Psychological interventions for asthma and stress reduction

Krewson,Celeste;

Psychological interventions may reduce asthma attacks and associated psychological stress, according to a recent study published in the Cochrane Database of Systematic Reviews.¹

Takeaways

Psychological interventions, such as behavioral, cognitive, and relaxation techniques, show promise in reducing asthma attacks and associated psychological stress in children and adolescents with asthma.
Asthma, a condition characterized by chronic airway inflammation, affects millions globally and can significantly impact individuals' quality of life due to respiratory symptoms and psychological burdens.
Children and adolescents with asthma, particularly those from disadvantaged backgrounds, are more prone to experiencing psychological distress, anxiety, and depression, highlighting the importance of addressing psychological aspects in asthma management.
The Cochrane review included various psychological interventions delivered by qualified professionals, ranging from individual therapies like cognitive behavioral therapy to group and family therapy sessions.
While the analysis showed positive effects of psychological interventions on anxiety, depression, asthma attacks, symptoms, and medication use, the certainty of evidence varied across outcomes, indicating the need for further research to establish the efficacy of these interventions comprehensively.

Asthma, presenting as chronic inflammation of the airways, leads to respiratory symptoms such as chest tightness, shortness of breath, wheeze, and cough.² Asthma symptoms have been estimated in 300 million people worldwide, significantly worsening the global disease burden. Attacks can be life-threatening, causing patients to experience major psychological burdens.

Children and adolescents experience increased rates of asthma, with symptoms presenting in 10.2% of children aged 6 to 7 years and 11.3% of those aged 13 to 14 years. Data has indicated these patients more often experience psychological distress, anxiety, and depression, with patients from poorer backgrounds disproportionately impacted.

The psychological stress of asthma may be treatable through psychological interventions, including behavioral, cognitive, cognitive behavioral, relaxation, psychodynamic psychotherapy, counseling, group therapy, and family therapy. Investigators conducted a review using Cochrane methodology to evaluate the efficacy of these interventions.

Studies included in the review were randomized control trials including male and female children and adolescents aged 5 to 18 years with asthma diagnosed by a physician or based on national or international guidelines. Interventions were eligible if they were created or delivered by a qualified professional.

Behavioral therapies included interventions that processed behaviors learned by association, while cognitive therapy included interventions that identified and developed management mechanisms of damaging thoughts. Cognitive behavioral therapy involved combining key elements from both models.

Relaxation techniques were also evaluated. One technique is progressive relaxation, when tension is systematically created and released in different parts of the body. Others are autogenic training, which focuses and attending to and controlling body feelings, and hypnosis, involving deep relaxation to create positive feelings.

The final relaxation technique assessed was biofeedback. This involves controlling biological indicator feedback through relaxation. Finally, psychodynamic psychotherapy, counseling, group therapy, and family therapy were evaluated.

The efficacy of the intervention in reducing psychological stress was the primary outcome of the analysis, determined based on standard validated questionnaires for anxiety and depression. Additional primary outcomes included medical contacts and asthma attacks.

Secondary outcomes included self-reported asthma symptoms, medication use, self-reported quality of life, and adverse events. Studies were found from the Cochrane Airways Group’s Specialized Register.

Titles and abstracts were independently screened by a pair of review authors, while full texts were independently screened for inclusion by 2 authors. Data extracted included methods, participants, interventions, outcomes, and notes.

There were 1639 participants across 24 studies included in the analysis.¹Of the studies, 3 included participants aged 5 to 12 years, 2 included participants aged 13 to 18 years, and 18 included participants from both age groups. All interventions except 1 were conducted face-to-face, with the final conducted online. Interventions lasted between 3 days and 8 months.

Psychological interventions had beneficial or mixed effects against anxiety compared to controls in 4 studies, while 1 reported no difference. Benefits were also found against depression in 2 studies. A reduction in medical contacts following psychological interventions was reported in 3 studies, while 2 found no difference.

Benefits in asthma attacks were reported in 2 studies, while 1 found little to no difference. For secondary outcomes, 4 studies found improvements in asthma symptoms and 6 found improvements in medication use. All outcomes had low certainty of evidence.

These results indicated positive effects on anxiety, depression, asthma attacks, asthma symptoms, and medication use following psychological interventions. However, because of mixed results in other studies, investigators concluded future research is necessary.