A randomised controlled feasibility trial of group cognitive behavioural therapy for people with severe asthma

Yorke, J; Adair, P; Doyle, A; Dubrow-Marshall, LJ; Fleming, S; Holmes, L; Menzies-Gow, A; Niven, R; Pilling, M; Shuldham, C

Abstract

Objectives: Evidence for the efficacy of Cognitive Behavioural Therapy (CBT) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group.This study aimed to assess the feasibility and acceptability of Group-CBT in severe asthma. Method: This was a two-centre, randomised controlled parallel group feasibility study. Eligible participants (patients with severe asthma and a clinically significant diagnosis of anxiety and/or depression – Hospital Anxiety and Depression Scale (HAD) score greater than 8 for the anxiety or depression sub-scale) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only.Follow-up was for 16weeks and endpoints were: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire, HAD, Dyspnoea-12, EuroQual-5D and EuroQuol-VAS.
Results: 51 patients were randomised: 36% (51 out of 140) consent rate and attrition at week 16 was 12.Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly demands of the programme. Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health. Participants who contributed to focus group discussions reported that Group-CBT contributed to a better understanding of their illness and related approaches to anxiety management and acceptance of their asthma condition. Although weekly face-to-face sessions were challenging,this was the preferred method of delivery for these participants.
Conclusions: This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma. It has been possible but not easy t orecruit and retain the sample. Options for a less demanding intervention schedule,such as less frequent face-to-face visits and the use of web-based interventions, require careful consideration.

Citation

Yorke, J., Adair, P., Doyle, A., Dubrow-Marshall, L., Fleming, S., Holmes, L., …Shuldham, C. (2016). A randomised controlled feasibility trial of group cognitive behavioural therapy for people with severe asthma. Journal of Asthma, 54(5), 543-554. https://doi.org/10.1080/02770903.2016.1229335

• Journal Article Type: Article
• Acceptance Date: Aug 22, 2016
• Online Publication Date: Nov 23, 2016
• Publication Date: Nov 23, 2016
• Deposit Date: Dec 12, 2016
• Publicly Available Date: Nov 23, 2017
• Journal: Journal of Asthma
• Print ISSN: 0277-0903
• Electronic ISSN: 1532-4303
• Publisher: Taylor and Francis
• Volume: 54
• Issue: 5
• Pages: 543-554
• DOI: https://doi.org/10.1080/02770903.2016.1229335