Randomised and non-randomised controlled trials that compared cognitive behavioural therapy (CBT) with another treatment, in patients (18 years or over) with stable moderate-to-severe chronic obstructive pulmonary disease and mild-to-moderate anxiety and/or depression (on validated self-report scales), were eligible for inclusion. CBT was defined as a psychological treatment which attempted to modify patients' negative thoughts and behavioural responses. Included trials were required to deliver CBT face-to-face. Eligible comparators were standard outpatient or primary care, education about disease management, exercise therapy with/without education, and pharmacotherapy. The primary outcome was change from baseline in anxiety and/or depression.
Randomised controlled trials (RCTs) and non-randomised trials were included in this review. Most trials were based in the USA, with one based in Brazil. The trials evaluated CBT alone or alongside exercise and/or education; comparators included waiting-list control, standard care, exercise, education and/or CBT. The overall population age was over 65 years, and all patients were diagnosed with severe chronic obstructive pulmonary disease. Outcomes were assessed using a range of scales including: the Centre for Epidemiological Studies Depression Scale; Beck Anxiety Inventory. Beck Depression Inventory; Hospital Anxiety and Depression Scale; the State-Trait Anxiety Inventory; and several measures of exercise, education and stress management at six, 10 and 12 weeks.
Studies were selected by one reviewer and checked by a second for eligibility.