Breakout 3.4 How to support the psychological needs of patients with COPD - Karen Heslop Respiratory Nurse Consultant/NIHR Clinical Academic Research Fellow RVI Newcastle upon Tyne Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013, Guoman Tower Hotel, London How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

1. How to support the psychological needs
of patients with COPD
Karen Heslop MSc PGD in CBT BSc (Hons)
Respiratory Nurse Consultant/NIHR Clinical Academic Research Fellow
RVI Newcastle upon Tyne
The Newcastle upon Tyne
Hospital NHS Trust
Introduction
 Umbrella term for chronic bronchitis and emphysema
 Affects over 3 million people in UK
 30,000 deaths per year
 Costly (£1 billion on health care costs)
 Morbidity and suffering – patients and families
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2. Burden of COPD
“When I can’t get my breath I think I am going to
die”
“I thought it was my last breath”
“I can walk about 5 yards. Sometimes I just sit &
cry…you get depressed… anyone would”.
“In the past I had a gun at home during the
amnesty I handed it in. If I still had it, I would
have considered shooting myself as I get very
depressed”
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Psychological Difficulties in COPD
 Higher rates of anxiety symptoms than those with cancer,
heart failure or other medical conditions
 Poorer survival
 Health care utilization
 Longer hospitalisation
 Persistent smoking
 Increased symptoms
 Poorer physical and social functioning
 Excessive use of medication (Ng, 2007)
 Decline rehabilitation (Angle & Baum, 1997)
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3. Anxiety & Panic in COPD
 38 % Anxiety symptoms (NICE, 2010)
 60% in Newcastle
 Higher than with cancer, heart failure or other medical
conditions
 Catastrophic thoughts & impending danger.
 Often unrecognised and untreated.
 Mistaken from worsening COPD.
 Significant predictor of the frequency of hospital admissions
for acute exacerbations of COPD (Yohannes, 2000).
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Depression
 Absence of positive affect (loss of interest & enjoyment in ordinary things &
experiences) & low mood
 2-3 times more common in patients with chronic illnesses such as COPD
 40% of patients.
 Chronic physical health can cause and exacerbate depression
 Patients tend to present with physical symptoms e.g. pain
 Attention shifts to physical health problem & depression may be overlooked
 Only a minority of patients discuss psychological problems (9% WHO, 1995)
 Treatment helps improve quality of life and life expectancy
(NICE 2009)
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4. Treatment of Anxiety & Depression (NICE, 2011, 2009)
Specialist
review
High intensity
psychological interventions
Combined treatments
Referral if needed
Low intensity psychological interventions
Combined treatments (moderate)
Referral if needed
Screening, Assessment, support, psycho-education,
active monitoring, physical exercise programme , peer
support, referral if needed
Treatment of anxiety & depression
 Self help – written information based on CBT principles
e.g. NTW Mental Health Trust leaflets on Anxiety &
Panic attacks
 Exercise
 Pulmonary rehabilitation
 CBT
 Pharmacological treatment if moderate to severe
 More research
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5. What is Cognitive Behaviour Therapy?
 A psychological intervention - usually short term
 Concentrates on the current difficulties
 Problem and solution focused
 Techniques directed at developing a shared
understanding of problem
 It’s about change
 Not suitable for everyone
Assessing What’s Happening
Environment/Trigger
Physical
Behaviour Thoughts
Feelings
Past experience - assumptions, attitudes, past learning
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6. Techniques
Case Study
 68 Year old Male
 Severe COPD
 Ex –smoker
 Previous coal miner
 Very anxious
 Main difficulties SOB & panic attacks
 Declined pulmonary rehabilitation
 Very supportive family
 BAI 63 BDI 10
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7. Hot Cross Bun
Situation
Activity or thoughts
Physical
SOB +++, Sweating, heart races Thoughts
Behaviour
I’m going to die
This is my last breath
Avoids activity if pos
Sits down
Turns on Fan
Shouts for wife for support
Emotions
Frightened
Guilty
Anxious (BAI 63)
Copyright K Heslop
Depressed (BDI 10) 18/02/2013
Treatment
 Education re COPD/panic attacks/depression
 Strategies :–
 planning & pacing activities
 distraction
 breathing control
 activity diary
 problem solving
 Follow up by telephone in 4 weeks!
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8. Outcome
 BAI 0 / BDI 0
 Never felt better
 Breathing better
 Plans things
 Doing more physical activity & going out more
 Feels more positive
 Learnt a lot in last 4 weeks
 No relapse 3 years later
PhD Research Study
Anxiety &Thoughts
Breathless Panic
Frightening
Depression
Reduced Respiratory
Anxiety
/Panic
Anxiety
Activity
Depression
Cycle
Training
Hospital Admissions Quality of Life
The Newcastle upon Tyne
Karen Heslop 21/9/2010 Hospital NHS Foundation Trust
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9. Thank You
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