Cognitive-behavioral therapy for chronic cardiopulmonary conditions: Preliminary outcomes from an open trial

Objective: To examine the effectiveness of tailored cognitive-behavioral therapy (CBT) for veterans with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) with comorbid symptoms of depression and/or anxiety. Method: Twenty-three veterans with CHF and/or COPD, identified from electronic medical records at a large Veterans Affairs medical center, with clinically significant symptoms of depression (Beck Depression Inventory-II [BDI-II] score ≥ 14) and/or anxiety (State Trait Anxiety Inventory [STAI] score ≥ 40) were enrolled in an open trial from August 2007 to August 2008. All patients received CBT delivered mostly by advanced psychology trainees that consisted of 6 weekly sessions and 3 telephone booster calls. The intervention expanded traditional CBT techniques in order to address patients' emotional and physical health difficulties using in-person and telephone-based sessions. Outcomes examined depression (BDI-II), anxiety (STAI), and disease-specific quality of life (Chronic Respiratory Questionnaire [CRQ] and Kansas City Cardiomyopathy Questionnaire [KCCQ]) postintervention and at 3-month follow-up. Results: Symptoms of depression (effect size = 0.97) and anxiety (effect size = 0.57) were improved at 8 weeks and maintained at 3-month follow-up. Physical disease outcomes were also improved for COPD (CRQ mastery effect size = 0.65, CRQ fatigue effect size = 0.75) and CHF (KCCQ overall summary score effect size = 1.19). Conclusions: Modifications to traditional CBT approaches have the potential to address the emotional and physical health challenges associated with complex cardiopulmonary patients. The brief duration and use of telephone-based sessions increase the opportunity for CBT interventions to be integrated within primary care settings, but additional trials are needed. Trial Registration: clinicaltrials.gov Identifier: NCT00727155.