Psychological considerations in pulmonary rehabilitation

Psychological distress is common in individuals with chronic obstructive pulmonary disease (COPD) and is often accompanied by stigma and shame associated with perceived blame for the disease's presence. The inclusion of psychological support is recognised in the international guidelines for pulmonary rehabilitation (PR), yet engagement in PR is poor and appears related to patients' lack of belief in its benefits for an ageing population living with a progressive condition. Such beliefs can be identified using comprehensive psychological assessment, employing both questionnaires and a detailed clinical interview. Patient testimonies, positive social support, monitoring of progress and sustained encouragement from compassionate PR providers may serve to challenge perceptions of PR as inadequate or threatening. In its current form, PR appears insufficient to address severe psychological symptoms, and we argue that discreet, focused psychological interventions tailored to the needs of older adults with COPD and targeted towards the most psychologically vulnerable are warranted. There is some evidence to support the application of cognitive behavioural therapy (CBT), mindfulness and motivational interviewing (MI), but complexities of the disease, variable willingness to engage in psychological therapies and uncertainty around the manner in which to deliver psychological support means proven psychological interventions for individuals with COPD still require development.