Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review

Figures & data

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Figure 1 Effects of cognitive behavior therapy (CBT) interventions (random effects models) presenting overall effect and subgroup analysis for intensity dyads (A) Anxiety. (B) Depression. (C) Dyspnea (Breathlessness). (D) Exercise capacity. (E) Quality of Life (Mental Wellbeing). (F) Quality of Life (Physical).

Abbreviations: HEUC/EC, High intensity intervention compared to Enhance Usual Care/Usual care; HH, High-intensity intervention compared to High-intensity comparator; HL, High-intensity intervention compared to Low-intensity comparator; LL, Low-intensity intervention compared to Low-intensity comparator; LUC, Low-intensity intervention compared to Usual care (including Enhanced Usual Care where appropriate).

Table 1 Summary of Meta-Regression Findings (K = Number of Studies, B = Regression Estimate. 95% CI = 95 Percent Confidence Limits)

Predictor Variable		Anxiety				Depression				QOL (Physical)				QOL (Mental Wellbeing)
		K	B	95% CI	P	K	B	95% CI	P	K	B	95% CI	P	K	B	95% CI	P
Threshold for anxiety/depression		22	0.15	(−0.26, 0.55)	0.46	20	−0.10	(−0.34, 0.13)	0.37	19	0.51	(−0.17, 1.18)	0.13	18	0.22	(−0.05, 0.50)	0.11
Number of intervention sessions		21	0.00	(−0.01, 0.01)	0.45	19	−0.00	(−0.01, 0.01)	0.40	18	−0.01	(−0.03, 0.01)	0.50	17	−0.00	(−0.01, 0.01)	0.47
Ratio intervention/comparison sessions		13	−0.11	(−0.18, −0.04)	0.005	12	−0.07	(−0.17, 0.03)	0.14	13	0.02	(−0.36, 0.41)	0.90	12	0.11	(0.04, 0.19)	0.005
Proportion of sessions CBT-focused		21	0.16	(−0.31, 0.63)	0.48	19	0.04	(−0.38, 0.47)	0.83	18	0.53	(−0.49, 1.54)	0.29	17	0.18	(−0.30, 0.66)	0.44
Intervention target (SM vs SPF)		22	0.17	(−0.36, 0.69)	0.51	20	0.15	(−0.10, 0.41)	0.22	19	−0.25	(−1.11, 0.62)	0.55	18	−0.16	(−0.50, 0.18)	0.35
Facilitator psychology professional		22	0.22	(−0.18, 0.62)	0.26	20	0.07	(−0.17, 0.31)	0.56	19	0.20	(−0.52, 0.93)	0.56	18	−0.17	(−0.45, 0.11)	0.21
Delivery (vs individual)	Individual + group	22	0.02	(−0.95, 0.94)	0.97	20	0.09	(−0.46, 0.64)	0.72	19	−0.63	(−2.22, 0.95)	0.41	18	−0.50	(−1.12, 0.13)	0.11
	Group		0.19	(−0.31, 0.69)	0.44		0.18	(−0.12, 0.48)	0.22		−0.15	(−0.92, 0.62)	0.69		0.02	(−0.30, 0.35)	0.87
Comparison sample size	≥60	22	0.06	(−0.39, 0.52)	0.78	20	0.05	(−0.27, 0.37)	0.75	19	0.29	(−0.55, 1.12)	0.48	18	−0.05	(−0.45, 0.35)	0.81
	30–60		−0.35	(−0.91, 0.22)	0.22		0.08	(−0.31, 0.48)	0.65		−0.26	(−1.15, 0.63)	0.54		−0.18	(−0.64, 0.27)	0.40
	N (continuous)	22	0.001	(−0.002, 0.005)	0.53	20	0.003	(−0.002, 0.003)	0.77	19	0.003	(−0.005, 0.011)	0.48	18	0.000	(−0.002, 0.003)	0.77
Intensity of Comparator (vs EUC/UC)	High	22	0.22	(−0.27, 0.70)	0.36	20	0.14	(−0.14, 0.43)	0.31	19	−0.25	(−0.92, 0.43)	0.45	18	−0.28	(−0.61, 0.06)	0.10
	Low		0.30	(−0.25, 0.85)	0.27		−0.00	(−0.35, 0.34)	0.98		1.07	(0.09, 2.06)	0.03		−0.26	(−0.65, 0.14)	0.19
Controlled clinical trial (vs randomized)		22	1.22	(−0.05, 2.49)	0.06	–	–	–	–	19	0.22	(−1.01, 1.45)	0.71	18	0.24	(−0.42, 0.90)	0.45
Study quality (PEDRO score)		22	−0.12	(−0.32, 0.09)	0.25	20	−0.02	(−0.15, 0.12)	0.80	19	−0.11	(−0.46, 0.24)	0.52	18	−0.06	(−0.23, 0.10)	0.43

Notes: Dyspnoea and exercise capacity not included in meta-regression (less than 10 studies).

Variable definition and interpretation

• Threshold for anxiety/depression = inclusion criterion for anxiety or depression (yes/no)

• Number of intervention sessions = total number of intervention sessions (inclusive of CBT)

• Ratio of intervention sessions/comparator sessions = Ratio of total number of intervention to comparator sessions (includes only comparators that reported sessions)

• Proportion of sessions CBT focused = number of CBT sessions as a proportion of all sessions provided in an intervention.

• Intervention target = CBT focus where specific psychological focus (SPF) was symptoms and Self-management (SM) included CBT as part of broader behavioral skill set.

• Facilitator psychology professional = Psychologist alone vs all other professionals (including a psychology professional

• Delivery = CBT mode with individual as reference group vs individual + group sessions or group sessions

• Comparison sample size = reference group is ≤30 for samples between 30 and 60 and ≥60. Sample size (N) as a continuous measure was run as a separate analysis.

• Intensity of comparator = reference group is Enhanced Usual Care/Usual care (EUC/UC) for high-intensity comparator and low-intensity comparator

• Controlled clinical trial = reference group is randomized controlled clinical trials (RCT)

• Study quality (PEDro score) = continuous variable.