Holas Pawel, Michałowski Jaroslaw, Gawęda Łukasz, Domagała-Kulawik Joanna
Faculty of Psychology, University of Warsaw, Krakowskie Przedmieście 26/28, 00 927 Warsaw, Poland.
SWPS University of Social Sciences and Humanities, Faculty of Social Sciences and Design in Poznan, Department of Psychology, Poznan, Poland.
Respir Med. 2017 Jul;128:7-12. doi: 10.1016/j.rmed.2017.04.011. Epub 2017 Apr 21.
Anxiety and panic attacks are more common in chronic obstructive pulmonary disease (COPD) than in the overall population. Individuals with panic attacks often attempt to avoid situations perceived as at risk of eliciting bodily sensations such as dyspnea, which paradoxically may lead to anxiety-related responsivity. Although there is some evidence that COPD individuals restrict their participation in various life activities because they fear that these may trigger breathlessness, little is known about agoraphobic avoidance and its impact on cognitions and emotional distress in this population. It was thus our aim to investigate the degree of agoraphobic avoidance in COPD individuals, its clinical concomitants and consequences.
A total of 48 patients with COPD and 48 matched controlled subjects completed measures of anxiety sensitivity, agoraphobic avoidance, anxiety and depression. Objective COPD severity was measured using forced expiratory volume in the first second.
Patients showed significant impairment in respiratory functioning and psychological distress. Relative to the control, the COPD group exhibited greater depression, anxiety, physical symptom concerns and avoidance (alone and accompanied), irrespective of whether they were panickers or not. Patients with high avoidance showed more intense physical concerns when compared to those with low avoidance. Importantly, the level of avoidance predicted emotional distress and increased physical concerns in COPD.
Physical concerns scores in COPD patients are partially explained by avoidance in this group. The results of the study provide evidence for the importance of evaluating avoidance in COPD patients and implicate targeting this behavior in therapeutic interventions.
焦虑和惊恐发作在慢性阻塞性肺疾病（COPD）患者中比在普通人群中更为常见。患有惊恐发作的个体常常试图避免那些被认为有引发诸如呼吸困难等身体感觉风险的情况，而这反而可能导致与焦虑相关的反应性增强。尽管有一些证据表明COPD患者会因为担心这些活动可能引发呼吸急促而限制自己参与各种生活活动，但对于广场恐惧症式的回避行为及其对该人群认知和情绪困扰的影响却知之甚少。因此，我们的目的是调查COPD患者中广场恐惧症式回避行为的程度、其临床伴随症状及后果。
共有48例COPD患者和48例匹配的对照受试者完成了焦虑敏感性、广场恐惧症式回避行为、焦虑和抑郁的测量。使用第一秒用力呼气量来测量客观的COPD严重程度。
患者在呼吸功能和心理困扰方面表现出显著损害。相对于对照组，COPD组无论是否为惊恐发作患者，均表现出更严重的抑郁、焦虑、对身体症状的担忧以及回避行为（独自和有人陪伴时）。与回避程度低的患者相比，回避程度高的患者对身体的担忧更强烈。重要的是，回避程度可预测COPD患者的情绪困扰和对身体担忧的增加。
COPD患者的身体担忧得分部分可由该组中的回避行为来解释。该研究结果为评估COPD患者的回避行为的重要性提供了证据，并表明在治疗干预中应针对这种行为。
