The Effect Of Cognitive Behavior Therapy On Chronic Obstructive Pulmonary Disease With Depression

Objective: 1.To explore the risk factors that pose depression in patients with chronic obstructive pulmonary disease;2.To explore the antidepressant effect of CBT and combination of CBT with health education on COPD patients with depression;to compare the differences between the two groups;and to analyze and compare the early effect and long-tern effect of the two intervention methods on the patients with depression.3.To explore the differences in pulmonary function improvement between the CBT and combination of CBT with health education used on the COPD patients with depression.Method: 1.Selected population: Patients in this study were hospitalized patients in COPD stable period.Chronic obstructive pulmonary disease can be divided into acute exacerbation period and stable period.Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)refers to the patient's short-term coughing,sputum,wheezing and / or shortness of breath,with at least one symptom aggravating,sputum being purulent or mucopurulent,and the amount increasing.Fever and other signs of inflammation significantly increased.Stable period refers to the stability or mildness of cough,sputum,shortness of breath and other symptoms.Most patients are admitted to the hospital for acute exacerbation and improved to the stable period after receiving regular medication of antibiotics and drugs to reduce phlegm,prevent asthma,relieve airway spasm and so on.The patients in the study were all in their stable period.2.Diagnosis of chronic obstructive pulmonary disease(COPD): Accord with diagnosis standard for COPD clinical symptoms and pulmonary function FEV1 / FVC <70%.3.Diagnosis standard for depression: According to the ICD-10 guidelines,the diagnosis is made by psychiatrists.The main manifestations of depression are silence,loss of interest,fatigue,decreased interest,sleep disorders and so on.In this study,patients who met the diagnostic criteria for COPD were first screened for the patient'shealth questionnaire-9(PHQ-9)and the HAMD-17 scale was used by patients with a screening score higher than 5 to assess their depression state and extent.The patients who scored between 7 and 17 points by HAMD-17 scale were selected in this study given that the cases below 7 didn't conform to the standard of depression and those above 17 were labeled as moderate or severe depression.Patients with severe depression cannot be intervened by simple cognitive behavioral therapy;instead,a psychiatrist should be consulted and,if necessary,medication is required,so we selected the patients with mild depression in this study.4.Collecting data: General information: name,gender,age,years of smoking,the amount of daily smoking,the smoking index,height,weight,BMI,the years of suffering from COPD,relevant examination of pulmonary function including FEV1,FEV1/FVC,FEV1.Some indicators such as dyspnea index(modified British medical research council,m MRC),and COPD assessment test(COPD assessment test,CAT)were evaluated.Patients who met both the diagnostic criteria for COPD and the criteria for mild depression were randomly divided into two groups: experimental group and control group.Two groups of patients were treated with standard COPD,with the control group receiving CBT and the experimental group the combination of CBT and health education.Each subject underwent pulmonary function tests.The evaluation was made on the HAMD-17 scale and pulmonary function was tested after 2 weeks and 2 months respectively(a complete cognitive behavioral therapy cycle).A comparison of the psychological state(depression)and improvement of pulmonary function in the two groups was conducted.Results: 1.Risk factors for depression complicated with COPD: A majority of the patients with COPD smoked with the smoking time(P=0.005),the smoking index(P=0.022)being the risk factors for depression.The amount of daily smoking didn't play a significant role in posing depression.(P=0.321>0.05).The longer the duration of COPD was,the higher the occurrence rate was(P<0.05).The higher the dyspnea index was,the more liable the patients are to suffer from depression(P<0.05).The higher the score of CAT,the higher the risk of depression(P<0.05).The patients withlower FEV1(%prediction)were more likely to suffer from depression(P = 0.041 <0.05),and(FEV1(one-second)P = 0.827)had no significant effect on the occurrence of depression complicated with COPD(P> 0.05).2.The patients in two groups had significant depression reduction,with the combination of CBT with health education(P=0.029<0.05)showing better effects compared with simple CBT(P<0.05).3.For patients with depression complicated with COPD,the improvement in pulmonary function was significant in the two groups,but there was no significant difference between the two groups(P = 0.077> 0.05).Conclusion: 1.The risk of depression in COPD patients was related to the years of smoking,smoking index,COPD course,dyspnea index,CAT value and FEV1(%expected value).The relationship between FEV1,FEV1/ FVC was not significant.2.The effect of CBT and the combination of CBT with health education on the reduction of depression is significant for the patients with depression complicated with COPD.On the basis of CBT,the addition of health education produces more pronounced effect,especially the long-term antidepressant effect.3.There was no significant difference in the improvement of pulmonary function between the two groups.