Content » Vol 49, Issue 3

Original report

Effectiveness of cognitive behavioural therapy in a community-based pulmonary rehabilitation programme: A controlled clinical trial

Edwin K. Luk, Alexandra Gorelik , Louis Irving, Fary Khan
Rehabilitation, Royal Melbourne Hospital, 3052 Melbourne, Australia. E-mail:
DOI: 10.2340/16501977-2189


Objective: To investigate whether the use of cognitive behavioural therapy in pulmonary rehabilitation addresses the depression and anxiety burden and thereby improves rehabilitation outcomes.
Design: Prospective controlled clinical trial.
Patients: A total of 70 patients with chronic obstructive pulmonary disease who were referred to a community centre for pulmonary rehabilitation.
Methods: Patients were allocated to either the control group, consisting of pulmonary rehabilitation alone, or to the treatment group, receiving pulmonary rehabilitation and an additional 6 sessions of group-based cognitive behavioural therapy. Assessments consisting of questionnaires and walk tests were conducted pre- and post-pulmonary rehabilitation.
Results: A total of 28 patients were enrolled. The cognitive behavioural therapy group had significant improvements in exercise capacity following pulmonary rehabilitation (mean change 32. 9 m, p = 0. 043), which was maintained at 3 months post-pulmonary rehabilitation (mean change 23. 4 m, p = 0. 045). Patients in the cognitive behavioural therapy group showed significant short-term improvements in fatigue, stress and depression (mean change 2. 4, p = 0. 016, 3. 9, p = 0. 024 and 4. 3, p = 0. 047, respectively) and a 3-month post-pulmonary rehabilitation improvement in anxiety score (mean change 3. 1, p = 0. 01). No
significant changes were seen in the control group.
Conclusion: The addition of cognitive behavioural
therapy improved patients’ physical, psychological and quality of life results. Cognitive behavioural
therapy should be considered for inclusion in a
pulmonary rehabilitation programme to enhance outcomes.

Lay Abstract

Cognitive Behavioural Therapy (CBT) improves pulmonary rehabilitation outcomes
Pulmonary rehabilitation has already been shown to be an effective form of treatment for patients with Chronic Obstructive Pulmonary Disease (COPD). This study showed that combining CBT together with pulmonary rehabilitation makes the program even more effective. In particular benefits were seen in improved walking and psychological state and a better quality of life. CBT should be considered an essential element in a pulmonary rehabilitation program.


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