By Qasim Farrukh (Class of 2023)
Approximately 300 million people in the world currently suffer from asthma, 25 million of which are Americans (Braman, 2006). What makes the condition of asthma so unique is that not only do cognitive processes impact how a patient interprets asthma symptoms but how an individual responds cognitively to these symptoms affects changes in immune and physiologic markers of asthma. In simpler terms, the lens through which the patient perceives their asthma symptoms has a considerable effect on the physiological symptoms that manifest within the body. Research has shown that there is an intricate relationship between asthma and other disorders such as anxiety, depression, and panic disorders, which has implications for asthma treatment (Hasler, 2005; Van Lieshout, 2008). As such, not only is it imperative to treat asthma with pharmacological medications such as inhalers, but patients must have access to various psychotherapy methods and coping strategies such as Cognitive Behavioral Therapy (CBT) to fully understand and combat the psychological components of asthma.
A good place to begin would be to understand the dynamics of an asthma attack. During an asthma attack, the muscles that surround the airway tighten, making them constricted. The lining then swells, and the cells make more mucus, clogging the airways as a result and making it difficult to breathe (Stress & Asthma, 2021). Due to the fatal and ambiguous nature of these symptoms that are also often consistent with anxiety and panic disorders, asthma patients are 4.5 times more likely to develop a panic disorder, and those with panic disorder are 6 times more likely as people without the anxiety condition to develop asthma (Hasler, 2005).
Due to the significance of these findings, it becomes particularly important that treatment plans for asthma must teach patients effective coping strategies that reduce the risk of severe asthma attacks. Research suggests that asthma patients who possess effective coping skills, including maintaining a positive vision of the disease without minimizing its potential danger and using active, cognitive strategies and flexible diversified behaviors typically experience less psychological morbidity, a feeling of greater personal control over asthma, and better long-term management of the disease (Barton, 2003). A great example of an effective cognitive strategy would be Cognitive Behavioral Therapy (CBT) adapted for asthma treatment, which can be readily taught to patients in various clinical scenarios. Additionally, strategies such as relaxation techniques control stress and anxiety, which researchers suggest may assist in improving respiratory function in asthma patients. In fact, two research studies measuring the effects of relaxation therapy on peak expiratory flow found that relaxation reduced emergency room visits (Van Lieshout, 2008).
Similarly, Cognitive Behavioral Therapy (CBT) has shown great promise in children with asthma who were taught problem-solving techniques, relaxation exercises, and kept asthma diaries. The children who went through this process were more equipped to deal with their illness in all kinds of situations in day-to-day life and had effectively learned how to minimize the effect of their asthma. The researchers also reported that the children who went through CBT also displayed improvement in other associated psychological variables such as more self-confidence, and improved feelings of self-efficacy, as reported by the parents. Lastly, the efficacy of CBT in this particular context was also solidified by the finding that restrictions in daily activities due to asthma decreased significantly for these children (Colland, 1993).
In essence, addressing the complexity of asthma in light of its psychological components through effective psychotherapeutic measures allows for better management of asthma in various ages and demographics. It is clearly evident that psychological distress exacerbates asthma symptoms, which as a result has a significant impact on physical health. As such, clinicians must incorporate both psychological and pharmacological components into treatment plans when it comes to effectively managing a condition that affects 25 million Americans.
References:
Adams, R. J., Wilson, D. H., Taylor, A. W., Daly, A., Tursan d'Espaignet, E., Dal Grande, E., & Ruffin, R. E. (2004). Psychological factors and asthma quality of life: a population based study. Thorax, 59(11), 930–935. https://doi.org/10.1136/thx.2003.010256
Barton, C., Clarke, D., Sulaiman, N., & Abramson, M. (2003). Coping as a mediator of psychosocial impediments to optimal management and control of asthma. Respiratory medicine, 97(7), 747–761. https://doi.org/10.1016/s0954-6111(03)00029-5
Braman S. S. (2006). The global burden of asthma. Chest, 130(1 Suppl), 4S–12S. https://doi.org/10.1378/chest.130.1_suppl.4S
Colland V. T. (1993). Learning to cope with asthma: a behavioural self-management program for children. Patient education and counseling, 22(3), 141–152. https://doi.org/10.1016/0738-3991(93)90094-d
Hasler, G., Gergen, P. J., Kleinbaum, D. G., Ajdacic, V., Gamma, A., Eich, D., Rössler, W., & Angst, J. (2005). Asthma and panic in young adults: a 20-year prospective community study. American journal of respiratory and critical care medicine, 171(11), 1224–1230. https://doi.org/10.1164/rccm.200412-1669OC
Stress & Asthma. (2021). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/9573-stress--asthma
Van Lieshout, R. J., & Macqueen, G. (2008). Psychological factors in asthma. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology, 4(1), 12–28. https://doi.org/10.1186/1710-1492-4-1-12
A good place to begin would be to understand the dynamics of an asthma attack. During an asthma attack, the muscles that surround the airway tighten, making them constricted. The lining then swells, and the cells make more mucus, clogging the airways as a result and making it difficult to breathe (Stress & Asthma, 2021). Due to the fatal and ambiguous nature of these symptoms that are also often consistent with anxiety and panic disorders, asthma patients are 4.5 times more likely to develop a panic disorder, and those with panic disorder are 6 times more likely as people without the anxiety condition to develop asthma (Hasler, 2005).
Due to the significance of these findings, it becomes particularly important that treatment plans for asthma must teach patients effective coping strategies that reduce the risk of severe asthma attacks. Research suggests that asthma patients who possess effective coping skills, including maintaining a positive vision of the disease without minimizing its potential danger and using active, cognitive strategies and flexible diversified behaviors typically experience less psychological morbidity, a feeling of greater personal control over asthma, and better long-term management of the disease (Barton, 2003). A great example of an effective cognitive strategy would be Cognitive Behavioral Therapy (CBT) adapted for asthma treatment, which can be readily taught to patients in various clinical scenarios. Additionally, strategies such as relaxation techniques control stress and anxiety, which researchers suggest may assist in improving respiratory function in asthma patients. In fact, two research studies measuring the effects of relaxation therapy on peak expiratory flow found that relaxation reduced emergency room visits (Van Lieshout, 2008).
Similarly, Cognitive Behavioral Therapy (CBT) has shown great promise in children with asthma who were taught problem-solving techniques, relaxation exercises, and kept asthma diaries. The children who went through this process were more equipped to deal with their illness in all kinds of situations in day-to-day life and had effectively learned how to minimize the effect of their asthma. The researchers also reported that the children who went through CBT also displayed improvement in other associated psychological variables such as more self-confidence, and improved feelings of self-efficacy, as reported by the parents. Lastly, the efficacy of CBT in this particular context was also solidified by the finding that restrictions in daily activities due to asthma decreased significantly for these children (Colland, 1993).
In essence, addressing the complexity of asthma in light of its psychological components through effective psychotherapeutic measures allows for better management of asthma in various ages and demographics. It is clearly evident that psychological distress exacerbates asthma symptoms, which as a result has a significant impact on physical health. As such, clinicians must incorporate both psychological and pharmacological components into treatment plans when it comes to effectively managing a condition that affects 25 million Americans.
References:
Adams, R. J., Wilson, D. H., Taylor, A. W., Daly, A., Tursan d'Espaignet, E., Dal Grande, E., & Ruffin, R. E. (2004). Psychological factors and asthma quality of life: a population based study. Thorax, 59(11), 930–935. https://doi.org/10.1136/thx.2003.010256
Barton, C., Clarke, D., Sulaiman, N., & Abramson, M. (2003). Coping as a mediator of psychosocial impediments to optimal management and control of asthma. Respiratory medicine, 97(7), 747–761. https://doi.org/10.1016/s0954-6111(03)00029-5
Braman S. S. (2006). The global burden of asthma. Chest, 130(1 Suppl), 4S–12S. https://doi.org/10.1378/chest.130.1_suppl.4S
Colland V. T. (1993). Learning to cope with asthma: a behavioural self-management program for children. Patient education and counseling, 22(3), 141–152. https://doi.org/10.1016/0738-3991(93)90094-d
Hasler, G., Gergen, P. J., Kleinbaum, D. G., Ajdacic, V., Gamma, A., Eich, D., Rössler, W., & Angst, J. (2005). Asthma and panic in young adults: a 20-year prospective community study. American journal of respiratory and critical care medicine, 171(11), 1224–1230. https://doi.org/10.1164/rccm.200412-1669OC
Stress & Asthma. (2021). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/9573-stress--asthma
Van Lieshout, R. J., & Macqueen, G. (2008). Psychological factors in asthma. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology, 4(1), 12–28. https://doi.org/10.1186/1710-1492-4-1-12
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