","article-title":"Effective techniques in health eating and physical activity interventions: a meta-regression","volume":"28","author":"Michie","year":"2014","journal-title":"Health Psychol"},{"key":"2024101707124403000_4.4.00094-2018.42","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200826090-00004"},{"key":"2024101707124403000_4.4.00094-2018.43","first-page":"120501211","article-title":"Surprisingly high prevalence of anxiety and depression in chronic breathing disorders","volume":"127","author":"Kunik","year":"2005","journal-title":"Chest"}],"container-title":["ERJ Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/23120541.00094-2018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T04:56:36Z","timestamp":1740372996000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/23120541.00094-2018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,11,22]]},"published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1183\/23120541.00094-2018"],"URL":"https:\/\/doi.org\/10.1183\/23120541.00094-2018","relation":{},"ISSN":["2312-0541"],"issn-type":[{"value":"2312-0541","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}