Posted 03.21.2018 | by AMRA
Chronic Obstructive Respiratory Disease (COPD) is an incurable progressive inflammatory lung disease that restricts airway flow and causes shortness of breath, wheezing, excessive mucus production, and coughing. The disease afflicts 16 million Americans and 65 million people worldwide. Treatment commonly includes smoking cessation, exercise, bronchodilator inhalers, anti-inflammatory medications, and supplementary oxygen. About one third of COPD patients report symptoms of anxiety and/or depression that are linked to poorer health and quality of life outcomes.
Farver-Vestergaard et al. [European Respiratory Journal] investigated whether Mindfulness-Based Cognitive Therapy (MBCT) could provide additional psychological, health, and quality of life benefits when provided in conjunction with standard pulmonary rehabilitation (PR).
The researchers randomly assigned 84 Danish COPD patients (average age = 67 years; 57% female) to PR alone or PR plus MBCT. PR was delivered in 2 weekly sessions over an 8-week period and consisted of exercise in combination with disease and lifestyle education.
The add-on MBCT program consisted of 8 weekly 105-minute group sessions. MBCT meditations were modified to focus on the sensations of heartbeat, blood flow, and contact of the feet with the floor rather than on the breath. Meditations were shortened, cognitive exercises simplified, and the full-day retreat eliminated.
Participants were assessed on anxiety, depression, COPD health status impairment, mindfulness (the Five Facet Mindfulness Questionnaire), self-compassion, COPD self-efficacy, and breathlessness-related catastrophizing at five time points: before treatment, mid-treatment, after treatment, and at 3- and 6-month follow-up.
Pre- and post-treatment measures were taken of activity level (using an accelerometer, a Fitbit-like device for measuring movement), and pre- and post-treatment blood samples were drawn to measure blood inflammatory factors including tumor necrosis factor alpha (TNF-α), and a variety of interleukins (IL-6, IL-8, and IL17E).
The results show that depression scores declined significantly for the MBCT group, but not for the PR group (Cohen’s d=0.51). This improvement in depressive symptoms was sustained at 3-month and 6-month follow-up.
Anxiety scores were unaffected in both groups. There was a trend toward improved COPD health status for MBCT participants, but not the PR participants (Cohen’s d=0.42, p=.06). TNF-α levels increased significantly for the PR group, but not for the MBCT group. There were no significant effects on interleukins or activity level.
An examination of moderating and meditating variables showed that younger COPD patients benefited significantly more from MBCT (Cohens’ d=0.38), and that improvements in self-compassion temporally preceded improvements in depressive symptoms.
The study demonstrates that MBCT can significantly decrease depressive symptoms in COPD patients beyond that of conventional pulmonary rehabilitation. MBCT’s marginally positive effect on COPD illness impairment status and the lack of TNF-α increase for MBCT participants points to potential health benefits. The finding in regard to TNF-α is important since TNF-α plays a pro-inflammatory role in COPD.
The study’s low initial enrollment rate and fairly large attrition rate (at 6-month follow-up, 36% of the MBCT group and 27% of PR group failed to complete assessments) led to a smaller sample size than intended, reducing the study’s power to detect potentially significant differences. The study is also limited by the absence of a placebo or active psychosocial control, and its reliance on blood rather than bronchoaveolar lavage samples to detect interleukin levels.
Farver-Vestergaard, I., O’Toole, M. S., O’Connor, M., Løkke, A., Bendstrup, E., Basdeo, S. A., . . . Zachariae, R. (2018). Mindfulness-based cognitive therapy in COPD: A cluster randomised controlled trial. European Respiratory Journal.