A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma
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 16 weeks and end points 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 to recruit 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.
The Journal of asthma official journal of the Association for the Care of Asthma