Strategies to improve anxiety and depression in patients with COPD: a mental health perspective

Athanasios Tselebis, Argyro Pachi, Ioannis Ilias, Epaminondas Kosmas, Dionisios Bratis, Georgios Moussas, Nikolaos Tzanakis, Athanasios Tselebis, Argyro Pachi, Ioannis Ilias, Epaminondas Kosmas, Dionisios Bratis, Georgios Moussas, Nikolaos Tzanakis

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms. Worldwide, the incidence of COPD presents a disturbing continuous increase. Anxiety and depression are remarkably common in COPD patients, but the evidence about optimal approaches for managing psychological comorbidities in COPD remains unclear and largely speculative. Pharmacological treatment based on selective serotonin reuptake inhibitors has almost replaced tricyclic antidepressants. The main psychological intervention is cognitive behavioral therapy. Of particular interest are pulmonary rehabilitation programs, which can reduce anxiety and depressive symptoms in these patients. Although the literature on treating anxiety and depression in patients with COPD is limited, we believe that it points to the implementation of personalized strategies to address their psychopathological comorbidities.

Keywords: COPD; anxiety; depression; pharmacological treatment; psychotherapy.

Figures

Figure 1
Figure 1
Recommendations for appropriate interventions following assessment of mental health symptoms in patients with COPD.

References

    1. Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. [Accessed December 21, 2015]. [Updated 2015]. Available from:
    1. National Heart Lung and Blood Institute . What is COPD? Bethesda, MD: US National Institutes of Health; [Accessed January 9, 2016]. Updated July 31, 2013. Available from: .
    1. Zwar NA, Marks GB, Hermiz O, et al. Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. Med J Aust. 2011;195(4):168–171.
    1. Nathell L, Nathell M, Malmberg P, et al. COPD diagnosis related to different guidelines and spirometry techniques. Respir Res. 2007;8(1):89.
    1. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–555.
    1. Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27:397–412.
    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442.
    1. Edmunds M, Scudder L. Examining the relationships between COPD and anxiety and depression. Heart Lung. 2009;38:34–47.
    1. Pooler A, Beech R. Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review. Int J Chron Obstruct Pulmon Dis. 2014;9:315–330.
    1. Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry. 2000;15:1090–1096.
    1. Lacasse Y, Rousseau L, Maltais F. Prevalence of depressive symptoms and depression in patients with severe oxygen-dependent chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2001;21:80–86.
    1. Aghanwa HS, Erhabor GE. Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital. J Psychosom Res. 2001;50:179–183.
    1. Hill K, Geist R, Goldstein RS. Anxiety and depression in end-stage COPD. Eur Respir J. 2008;31(3):667–677.
    1. Tselebis A, Bratis D, Pachi A, et al. Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) In: Zirimis L, Papazoglakis A, editors. Chronic Obstructive Pulmonary Disease: New Research. New York, NY: Nova Science Publishers; 2013. pp. 15–40.
    1. Light RW, Merrill EJ, Despars JA, et al. Prevalence of depression and anxiety in patients with COPD: relationship to functional capacity. Chest. 1985;87:35–38.
    1. Di Marco F, Verga M, Reggente M, et al. Anxiety and depression in COPD patients: the roles of gender and disease severity. Respir Med. 2006;100:1767–1774.
    1. Katz PP, Julian LJ, Omachi TA, et al. The impact of disability on depression among individuals with COPD. Chest. 2010;137:838–845.
    1. McSweeny AJ, Grant I, Heaton RK, et al. Life quality of patients with chronic obstructive pulmonary disease. Arch Intern Med. 1982;142(3):473–478.
    1. Isoaho R, Keistinen T, Laippala P, et al. Chronic obstructive pulmonary disease and symptoms related to depression in elderly persons. Psychol Rep. 1995;76:287–297.
    1. Borak J, Sliwinski P, Piasecki Z, et al. Psychological status of COPD patients on long term oxygen therapy. Eur Respir J. 1991;4:59–62.
    1. Engstrom CP, Persson LO, Larsson S, et al. Functional status and well being in chronic obstructive pulmonary disease with regard to clinical parameters and smoking: a descriptive and comparative study. Thorax. 1996;51:825–830.
    1. White RJ, Rudkin ST, Ashley J, et al. Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease. J R Coll Physicians Lond. 1997;31:541–545.
    1. Bosley CM, Corden ZM, Rees PJ, et al. Psychological factors associated with use of home nebulized therapy for COPD. Eur Respir J. 1996;9:2346–2350.
    1. Jones PW, Baveystock CM, Littlejohns P. Relationships between general health measured with the sickness impact profile and respiratory symptoms, physiological measures, and mood in patients with chronic airflow limitation. Am Rev Respir Dis. 1989;140:1538–1543.
    1. Karajgi B, Rifkin A, Doddi S, et al. The prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease. Am J Psychiatry. 1990;147:200–201.
    1. Mikkelsen RL, Middelboe T, Pisinger C, et al. Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review. Nord J Psychiatry. 2004;58:65–70.
    1. Dowson CA, Kuijer RG, Mulder RT. Anxiety and self-management behaviour in chronic obstructive pulmonary disease: what has been learned? Chron Respir Dis. 2004;1:213–220.
    1. Hynninen KM, Breitve MH, Wiborg AB, et al. Psychological characteristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res. 2005;59:429–443.
    1. Maurer J, Rebbapragada V, Borson S, et al. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest. 2008;134(4 Suppl):43S–56S.
    1. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage. 2006;31:58–69.
    1. Felker B, Katon W, Hedrick SC, et al. The association between depressive symptoms and health status in patients with chronic pulmonary disease. Gen Hosp Psychiatry. 2001;23:56–61.
    1. Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly patients with chronic obstructive pulmonary disease. Age Ageing. 2006;35(5):457–459.
    1. Hanania NA, Mullerova H, Locantore NW, et al. Determinants of depression in the ECLIPSE chronic obstructive pulmonary disease cohort. Am J Respir Crit Care Med. 2011;183:604–611.
    1. Cully JA, Graham DP, Stanley MA, et al. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics. 2006;47:312–319.
    1. Prigatano GP, Wright EC, Levin D. Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease. Arch Intern Med. 1984;144(8):1613–1619.
    1. Kosmas E, Tselebis A, Bratis D, et al. The Relationship between the adherence to treatment and the psychological profile of patients with chronic obstructive pulmonary disease. Chest. 2014;145(3_MeetingAbstracts):377A.
    1. Stapleton RD, Nielsen EL, Engelberg RA, et al. Association of depression and life-sustaining treatment preferences in patients with COPD. Chest. 2005;127:328–334.
    1. Laurin C, Moullec G, Bacon SL, et al. Impact of anxiety and depression on chronic obstructive pulmonary disease exacerbation risk. Am J Respir Crit Care Med. 2012;185:918–923.
    1. Fan VS, Curtis JR, Tu SP, et al. Using quality of life to predict hospitalization and mortality in patients with obstructive lung diseases. Chest. 2002;122:429–436.
    1. Almagro P, Calbo E, de Echagüen AO, et al. Mortality after hospitalization for COPD. Chest. 2002;121:1441–1448.
    1. Stage KB, Middelboe T, Pisinger C. Depression and chronic obstructive pulmonary disease (COPD). Impact on survival. Acta Psychiatr Scand. 2005;111(4):320–323.
    1. Fan VS, Ramsey SD, Giardino ND, et al. Sex, depression, and risk of hospitalization and mortality in chronic obstructive pulmonary disease. Arch Intern Med. 2007;167:2345–2353.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994.
    1. World Health Organization . The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research. Geneva, Switzerland: WHO; 1993.
    1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–55.
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–897.
    1. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State–Trait Anxiety Inventory (Form Y) Palo Alto, CA: Consulting Psychologist’s Press; 1983.
    1. Willgoss TG, Yohannes AM. Anxiety disorders in patients with COPD: a systematic review. Respir Care. 2013;58(5):858–866.
    1. Smoller JW, Pollack MH, Otto MW, et al. Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations. Am J Respir Crit Care Med. 1996;154(1):6–17.
    1. Klein DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry. 1993;50:306–317.
    1. Dudley DL, Glaser EM, Jorgenson BN, et al. Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease. Part 2: psychosocial treatment. Chest. 1980;77(4):544–551.
    1. Kim HF, Kunik ME, Molinari VA, et al. Functional impairment in COPD patients: the impact of anxiety and depression. Psychosomatics. 2000;41:465–471.
    1. Pauwels RA, Buist AS, Calverley PMA, et al. GOLD Scientific Committee Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163:1256–1276.
    1. Patton GC, Hibbert M, Rosier MJ, et al. Is smoking associated with depression and anxiety in teenagers? Am J Public Health. 1996;86:225–230.
    1. Breslau N, Kilbey MM, Andreski P. Nicotine withdrawal symptoms and psychiatric disorders: findings from an epidemiologic study of young adults. Am J Psychiatry. 1992;149:464–469.
    1. Acri JB, Grunberg N. A psychophysical task to quantify smoking cessation induced irritability: the reactive irritability scale (RIS) Addict Behav. 1992;17:587–601.
    1. Parrott AC. Stress modulation over the day in cigarette smokers. Addiction. 1995;90:233–244.
    1. Thornton A, Lee P, Fry J. Differences between smokers, ex-smokers, passive smokers and non-smokers. J Clin Epidemiol. 1994;47(10):1143–1162.
    1. Umezawa A. A respiratory control method based on psycho-physiological studies Proceedings of the 11th Annual Meeting of the International Society for the Advancement of Respiratory Psychophysiology (ISARP), Princeton NJ, October 17–19, 2004. Biol Psychiatry. 2006;(72):222–238.
    1. O’Donnell D, Banzett R, Carrieri-Kohlman V, et al. Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable. Proc Am Thorac Soc. 2007;4:145–168.
    1. Jolley CJ, Moxham J. A physiological model of patient-reported breathlessness during daily activities in COPD. Eur Respir Rev. 2009;18(112):66–79.
    1. Liotti M, Brannan S, Egan G, et al. Brain responses associated with consciousness of breathlessness (air hunger) Proc Natl Acad Sci U S A. 2001;98:2035–2040.
    1. Evans KC, Banzett RB, Adams L, et al. BOLD fMRI identifies limbic, paralimbic, and cerebellar activation during air hunger. J Neurophysiol. 2002;88:1500–1511.
    1. Livermore N, Butler J, Sharpe L, McBain R, Gandevia S, McKenzie D. Panic attacks and perception of inspiratory resistive loads in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008;178:7–12.
    1. Bailey PH. The dyspnea–anxiety–dyspnea cycle – COPD patients’ stories of breathlessness: “It’s scary/when you can’t breathe”. Qual Health Res. 2005;14(6):760–778.
    1. Porzelius J, Vest M, Nochomovitz M. Respiratory function, cognitions, and panic in chronic obstructive pulmonary patients. Behav Res Ther. 1992;30:75–77.
    1. Howard C, Hallas C, Wray J, et al. The relationship between illness perceptions and panic in chronic obstructive pulmonary disease. Behav Res Ther. 2009;47:71–76.
    1. McKenzie D, Butler J, Gandevia S. Respiratory muscle function and activation in chronic obstructive pulmonary disease. J Appl Physiol. 2009;107:621–629.
    1. Vanderpool M. Resilience: a missing link in our understanding of survival. Harv Rev Psychiatry. 2002;10:302–306.
    1. Dowson CA, Town GI, Framptom C, et al. Psychopathology and illness beliefs influence COPD self-management. J Psychosom Res. 2004;56(3):333–340.
    1. O’Donnell DE, Webb K, McGuire M. Controlling Breathlessness and Cough Comprehensive Management of COPD. Hamilton, ON: BC Decker; 2002.
    1. Lustig FM, Haas A, Castillo R. Clinical and rehabilitation regime in patients with chronic obstructive pulmonary diseases. Arch Phys Med Rehabil. 1972;53:315–322.
    1. Cantor L, Jacobson R. COPD: how to manage comorbid depression and anxiety. J Fam Pract. 2003;2:11.
    1. Brown GW, Andrews B, Harris T, Adler Z, Bridge L. Social support, self esteem and depression. Psychol Med. 1986;6:238–247.
    1. Holahan CK, Holahan CJ. Self-efficacy, social support, and depression in aging: a longitudinal analysis. J Gerontol. 1987;42(1):65–68.
    1. Kaptein AA, Scharloo M, Fischer MJ, et al. Illness perceptions and COPD: an emerging field for COPD patient management. J Asthma. 2008;45:625–629.
    1. Tselebis A, Kosmas E, Bratis D, et al. Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients. Ann Gen Psychiatry. 2010;9:16.
    1. Mishima M, Oku Y, Muro S, et al. Relationship between dyspnoea in daily life and psycho-physiologic state in patients with chronic obstructive pulmonary disease during long term domiciliary oxygen therapy. Intern Med. 1996;35:453–458.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: APA; 2015.
    1. Gift AG, McCrone SH. Depression in patients with COPD. Heart Lung. 1993;22:289–297.
    1. Koenig HG. Differences between depressed patients with heart failure and those with pulmonary disease. Am J Geriatr Psychiatry. 2006;14:211–219.
    1. Kurosawa H, Shimizu Y, Nishimatsu Y, et al. The relationship between mental disorders and physical severities in patients with acute myocardial infarction. Jpn Circ J. 1983;47(6):723–728.
    1. Katon W, Sullivan MD. Depression and chronic medical illness. J Clin Psychiatry. 1990;51:3–11.
    1. Evans DL, Staab JP, Petitto JM, et al. Depression in the medical setting: biopsychological interactions and treatment considerations. J Clin Psychiatry. 1999;60(Suppl 4):40–55.
    1. Yohannes AM, Baldwin RC, Connolly MJ. Prevalence of sub-threshold depression in elderly patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry. 2003;18:412–416.
    1. Emery CF, Green MR, Suh S. Neuropsychiatric function in chronic lung disease: the role of pulmonary rehabilitation. Respir Care. 2008;53(9):1208–1216.
    1. Graydon JE, Ross E. Influence of symptoms, lung function, mood, and social support on level of functioning of patients with COPD. Res Nurs Health. 1995;18(6):525–533.
    1. Weaver TE, Richmond TS, Narsavage GL. An explanatory model of functional status in chronic obstructive pulmonary disease. Nurs Res. 1997;46(1):26–31.
    1. Johnson G, Kong DC, Thoman R. Factors associated with medication nonadherence in patients with COPD. Chest. 2005;128(5):3198–3204.
    1. Leidy NK. Functional performance in people with chronic obstructive pulmonary disease. Image J Nurs Sch. 1995;27(1):23–34.
    1. Wagena EJ, Kant I, Huibers MJ, et al. Psychological distress and depressed mood in employees with asthma, chronic bronchitis or emphysema: a population-based observational study on prevalence and the relationship with smoking cigarettes. Eur J Epidemiol. 2004;19(2):147–153.
    1. Post L, Collins C. The poorly coping COPD patient: a psychotherapeutic perspective. Int J Psychiatry Med. 11(2):1981–1982. 173–182.
    1. Cleland JA, Lee AJ, Hall S. Associations of depression and anxiety with gender, age, health-related quality of life and symptoms in primary care COPD patients. Fam Pract. 2007;24(3):217–223.
    1. Norwood RJ. A review of etiologies of depression in COPD. Int J Chron Obstruct Pulmon Dis. 2007;2(4):485–491.
    1. Schmidt NB, Telch MJ, Jaimez TL. Biological challenge manipulation of PCO2 levels: a test of Klein’s (1993) suffocation alarm theory of panic. J Abnorm Psychol. 1996;105(3):446–454.
    1. Ferguson DM. Comorbidity between depressive disorders and nicotine dependence in a cohort of 16 year olds. Arch Gen Psychiatry. 1996;53:1043–1047.
    1. Agle DP, Baum GL. Psychological aspects of chronic obstructive pulmonary disease. Med Clin North Am. 1977;61(4):749–758.
    1. Dunlop DD, Lyons JS, Manheim LM, et al. Arthritis and heart disease as risk factors for major depression: the role of functional limitation. Med Care. 2004;42(6):502–511.
    1. Cooper CB. Determining the role of exercise in patients with chronic pulmonary disease. Med Sci Sports Exerc. 1995;27:147–157.
    1. van Dijk EJ, Vermeer SE, de Groot JC, et al. Arterial oxygen saturation, COPD, and cerebral small vessel disease. J Neurol Neurosurg Psychiatry. 2004;75:733–736.
    1. Campbell JJ, 3rd, Coffey CE. Neuropsychiatric significance of sub-cortical hyperintensity. J Neuropsychiatry Clin Neurosci. 2001;13:261–288.
    1. El-Ad B, Lavie P. Effect of sleep apnea on cognition and mood. Int Rev Psychiatry. 2005;17(4):277–282.
    1. Ozge C, Ozge A, Unal O. Cognitive and functional deterioration in patients with severe COPD. Behav Neurol. 2006;17(2):121–130.
    1. Aloia MS, Arnedt JT, Davis JD, et al. Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc. 2004;10:772–785.
    1. Figiel GS, Krishnan KR, Doraiswamy PM, et al. Subcortical hyperintensities on brain magnetic resonance imaging: a comparison between late age onset and early onset elderly depressed subjects. Neurobiol Aging. 1991;12:245–247.
    1. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33:1165–1185.
    1. Nussbaumer-Ochsner Y, Rabe KF. Systemic manifestations of COPD. Chest. 2011;139(1):165–173.
    1. Eagan TM, Ueland T, Wagner PD, et al. Systemic inflammatory markers in COPD: results from the Bergen COPD Cohort Study. Eur Respir J. 2010;35:540–548.
    1. Anisman H, Merali Z, Hayley S. Neurotransmitter, peptide and cytokine processes in relation to depressive disorder: comorbidity between depression and neurodegenerative disorders. Prog Neurobiol. 2008;85:1–74.
    1. Bemt L, Schermer T, Bor H. The risk for depression comorbidity in patients with COPD. Chest. 2009;135(1):108–111.
    1. Gift AG, Wood RM, Cahill CA. Depression, somatization and steroid use in chronic obstructive pulmonary disease. Int J Nurs Stud. 1989;26:281–286.
    1. Cafarella PA, Effing TW, Usmani ZA. Treatments for anxiety and depression in patients with chronic obstructive pulmonary disease: a literature review. Respirology. 2012;17(4):627–638.
    1. National Institute for Health and Care Excellence . Depression in Adults with a Chronic Physical Health Problem. Treatment and Management. London, UK: National Institute for Health and Care Excellence; 2009. [Accessed December 21, 2015]. Available from: .
    1. da Costa Santos CM, de Mattos Pimenta CA, Nobre MR. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem. 2007;15(3):508–511.
    1. O’Connor D, Green S, Higgins JPT. Defining the review question and developing criteria for including studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.0. London, UK: The Cochrane Collaboration; [Accessed December 21, 2015]. Updated February 2008. Available from:
    1. Critical Appraisal Skills Programme Critical Appraisal Skills Programme: Making Sense Of Evidence. Secondary Critical Appraisal Skills Programme: Making Sense Of Evidence. 2013. [Accessed December 21, 2015]. Available from:
    1. National Institute for Health and Clinical Excellence Depression. The treatment and management of depression in adults This is a partial update of NICE clinical guideline 23. NICE clinical guideline 90. Oct, 2009. [Accessed January 9, 2016]. Available from: .
    1. Yohannes AM. Management of anxiety and depression in patients with COPD. Expert Rev Respir Med. 2008;2:337–347.
    1. Xu W, Collet JP, Shapiro S, et al. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med. 2008;178:913–920.
    1. Koenig HG. Predictors of depression outcomes in medical inpatients with chronic pulmonary disease. Am J Geriatr Psychiatry. 2006;14:939–948.
    1. Kunik ME, Roundy K, Veazey C, et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest. 2005;127:1205–1211.
    1. Cicutto LC, Brooks D. Self-care approaches to managing chronic obstructive pulmonary disease: a provincial survey. Respir Med. 2006;100:1540–1546.
    1. Covino NA, Dirks JF, Kinsman RA, et al. Patterns of depression in chronic illness. Psychother Psychosom. 1982;37:144–153.
    1. Coffey CE, Figiel GS, Djang WT, et al. Leukoencephalopathy in elderly depressed patients referred for ECT. Biol Psychiatry. 1988;24:143–161.
    1. Hickie I, Scott E, Mitchell P, et al. Subcortical hyperintensities on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression. Biol Psychiatry. 1995;37:151–160.
    1. Krishnan KR, Hays JC, Tupler LA, et al. Clinical and phenomenological comparisons of late-onset and early-onset depression. Am J Psychiatry. 1995;152:785–788.
    1. Krishnan KR, Hays JC, Blazer DG. MRI-defined vascular depression. Am J Psychiatry. 1997;154:497–501.
    1. Fujikawa T, Yamawaki S, Touhouda Y. Background factors and clinical symptoms of major depression with silent cerebral infarction. Stroke. 1994;25:798–801.
    1. Covey LS, Glassman AH, Stetner F. Major depression following smoking cessation. Am J Psychiatry. 1997;154(2):263–265.
    1. Covey LS. Tobacco cessation among patients with depression. Prim Care. 1999;26(3):691–706.
    1. Hillas G, Perlikos F, Tsiligianni I, et al. Managing comorbidities in COPD. International Journal of COPD. 2015;10:95–109.
    1. Nelson DR. The cytochrome p450 homepage. Hum Genomics. 2009;4:59–65.
    1. Steen SN. The effects of psychotropic drugs on respiration. Pharmacol Ther B. 1976;2:717–741.
    1. Man GCW, Hsu K, Spoule BJ, et al. Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest. 1986;90:832–836.
    1. Halvorsen T, Martinussen PE. Benzodiazepine use in COPD: empirical evidence from Norway. Int J Chron Obstruct Pulmon Dis. 2015;10:1695–1702.
    1. Ekström MP, Bornefalk-Hermansson A, Abernethy AP, et al. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. 2014;348:g445.
    1. Borson S, McDonald GJ, Gayle T, et al. Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Psychosomatics. 1992;33:190–201.
    1. Light RW, Merrill EJ, Despars J, et al. Doxepin treatment of depressed patients with chronic obstructive pulmonary disease. Arch Intern Med. 1986;146:1377–1380.
    1. Ström K, Boman G, Pehrsson K, et al. Effect of protriptyline, 10 mg daily, on chronic hypoxaemia in chronic obstructive pulmonary disease. Eur Respir J. 1995;8:425–429.
    1. Gordon GH, Michiels TM, Mahutte CK, et al. Effect of desipra-mine on control of ventilation and depression scores in patients with severe chronic obstructive pulmonary disease. Psychiatry Res. 1985;15:25–32.
    1. Sharma TN, Goyal RL, Gupta PR, et al. Psychiatric disorders in COPD with special reference to the usefulness of imipramine–diazepam combination. Indian J Chest Dis Allied Sci. 1988;30:263–268.
    1. Borson S, Claypoole K, McDonald GL. Depression and chronic obstructive pulmonary disease: treatment trials. Semin Clin Neuropsychiatry. 1998;3:115–130.
    1. Yohannes AM, Connolly MJ, Baldwin RC. A feasibility study of antidepressant drug therapy in depressed elderly patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry. 2001;16:451–454.
    1. Eiser N, Harte R, Spiros K. Effect of treating depression on quality-of-life and exercise tolerance in severe COPD. COPD. 2005;2:233–241.
    1. Papp LA, Weiss JR, Greenberg HE, et al. Sertraline for chronic obstructive pulmonary disease and comorbid anxiety and mood disorders. Am J Psychiatry. 1995;152:1531.
    1. Smoller JW, Pollack MH, Systrom D, et al. Sertraline effects on dyspnea in patients with obstructive airways disease. Psychosomatics. 1998;39:24–29.
    1. Lacasse Y, Beaudoin L, Rousseau L, et al. Randomized trial of paroxetine in end-stage COPD. Monaldi Arch Chest Dis. 2004;61:140–147.
    1. Evans M, Hammond M, Wilson K, et al. Placebo controlled treatment trial of depression in elderly physically ill patients. Int J Geriatr Psychiatry. 1997;12:817–824.
    1. Silvertooth EJ, Doraiswamy PM, Clary GL, et al. Citalopram and quality of life in lung transplant recipients. Psychosomatics. 2004;45:171–272.
    1. Hegerl U, Mergl R. Depression and suicidality in COPD: understandable reaction or independent disorders? Eur Respir J. 2014;44(3):734–743.
    1. Voekel M, Voelkel NF, MacNee W. Chronic Obstructive Lung Diseases 2. Psychosocial Aspects of Chronic Obstructive Pulmonary Disease. Hamilton, ON: B.C. Decker Inc; 2008.
    1. Brenes GA. Anxiety and chronic obstructive pulmonary disease: prevalence, impact, and treatment. Psychosom Med. 2003;65:963–970.
    1. Argyropoulou P, Patakas D, Koukou A, et al. Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease. Respiration. 1993;60:216–220.
    1. Singh NP, Despars JA, Stansbury DW, et al. Effects of buspirone on anxiety levels and exercise tolerance in patients with chronic airflow obstruction and mild anxiety. Chest. 1993;103:800–804.
    1. Usmani ZA, Carson KV, Cheng J, et al. Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease (Review) Cochrane Database Syst Rev. 2011;(11):CD008483.
    1. Subbe C, Collier GM, Bedson E, et al. ISRCTN41544517: Pilot Study to Examine the Effect of Citalopram on Health Status, Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease. 2004. [Accessed December 21, 2015]. Available from: .
    1. Yohannes AM, Connolly MJ. Do antidepressants work in patients with chronic obstructive pulmonary disease with comorbid depression? Expert Rev Respir Med. 2011;5(6):727–729.
    1. Wilson I. Depression in the patient with COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(1):61–64.
    1. Yohannes AM, Alexopoulos GS. Pharmacologic treatment of depression in older patients with COPD: impact on the course of the disease and health outcomes. Drugs Aging. 2014;31(7):483–492.
    1. Bourbeau J, Nault D, Borycki E. Comprehensive Management of Chronic Obstructive Pulmonary Disease. Hamilton, ON: B.C. Decker Inc; 2002.
    1. McHugh RK, Whitton SW, Peckham AD, et al. Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. J Clin Psychiatry. 2013;74(6):595–602.
    1. National Institute for Health and Clinical Excellence . NICE Clinical Guideline 22 Anxiety (Amended): Management of Anxiety (Panic Disorder, With or Without Agoraphobia, and Generalized Anxiety Disorder) in Adults in Primary, Secondary or Community Care. London, UK: National Institute for Health and Clinical Excellence; 2007. [Accessed January 9, 2016]. Available from: .
    1. National Institute for Health and Clinical Excellence . CG91 Depression with a Chronic Physical Health Problem: NICE Guideline. London, UK: National Collaborating Centre for Mental Health; 2009. [Accessed January 9, 2016]. Available from: .
    1. Beck AT, Rush AJ, Shaw BF, et al. Cognitive Therapy for Depression. New York, NY: Guildford Press; 1979.
    1. Heslop K, De Soyza A, Baker CR, Stenton C, Burns GP. Using individualized cognitive behavioral therapy as a treatment for people with COPD. Nurs Times. 2009;105:14–17.
    1. Kraus CA, Kunik ME, Stanley MA. Use of cognitive behavioral therapy in late-life psychiatric disorders. Geriatrics. 2007;62:21–26.
    1. Lightner E. Effect of individual cognitive behavioral therapy on depression and anxiety in older adults with chronic obstructive pulmonary disease: a feasibility study. Psychology Dissertations. 2010. [Accessed December 21, 2015]. Paper 81. Available from: .
    1. Ekers D, Richards D, Gilbody S. A meta-analysis of randomized trials of behavioural treatment of depression. Psychol Med. 2008;38:611–623.
    1. Hynninen M, Bjerke N, Pallesen S, et al. A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD. Respir Med. 2010;104:986–994.
    1. Kunik ME, Braun U, Stanley MA, et al. One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease. Psychol Med. 2001;31:717–723.
    1. Smith SMS, Sonego S, Ketcheson L, et al. A review of the effectiveness of psychological interventions used for anxiety and depression in chronic obstructive pulmonary disease. BMJ Open Respir Res. 2014;1:e000042.
    1. Coventry PA, Gellatly JL. Improving outcomes for COPD patients with mild-to-moderate anxiety and depression: a systematic review of cognitive behavioural therapy. Br J Health Psychol. 2008;13:381–400.
    1. Yalom ID, Leszcz M. The Theory and Practice of Group Psychotherapy. 5th ed. New York, NY: Basic Books; 2005. p. XII.
    1. Butler T, Fuhriman A. Curative factors in group therapy: a review of the recent literature. Small Group Res. 1983;14:131–142.
    1. Vickers A, Zollman C. ABC of complementary medicine. Hypnosis and relaxation therapies. BMJ. 1999;319:1346–1349.
    1. Volpato E, Banfi P, Roger SM, et al. Relaxation techniques for people with chronic obstructive pulmonary disease: a systematic review and a meta-analysis. Evid Based Complement Alternat Med. 2015;2015:628365.
    1. Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry. 1974;37:37–46.
    1. Devine EC, Pearcy J. Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease. Patient Educ Couns. 1996;29:167–178.
    1. Lolak S, Connors GL, Sheridan MJ, et al. Effects of progressive muscle relaxation training on anxiety and depression in patients enrolled in an outpatient pulmonary rehabilitation program. Psychother Psychosom. 2008;77:119–125.
    1. Yeh GY, Roberts DH, Wayne PM, et al. Tai chi exercise for patients with chronic obstructive pulmonary disease: a pilot study. Respir Care. 2010;55:1475–1482.
    1. Donesky-Cuenco D, Nguyen HQ, Paul S, et al. Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med. 2009;15:225–234.
    1. Lord VM, Cave P, Hume VJ, et al. Singing teaching as a therapy for chronic respiratory disease – a randomised controlled trial and qualitative evaluation. BMC Pulm Med. 2010;10:41.
    1. Lord VM, Hume VJ, Kelly JL, et al. Singing classes for chronic obstructive pulmonary disease: a randomized controlled trial. BMC Pulm Med. 2012;12:69.
    1. Bonilha AG, Onofre F, Vieira ML, et al. Effects of singing classes on pulmonary function and quality of life of COPD patients. Int J Chron Obstruct Pulmon Dis. 2009;4:1–8.
    1. Pumar MI, Gray CR, Walsh JR, et al. Anxiety and depression – important psychological comorbidities of COPD. J Thorac Dis. 2014;6(11):1615–1631.
    1. Nici L, Donner C, Wouters E, et al. ATS/ERS Pulmonary Rehabilitation Writing Committee American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–1414.
    1. Richard Z. The nonpharmacologic treatment of chronic obstructive pulmonary disease. Advances in our understanding of pulmonary rehabilitation. Proc Am Thorac Soc. 2007;4(7):549–553.
    1. Stockley RA. Chronic Obstructive Pulmonary Disease. Oxford, UK: Blackwell Publishing Ltd; 2007.
    1. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):1011–1027.
    1. Goldstein RS, Gort EH, Stubbing D, et al. Randomised controlled trial of respiratory rehabilitation. Lancet. 1994;344:1394–1397.
    1. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355:362–368.
    1. Mota S, Güell R, Barreiro E, et al. Clinical outcomes of expiratory muscle training in severe COPD patients. Respir Med. 2007;101(3):516–524.
    1. Emery CF, Shermer RL, Hauck ER, et al. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychol. 2003;22:598–604.
    1. Kozora E, Tran ZV, Make B. Neurobehavioral improvement after brief rehabilitation in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2002;22:426–430.
    1. Garuti G, Cilione C, Dell’Orso D, et al. Impact of comprehensive pulmonary rehabilitation on anxiety and depression in hospitalized COPD patients. Monaldi Arch Chest Dis. 2003;59:56–61.
    1. Boutou AK, Tanner RJ, Lord VM, et al. An evaluation of factors associated with completion and benefit from pulmonary rehabilitation in COPD. BMJ Open Respir Res. 2014;1:e000051.
    1. Fischer MJ, Scharloo M, Abbink JJ, et al. Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient’s perspective. Clin Rehabil. 2007;21:212–221.
    1. Robertson N. Running up that hill: how pulmonary rehabilitation can be enhanced by understanding patient perceptions of their condition. Chron Respir Dis. 2010;7(4):203–205.
    1. Dishman RK. Brain monoamines, exercise, and behavioral stress: animal models. Med Sci Sports Exerc. 1997;29(1):63–74.
    1. Ransford CP. A role for amines in the antidepressant effect of exercise: a review. Med Sci Sports Exerc. 1982;14(1):1–10.
    1. Dunn AL, Reigle TG, Youngstedt SD, et al. Brain norepinephrine and metabolites after treadmill training and wheel running in rats. Med Sci Sports Exerc. 1996;28(2):204–209.
    1. Jacobs BL. Serotonin, motor activity and depression-related disorders. Am Sci. 1994;82:456–463.
    1. Chaouloff F. Effects of acute exercise on central serotonergic systems. Med Sci Sports Exerc. 1997;29(1):58–62.
    1. Raglin JS, Morgan WP. Influence of exercise and quiet rest on state anxiety and blood pressure. Med Sci Sports Exerc. 1981;19(5):456–463.
    1. Carr DB, Bullen BA, Skrinar GS, et al. Physical conditioning facilitates the exercise-induced secretion of beta-endorphin and beta-lipotropin in women. N Engl J Med. 1981;305(10):597–617.
    1. Farrell PA, Gates WK, Maksud MG, et al. Increases in plasma beta-endorphin/beta-lipotropin immunoreactivity after treadmill running in humans. J Appl Physiol Respir Environ Exerc Physiol. 1982;52(5):1245–1249.
    1. Gambert SR, Hagen TC, Garthwaite TL. Exercise and the endogenous opioids. N Engl J Med. 1981;305:1590–1591.
    1. Pitsavos C, Chrysohoou C, Panagiotakos DB, et al. Association of leisure-time physical activity on inflammation markers (C-reactive protein, white cell blood count, serum amyloid A, and fibrinogen) in healthy subjects (from the ATTICA study) Am J Cardiol. 2003;91(3):368–370.
    1. Church TS, Barlow CE, Earnest CP, et al. Associations between cardiorespiratory fitness and C-reactive protein in men. Arterioscler Thomb Vasc Biol. 2002;22(11):1869–1876.
    1. Morrow J, Nolen-Hoeksema S. Effects of response to depression on the remediation of depressive affect. J Pers Soc Psychol. 1990;58(3):519–527.
    1. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta earthquake. J Pers Soc Psychol. 1991;61(1):115–121.
    1. McAuley E, Jerome GJ, Marquez DX, et al. Exercise self-efficacy in older adults: social, affective, and behavioral influences. Ann Behav Med. 2003;25(1):1–7.
    1. Craft LL. Exercise and clinical depression: examining two psychological mechanisms. Psychol Sport Exerc. 2003;6:151–171.
    1. Lewinsohn PM, Gotlib IH. Behavioral theory and treatment of depression. In: Beckham EE, Leber WR, editors. Handbook of Depression. 2nd ed. New York, NY: Guildford Press; 1995. pp. 352–375.
    1. Bartoholomew JB, Ciccolo JT. Exercise, depression, and cognition. In: Spirduso WW, Poon LW, Chodzko-Zajko W, editors. Exercise and Its Mediating Effects on Cognition. Vol. 2. Champaign, IL: Human Kinetics; 2008. pp. 33–46.
    1. Coventry PA, Hind D. Comprehensive pulmonary rehabilitation for anxiety and depression in adults with chronic obstructive pulmonary disease: systematic review and meta-analysis. J Psychosom Res. 2007;63:551–565.
    1. Withers NJ, Rudkin ST, White RJ. Anxiety and Depression in Sever Chronic Obstructive Pulmonary Disease: The Effects of Pulmonary Rehabilitation. Bristol, UK: Department of Medicine, Frenchay Hospital; 1999.
    1. Alexopoulos GS, Kiosses DN, Sirey JA, et al. Untangling therapeutic ingredients of a personalized intervention for patients with depression and severe COPD. Am J Geriatr Psychiatry. 2014;22(11):1316–1324.
    1. Ries AL, Kaplan RM, Limberg TM, et al. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med. 1995;122:823–832.
    1. Sassi-Dambron DE, Eakin EG, Ries AL, et al. Treatment of dyspnea in COPD: a controlled clinical trial of dyspnea management strategies. Chest. 1995;107:724–729.
    1. Lorig KR, Sobel DS, Stewart AL, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37:5–14.
    1. Pantou I, Harikiopoulou M, Bratis D, et al. The impact of rehabilitation-induced symptomatic, functional and psychological outcomes on health-related quality of life. European Respiratory Society, Annual Congress. September 2–6, 2006, Munich, Germany. European Respiratory Journal. 2006;28(suppl 5) Published in.
    1. Paz-Dıaz H, Montes de Oca M, Lopez JM, et al. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil. 2006;86(1):30–35.
    1. Jácome C, Marque A. Impact of pulmonary rehabilitation in subjects with mild COPD. Respir Care. 2014;59(10):1577–1582.
    1. Alexopoulos GS, Sirey JA, Raue PJ, et al. Outcomes of depressed patients undergoing inpatient pulmonary rehabilitation. Am J Geriatr Psychiatry. 2006;14:466–475.
    1. Guell R, Resqueti V, Sangenis M, et al. Impact of pulmonary rehabilitation on psychosocial morbidity in patients with severe COPD. Chest. 2006;129:899–904.
    1. Kosmas E, Tselebis A, Bratis D, et al. Impact of pulmonary rehabilitation on anxiety and depression in patients with COPD; European Respiratory Society, Annual Congress; Berlin, Germany: 2008.
    1. Pantou I, Harikiopoulou M, Mpletsa M, et al. Does the severity of chronic obstructive pulmonary disease reflect on the outcomes of pulmonary rehabilitation?. European Respiratory Society, Annual Congress; Stockholm: 2007.
    1. Mignogna J, Cully JA. Depression and anxiety in patients with COPD: a focus on psychological treatments in ambulatory care settings. Curr Respir Med Rev. 2012;8:137–144.
    1. Panagioti M, Scott C, Blakemor A, et al. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2014;9:1289–1306.
    1. Yohannes AM, Alexopoulos GS. Depression and anxiety in patients with COPD. Eur Respir Rev. 2014;23(133):345–349.
    1. U.S. Preventive Services Task Force Screening for depression: recommendations and rationale. Ann Intern Med. 2002;136:760–764.
    1. Gilbody S, House AO, Sheldon TA. Screening and case finding instruments for depression. Cochrane Database Syst Rev. 2005;(4):CD002792.
    1. Cavanaugh S, Clark DC, Gibbons RD. Diagnosing depression in the hospitalized medically ill. Psychosomatics. 1983;24:809–815.
    1. Bukberg J, Penman D, Holland JC. Depression in hospitalized cancer patients. Psychosom Med. 1984;46:199–212.
    1. Endicott J. Measurement of depression in patients with cancer. Cancer. 1984;53:2243–2249.
    1. Yates WR, Mitchell J, Rush AJ, et al. Clinical features of depressed outpatients with and without co-occurring general medical conditions in STAR*D. Gen Hosp Psychiatry. 2004;26:421–429.
    1. Yohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr Psychiatry. 2010;25:1209–1221.
    1. Simon GE, Von Korff M. Medical co-morbidity and validity of DSM-IV depression criteria. Psychol Med. 2006;36:27–36.
    1. Engstrom CP, Persson LO, Larsso S, et al. Health-related quality of life in COPD: why both disease-specific and generic measures should be used. Eur Respir J. 2001;18:69–76.
    1. Alexopoulos GS, Raue PJ, Sirey JA, Arean PA. Developing an intervention for depressed, chronically medically ill elders: a model from COPD. Int J Geriatr Psychiatry. 2008;23(5):447–453.
    1. Alexopoulos GS, Kiosses DN, Sirey JA, et al. Personalised intervention for people with depression and severe COPD. Br J Psychiatry. 2013;202(3):235–236.
    1. Gilbody S, Bower P, Fletcher J, et al. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006;166:2314–2321.
    1. Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012;10:CD006525.
    1. Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363(27):2611–2620.
    1. Coventry PA, Bower P, Keywort C, et al. The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis. PLoS One. 2013;8(4):e60532.
    1. Clark NM, Dodge JA, Partridge MR, et al. Focusing on outcomes: making the most of COPD interventions. Int J Chron Obstruct Pulmon Dis. 2009;4:61–77.
    1. Almagro P, Castro A. Helping COPD patients change health behavior in order to improve their quality of life. Int J Chron Obstruct Pulmon Dis. 2013;8:335–345.
    1. Momtaz OM, Rabei SM, Tawfike NR, et al. Effect of treatment of depression and anxiety on physiological state of severe COPD patients. Egypt J Chest Dis Tuberc. 2015;64:29–34.
    1. He Y, Zheng Y, Xu C, et al. Sertraline hydrochloride treatment for patients with stable chronic obstructive pulmonary disease complicated with depression: a randomized controlled trial. Clin Respir J. 2014 Oct 13; Epub.
    1. Bove DG, Overgaard D, Lomborg K, et al. Efficacy of a minimal home-based psychoeducative intervention versus usual care for managing anxiety and dyspnoea in patients with severe chronic obstructive pulmonary disease: a randomised controlled trial protocol. BMJ Open. 2015;5:e008031.
    1. Howard C, Dupont S. The COPD breathlessness manual’: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. NPJ Prim Care Respir Med. 2014;24:14076.
    1. Jiang X, He G. Effects of an uncertainty management intervention on uncertainty, anxiety, depression, and quality of life of chronic obstructive pulmonary disease outpatients. Res Nurs Health. 2012;35(4):409–418.
    1. Kapella MC, Herdegen JJ, Perlis ML, et al. Cognitive behavioral therapy for insomnia comorbid with COPD is feasible with preliminary evidence of positive sleep and fatigue effects. Int J Chron Obstruct Pulmon Dis. 2011;6:625–635.
    1. Livermore N, Sharpe L, McKenzie D. Prevention of panic attacks and panic disorder in COPD. Eur Respir J. 2010;35:557–563.
    1. Lamers F, Jonkers CC, Bosma H, et al. Improving quality of life in depressed COPD patients: effectiveness of a minimal psychological intervention. COPD. 2010;7(5):315–322.
    1. Kunik ME, Veazey C, Cully JA, et al. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients; a randomized controlled trial. Psychol Med. 2008;37:1–12.
    1. Blumenthal JA, Babyak MA, Keefe FJ, et al. Telephone-based coping skills training for patients awaiting lung transplantation. J Consult Clin Psychol. 2006;74(3):535–544.
    1. de Godoy DV, de Godoy RF, Becker Júnior B, et al. The effect of psychotherapy provided as part of a pulmonary rehabilitation program for the treatment of patients with chronic obstructive pulmonary disease. J Bras Pneumol. 2005;31:499–505.
    1. de Godoy DV, de Godoy RF. A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2003;84:1154–1157.
    1. Emery CF, Schein RL, Hauck ER, et al. Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychol. 1998;17(3):232–240.
    1. Eiser N, West C, Evans S, et al. Effects of psychotherapy in moderately severe COPD: a pilot study. Eur Respir J. 1997;10:1581–1584.
    1. Ramsenthaler C, Siegert RJ, Weatherall M, et al. Cognitive behavioural therapy (CBT) for panic and anxiety in chronic obstructive pulmonary disease – a systematic review. Palliat Med. 2012;26(6):1.
    1. Baraniak A, Sheffield D. The efficacy of psychologically based interventions to improve anxiety, depression and quality of life in COPD: a systematic review and meta-analysis. Patient Educ Couns. 2011;83(1):29–36.
    1. Mkacher W, Mekki M, Chaieb F, et al. Balance training in pulmonary rehabilitation: effects on psychosocial outcomes. J Cardiopulm Rehabil Prev. 2015;35(4):278–285.
    1. Reychler G, Mottart F2, Boland M, et al. Influence of ambient music on perceived exertion during a pulmonary rehabilitation session: a randomized crossover study. Respir Care. 2015;60(5):711–717.
    1. Kaymaz D, Ergün P, Demirci E, et al. Comparison of the effects of neuromuscular electrical stimulation and endurance training in patients with severe chronic obstructive pulmonary disease. Tuberk Toraks. 2015;63(1):1–7.
    1. Valenza MC, Valenza-Pena G, Torres-Sanchez I, et al. Effectiveness of controlled breathing techniques on anxiety and depression in hospitalized patients with COPD: a randomized clinical trial. Respir Care. 2014;59(2):209–215.
    1. Leung RWM, McKeough ZJ, Peters MJ, et al. Short-form Sun-style t’ai chi as an exercise training modality in people with COPD. Eur Respir J. 2013;41(5):1051–1057.
    1. Santana MJ, S-Parrilla J, Mirus J, et al. An assessment of the effects of Iyengar yoga practice on the health-related quality of life of patients with chronic respiratory diseases: a pilot study. Can Respir J. 2013;20(2):e17–e23.
    1. Singh VP, Rao V, Prem V, Sahoo RC, Keshav Pai K. Comparison of the effectiveness of music and progressive muscle relaxation for anxiety in COPD – a randomized controlled pilot study. Chron Respir Dis. 2009;6(4):209–216.
    1. Bauldoff GS, Hoffman LA, Zullo TG, et al. Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli. Chest. 2002;122(3):948–954.
    1. Gift AG, Moore T, Soeken K. Relaxation to reduce dyspnea and anxiety in COPD patients. Nurs Res. 1992;41:242–246.
    1. Luk EK, Khan F, Irving L. Maintaining gains following pulmonary rehabilitation. Lung. 2015;193(5):709–715.
    1. Sciriha A, Lungaro-Mifsud S, Scerri J, et al. Pulmonary rehabilitation in chronic obstructive pulmonary disease: outcomes in a 12 week programme. Eur J Physiother. 2015;17(4):1–9.
    1. Grosbois JM, Gicquello A, Langlois C, et al. Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:2037–2044.
    1. da Costa CC, de Azeredo LC, Colombo C, et al. Effect of a Pulmonary Rehabilitation Program on the levels of anxiety and depression and on the quality of life of patients with chronic obstructive pulmonary disease. Rev Port Pneumol. 2014;20(6):299–304.
    1. Tselebis A, Bratis D, Pachi A, et al. A pulmonary rehabilitation program reduces levels of anxiety and depression in COPD patients. Multidiscip Respir Med. 2013;8(1):41.
    1. Bhandari NJ, Jain T, Marolda C, et al. Comprehensive pulmonary rehabilitation results in clinically meaningful improvements in anxiety and depression in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2013;33(2):123–127.
    1. Hogg L, Garrod R, Thornton H, et al. Effectiveness, attendance, and completion of an integrated, system-wide pulmonary rehabilitation service for COPD: prospective observational study. COPD. 2012;9(5):546–554.
    1. Bentsen SB, Wentzel-Larsen T, Henriksen AH, et al. Anxiety and depression following pulmonary rehabilitation. Scand J Caring Sci. 2013;27(3):541–550.
    1. Harrison SL, Greening NJ, Williams JE, et al. Have we underestimated the efficacy of pulmonary rehabilitation in improving mood? Respir Med. 2012;106(6):838–844.
    1. Bratås O, Espnes GA, Rannestad T, et al. Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation. Scand J Caring Sci. 2012;26(2):219–227.
    1. von Leupoldt A, Taube K, Lehmann K, et al. The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD. Chest. 2011;140(3):730–736.
    1. Pirraglia PA, Casserly B, Velasco R, et al. Association of change in depression and anxiety symptoms with functional outcomes in pulmonary rehabilitation patients. J Psychosom Res. 2011;71(1):45–49.
    1. Bratås O, Espnes GA, Rannestad T, et al. Pulmonary rehabilitation reduces depression and enhances health-related quality of life in COPD patients – especially in patients with mild or moderate disease. Chron Respir Dis. 2010;7(4):229–237.
    1. Spencer LM, Alison JA, McKeough ZJ. Do supervised weekly exercise programs maintain functional exercise capacity and quality of life, twelve months after pulmonary rehabilitation in COPD? BMC Pulm Med. 2007;7:7.
    1. Ozdemir EP, Solak O, Fidan F, et al. The effect of water-based pulmonary rehabilitation on anxiety and quality of life in chronic pulmonary obstructive disease patients. Turk Klin J Med Sci. 2010;30(3):880–887.
    1. Godoy RF, Teixeira PJ, Becker Júnior B, et al. Long-term repercussions of a pulmonary rehabilitation program on the indices of anxiety, depression, quality of life and physical performance in patients with COPD. J Bras Pneumol. 2009;35(2):129–136.
    1. Elçi A, Börekçi S, Ovayolu N, et al. The efficacy and applicability of a pulmonary rehabilitation programme for patients with COPD in a secondary-care community hospital. Respirology. 2008;13(5):703–707.
    1. Kayahan B, Karapolat H, Atýntoprak E, et al. Psychological outcomes of an outpatient pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease. Respir Med. 2006;100(6):1050–1057.
    1. Arnardóttir RH, Boman G, Larsson K, et al. Interval training compared with continuous training in patients with COPD. Respir Med. 2007;101(6):1196–204.
    1. Goldberg R, Hillberg R, Reinecker L, et al. Evaluation of patients with severe pulmonary disease before and after pulmonary rehabilitation. Disabil Rehabil. 2004;26(11):641–648.
    1. Trappenburg JC, Troosters T, Spruit MA, et al. Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2005;86(9):1788–1792.
    1. Cilione C, Lorenzi C, Dell Orso D, et al. Predictors of change in exercise capacity after comprehensive COPD inpatient rehabilitation. Med Sci Monit. 2002;8(11):CR740–CR745.
    1. White RJ, Rudkin ST, Harrison ST, et al. Pulmonary rehabilitation compared with brief advice given for severe chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2002;22:338–344.
    1. Emery CF, Leatherman NE, Burker EJ, et al. Psychological outcomes of a pulmonary rehabilitation program. Chest. 1991;100:613–617.
    1. Dekhuijzen PN, Beek MM, Folgering HT, et al. Psychological changes during pulmonary rehabilitation and target-flow inspiratory muscle training in COPD patients with a ventilatory limitation during exercise. Int J Rehabil Res. 1990;13(2):109–117.
    1. Wiles L, Cafarella P, Williams MT. Exercise training combined with psychological interventions for people with chronic obstructive pulmonary disease. Respirology. 2015;20(1):46–55.
    1. Scottish Intercollegiate Guidelines Network Critical Appraisal: Notes and Checklists. Secondary Critical Appraisal: Notes and Checklists. 2014. [Accessed December 21, 2015]. Available from: .

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