***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Previous research indicates a high prevalence of untreated anxiety and depression in patients with chronic obstructive pulmonary disease ( COPD ) . The current study examined the effect of cognitive behavioral therapy ( CBT ) in groups for co-morbid , clinical ly significant anxiety and depression in COPD out patients of both sexes . METHODS In a r and omized , controlled trial ,  CBT ( n = 25 ) was compared with enhanced st and ard care  ( n = 26 ) . Participants in both conditions were followed up at 2 and 8 months from baseline . Main outcome measures comprised the Beck Anxiety Inventory and the Beck Depression Inventory-II . Measures of health status and sleep were included as secondary outcomes . The effects of sex and age were also investigated . RESULTS CBT result ed in improvement in symptoms of anxiety and depression , with effect sizes of 1.1 and 0.9 at post-treatment , respectively . The improvement was maintained at the 8-month follow-up , with effect sizes of 1.4 and 0.9 . In the control group , there was no significant change . Compared to men , women had higher symptom levels throughout the whole study period . Younger patients had more anxiety and depression , age had also differential effects in the two groups on change in depressive symptoms . Changes in sleep and health status were small in both groups . CONCLUSIONS The findings indicate that CBT may provide rapid symptom relief for COPD patients with clinical ly significant anxiety and depression , and underline the need for integrating mental health care into the overall medical regimen for COPD BACKGROUND Chronic obstructive pulmonary disease ( COPD ) affects 14 to 20 million Americans and is associated with increased prevalence of affective disorders , contributing significantly to disability . This study compared cognitive behavioral therapy ( CBT ) group treatment for anxiety and depression with COPD education for COPD patients with moderate-to-severe anxiety and /or depressive symptoms . METHOD A r and omized controlled trial ( RCT ) was conducted between 11 July 2002 and 30 April 2005 at the Michael E. DeBakey VA Medical Center , Houston , TX . Participants were 238 patients treated for COPD the year before , with forced expiratory value in 1 second (FEV)1/forced vital capacity (FVC)<70 % and FEV1<70 % predicted , and symptoms of moderate anxiety and /or moderate depression , who were being treated by a primary care provider or pulmonologist . Participants attended eight sessions of CBT or COPD education . Assessment s were at baseline , at 4 and 8 weeks , and 4 , 8 and 12 months . Primary outcomes were disease-specific and generic quality of life ( QoL ) [ Chronic Respiratory Question naire ( CRQ ) and Medical Outcomes Survey Short Form-36 ( SF-36 ) respectively ] . Secondary outcomes were anxiety [ Beck Anxiety Inventory ( BAI ) ] , depressive symptoms [ Beck Depression Inventory-II ( BDI-II ) ] , 6-minute walk distance ( 6MWD ) and use of health services . RESULTS Both treatments significantly improved QoL , anxiety and depression ( p<0.005 ) over 8 weeks ; the rate of change did not differ between groups . Improvements were maintained with no significant change during follow-up . Ratios of post- to pretreatment use of health services were equal to 1 for both groups . CONCLUSIONS CBT group treatment and COPD education can achieve sustainable improvements in QoL for COPD patients experiencing moderate-to-severe symptoms of depression or anxiety This study examined whether cognitive behavioural therapy ( CBT ) could prevent the development or worsening of panic-spectrum psychopathology and anxiety symptoms in chronic obstructive pulmonary disease ( COPD ) . 41 patients with COPD , who had undergone pulmonary rehabilitation , were r and omised to either a four-session CBT intervention condition ( n = 21 ) or a routine care condition ( n = 20 ) . Assessment s were at baseline , post-intervention , and at 6- , 12- and 18-month follow-ups . Primary outcomes were the rates of panic attacks , panic disorder and anxiety symptoms . Secondary outcomes were depressive symptoms , catastrophic cognitions about breathing difficulties , disease-specific quality of life and hospital admission rates . There were no significant differences between the groups on outcome measures at baseline . By the 18-month follow-up assessment , 12 ( 60 % ) routine care group participants had experienced at least one panic attack in the previous 6 months , with two ( 17 % ) of these being diagnosed with panic disorder , while no CBT group participants experienced any panic attacks during the follow-up phase . There were also significant reductions in anxiety symptoms and catastrophic cognitions in the CBT group at all three follow-ups and a lower number of hospital admissions between the 6- and 12-month follow-ups . The study provides evidence that a brief , specifically targeted CBT intervention can treat panic attacks in COPD patients and prevent the development and worsening of panic-spectrum psychopathology and anxiety symptoms OBJECTIVE To assess the effect of psychotherapy on the anxiety and depression levels of patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN A blind , r and omized , controlled trial . SETTING Outpatient university pulmonary rehabilitation program in Brazil . PARTICIPANTS Thirty patients with COPD ( mean age , 60.33y ; 22 men ) attending a pulmonary rehabilitation program were r and omized into 2 groups : experimental group ( G1 ) and control group ( G2 ) . Both groups underwent a 12-week treatment program . INTERVENTIONS Group 1 ( n=14 ) participated in 24 sessions of physical exercise , 24 sessions of physiotherapy , 12 psychologic sessions , and 3 educational sessions . Group 2 did not participate in psychotherapy sessions . MAIN OUTCOME MEASURES All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program by using 3 instruments : the Beck Anxiety Inventory ( BAI ) , Beck Depression Inventory ( BDI ) , and 6-minute walk distance ( 6MWD ) . RESULTS Both groups showed statistically significant improvements on the 6MWD ( G1 , P<.001 ; G2 , P=.03 ) . Only G1 had a significant reduction in anxiety and depression levels ( G1 : BAI , P<.001 ; BDI , P<.001 ; G2 : BAI , P=.156 ; BDI , P=.142 ) . Statistically significant differences existed between G1 and G2 for BAI ( P<.001 ) and BDI ( P=.02 ) . CONCLUSIONS Including psychotherapy in a pulmonary rehabilitation program for COPD reduced patients ' anxiety and depression levels but did not modify 6MWD performance ABSTRACT Depression and anxiety are highly prevalent in elderly COPD patients . Since symptoms of depression and anxiety reduce quality of life in these patients , treatments aim ed at improving mental health may improve their quality of life . This study evaluated the effectiveness of a nurse-led Minimal Psychological Intervention ( MPI ) in reducing depression and anxiety , and improving disease-specific quality of life in elderly COPD patients . In a r and omized controlled trial an MPI was compared with usual care in COPD patients . COPD patients aged 60 years or over , and with minor or mild to moderate major depression were recruited in primary care ( n = 187 ) . The intervention was based on principles of cognitive behavioural therapy ( CBT ) and self-management . Outcomes were symptoms of depression , symptoms of anxiety , and disease-specific quality of life , assessed at baseline and at one week and three and nine months after the intervention . Results showed that patients receiving the MPI had significantly fewer depressive symptoms ( mean BDI difference 2.92 , p = 0.04 ) and fewer symptoms of anxiety ( mean SCL difference 3.69 , p = 0.003 ) at nine months than patients receiving usual care . Further , mean SGRQ scores were significantly more favourable in the intervention group than in the control group after nine months ( mean SGRQ difference 7.94 , p = 0.004 ) . To conclude , our nurse-led MPI reduced symptoms of depression and anxiety and improved disease-specific quality of life in elderly COPD patients . The MPI appears to be a valuable addition to existing disease-management programmes for COPD patients BACKGROUND We hypothesized that compared to an educational intervention , a single 2 h session of cognitive behavioural therapy ( CBT ) , with 6-week follow-up , would reduce anxiety and depression , improve physical and mental functioning , and lead to a better quality of life and greater satisfaction with treatment in older patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Fifty-six subjects were recruited from a large , urban , academically affiliated Veterans Affairs ( VA ) Hospital , a non-profit private hospital , and a local newspaper , for a single blind r and omized controlled clinical trial . One 2 h session of group CBT was design ed to reduce symptoms of anxiety , with specific components including relaxation training , cognitive interventions , and graduated practice , followed by homework and weekly calls for 6 weeks . This was compared to a group that received 2 h of COPD education , followed by weekly calls . Pre- and post-intervention subjects in both groups were administered SF-36 , Geriatric Depression Scale , Beck Anxiety Inventory , 6 min walk test , and the FEV-1 . Following the intervention , both groups completed the Client Satisfaction Question naire . RESULTS When compared with a group that received education about COPD , 2 h CBT group showed decreased depression and anxiety . Contrary to our hypothesis , despite the decrease in depression and anxiety , there was no change in the physical functioning of the patients . CONCLUSIONS Twenty to 40 % of patients with COPD have high levels of anxiety and depression . Our study finds that as little as 2 h of CBT administered in a group setting is able to reduce these anxious and depressive symptoms STUDY OBJECTIVES To study the short-term and long-term effects of combining activity training or lectures to exercise training on quality of life , functional status , and exercise tolerance . DESIGN R and omized clinical trial . SETTING Outpatient pulmonary rehabilitation center . PARTICIPANTS Forty-three out patients with COPD . INTERVENTIONS Patients were r and omized to one of three treatment groups : exercise training alone , exercise training plus activity training , and exercise training plus a lecture series . The mean treatment period was 10 weeks . MEASUREMENT The Chronic Respiratory Disease Question naire , the modified version of the Pulmonary Functional Status and Dyspnea Question naire , and the COPD Self-Efficacy Scale were administered at baseline , and 6 , 12 , 18 , and 24 weeks from the beginning of the rehabilitation program . The 6-min walk test was used to measure exercise tolerance . RESULTS Benefits of activity training combined with exercise included less dyspnea ( p < or = 0.04 ) and fatigue ( p < or = 0.01 ) , and increased activity involvement ( p < or = 0.02 ) and total functional status ( p < or = 0.02 ) in the short term compared to comparison treatment groups for comparatively older participants . Compared to the lecture series adjunct , the activity training adjunct result ed in significantly higher gains in total quality of life ( p = 0.04 ) maintained at 24 weeks . Significantly worse emotional function and functional status result ed from the lecture series adjunct in the oldest participants ( p < or = 0.03 ) . Treatment groups did not differ significantly on exercise tolerance or self-efficacy . CONCLUSIONS Evidence for additional benefits of activity-specific training combined with exercise was found . A behavioral method emphasizing structured controlled breathing and supervised physical activity was statistically significantly more effective than didactic instruction in facilitating additional gains and meeting participants ' learning needs In this controlled , r and omized study we explored the effects of an uncertainty management intervention on uncertainty , anxiety , depression , and quality of life ( QOL ) of chronic obstructive pulmonary disease ( COPD ) out patients in China . Ninety-six COPD out patients completed the study ( n = 49 in the intervention group ; n = 47 in the control group ) . Over the 10-month study duration , the intervention group received a cognitive behavioral intervention . Compared with the control group , the intervention group showed significant improvement in uncertainty , coping strategy , anxiety , depression , and the mental health domains of QOL after the intervention , providing the first evidence that uncertainty management can improve the emotional status and QOL of COPD out patients 
    Output:
    
No change occurred when sensitivity analyses were conducted .
Conclusion Anxiety and depression in COPD patients are known to impact on health outcomes .
Effective psychological interventions such as CBT may assist people with COPD in reducing psychological burden .