***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: The purpose of this study was to test the effectiveness of a taped relaxation message in reducing dyspnea and anxiety in chronic obstructive pulmonary disease ( COPD ) patients . Twenty-six adult COPD patients with dyspnea were r and omly assigned to two groups . The treatment group was taught relaxation using a prerecorded tape while the control group was instructed to sit quietly .  Skin temperature , heart rate , and respiratory rate were recorded for all subjects during a total of four weekly sessions . Anxiety , dyspnea , and airway obstruction were measured at the beginning and end of the study . The relaxation group achieved the preset relaxation criteria . Dyspnea , anxiety , and airway obstruction were induced in the relaxation group while the control group remained the same or became worse Chronic obstructive pulmonary disease ( COPD ) affects over 16 million people in the United States and is a major cause of disability and death worldwide . Its prevalence and mortality are increasing disproportionately among the elderly , women , African-Americans , persons of lower socioeconomic status , and the population s of developing countries in which tobacco is aggressively marketed . In contrast to other major chronic diseases such as heart disease and cancer , medical treatments for COPD have not made decisive inroads into its morbidity or death rates over the last 20 years , result ing in continuing efforts to reduce disability in patients with established disease . Depression is a source of increased disability in COPD , and , as in other chronically ill patient population s , is often unrecognized and untreated in the primary and specialty care sectors . Nearly half of all patients experience some depressive symptoms and at least one-fifth have had one or more major depressive episodes , frequently of long duration . Evidence from r and omized controlled trials supports the thesis that patients with mild depression improve with multidisciplinary rehabilitation , whereas patients with major depression may require specific pharmacotherapy to achieve significant improvement in mood disorder and day-to-day function . In addition to its impact on disability , depression may contribute indirectly to the etiology and progression of COPD through its relationship to addictive smoking . Mood disorder in adolescence and early adulthood contributes to early smoking and failure to quit , even after the onset of respiratory disease in later life . Patients with a history of major depression are more likely to fail in smoking cessation programs and to develop a major depressive episode when they do stop . This relationship calls for psychiatrically informed intervention models to improve long-term abstinence rates . The functional impairments associated with COPD are themselves potential promoters of depressive morbidity and chronicity , acting through complex causal pathways . Progressive hypoxia due to respiratory insufficiency leads to structural brain changes and neurocognitive deficits that impair day-to-day function and reduce adaptive potential ;  and oxygen therapy , as now practice d , offers minimal neurocognitive and mood benefits to most patients . Limited data from studies of experimental hypoxia in animals suggest that relatively mild lack of oxygen impairs the function and plasticity of critical neurotransmitter systems implicated in both cognition and mood , although current practice st and ards withhold oxygen therapy until late in the course of disease when the damaging effects of hypoxia on the brain have become well established . Neuropsychiatric approaches to the prevention , delay , and treatment of brain dysfunction should be a primary objective of research to improve patient outcomes . A comprehensive relational model that links pulmonary disease , hypoxia , neurocognitive impairment , and structural brain disease with depression provides a useful framework for the design of such studies . The near-term research agenda should include three components : ( 1 ) practical methods for improving physician and patient recognition of depression and neurocognitive impairment as targets for intervention ; ( 2 ) additional trials of st and ard antidepressant treatment approaches for both major and minor depression ; and ( 3 ) tests of the hypothesis that late-onset depression in patients with COPD is a marker for the presence of neurocognitive deficits and structural brain changes . The long-range research agenda must aim at preventive interventions design ed to forestall brain deterioration . Controlled clinical trials of supplemental oxygen in patients with mild hypoxia and minimal cognitive deficits are needed to determine whether early treatment can reverse or moderate decline , reduce the incidence and chronicity of depression , and improve response to antidepressant treatment . Novel neuroprotective therapies such as antioxidant supplementation and modulation of monoaminergic neurotransmission , coupled with overall improvements in long-term respiratory disease management that minimize episodes of increased systemic oxidative stress , should be considered for multisite trials design ed to define optimal treatment and prevention 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 Background Anxiety and depression are common co-morbidities in patients with chronic obstructive pulmonary disease ( COPD ) . Serious implication s can result from psychological difficulties in COPD including reduced survival , lower quality of life , and reduced physical and social functioning , increased use of health care re sources and are associated with unhealthy behaviours such as smoking . Cognitive behavioural therapy ( CBT ) is a psychological intervention which is recommended for the treatment of many mental health problems including anxiety and depression . Unfortunately access to trained CBT therapists is limited . The aim of this study is to test the hypothesis that CBT delivered by respiratory nurses is effective in the COPD population . In this paper the design of the Newcastle Chronic Obstructive Pulmonary Disease Cognitive Behavioural Therapy Study ( Newcastle COPD CBT Care Study ) is described . Methods / Design This is a prospect i ve open r and omised controlled trial comparing CBT with self-help leaflets . The primary outcome measure is the Hospital Anxiety & Depression Scale ( HADS ) – anxiety subscale . Secondary outcome measures include disease specific quality of life COPD Assessment Tool ( CAT ) , generic quality of life ( EQ5D ) and HADS-depression subscale . Patients will be followed up at three , six and 12 months following r and omisation . Discussion This is the first r and omised controlled trial to evaluate the use of cognitive behavioural therapy undertaken by respiratory nurses . Recruitment has commenced and should be complete by February 2014.Trial registration Current Controlled Trials , IS RCT Objectives : To examine the association of anxiety and depression with pulmonary-specific symptoms of Chronic Obstructive Pulmonary Disease ( COPD ) , and to determine the extent to which disease severity and functional capacity modify this association . Method : Patients ( N = 162 ) enrolled in the INSPIRE-II study , an ongoing r and omized , clinical trial of COPD patients and their caregivers who received either telephone-based coping skills training or education and symptom monitoring .  Patients completed a psychosocial test battery including : Brief Fatigue Inventory , St. George 's Respiratory Question naire , UCSD Shortness of Breath Question naire , State-Trait Anxiety Inventory , and Beck Depression Inventory .  Measures of disease severity and functional capacity ( i.e. , FEV1 and six-minute walk test ) were also obtained . Results : After covariate adjustment , higher anxiety and depression levels were associated with greater fatigue levels ( ps < .001 , ΔR2 = 0.16 and 0.29 , respectively ) , shortness of breath ( ps < .001 , ΔR2 = 0.12 and 0.10 ) , and frequency of COPD symptoms ( ps < .001 , ΔR2 = 0.11 and 0.13 ) . In addition , functional capacity was a moderator of anxiety and pulmonary-specific COPD symptoms . The association between anxiety and shortness of breath ( p = 0.009 ) and frequency of COPD symptoms ( p = 0.02 ) was greater among patients with lower functional capacity . Conclusions : Anxiety and depression were associated with higher levels of fatigue , shortness of breath , and frequency of COPD symptoms . It is important for clinicians to be aware of the presence of anxiety and depression in COPD patients , which appears to correlate with pulmonary-specific COPD symptoms , especially in patients with lower functional capacity . Prospect i ve design studies are needed to eluci date the causal relationships between anxiety and depression and pulmonary-specific symptoms in COPD patients Over the ensuing seven months she had three more clinical relapses , each accompanied by reappearance in the stools of either the organism or its cytotoxin , or both . Each improvement after vancomycin ( eight to 14-daycourses ) was accompanied by disappearance of the organism . At one point she was given cholestyramine , but she was unable to tolerate it . Her illness was punctuated by malnutrition and episodes of heart failure . She was given no other antibiotics . After the sixth relapse maintenance treatment with oral vancomycin 125 mg eight-hourly was begun . With this regimen diarrhoea was controlled and stools over the next 10 weeks remained negative for C difficile and its cytotoxin . There was no adverse reaction to vancomycin throughout 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 
    Output:
    
We found only low- quality evidence for the efficacy of psychological therapies among people with COPD with anxiety .