Chest
Special ReportPsychosocial Concomitants to Rehabilitation in Chronic Obstructive Pulmonary Disease: Part I. Psychosocial and Psychological Considerations
Section snippets
Psychological Characteristics of the COPD Patient
While there are some similarities in the composite clinical picture of the COPD patient, there also are considerable variations in individual personality, disease stages, degree of impairment, and socioeconomic, educational, or cultural resources. In a study of 45 patients, Lustig et al10 described COPD patients as “highly anxious, socially isolated, lonely, and afraid to commit themselves to vocational activities.” Dudley et al3 observed that many severely disabled COPD patients tended to live
EMOTIONAL STATES AND PSYCHOPHYSIOLOGY ASSOCIATED WITH COPD
To understand the patient with COPD, it is helpful to consider some of the elements of basic pulmonary psychophysiology. Psychological states of action, such as significant degree of anxiety, anger, and euphoria, are associated with increased energy expenditure, elevated ventilation, high oxygen consumption, and skeletal muscle tension; while psychological states of nonaction, such as apathy, depression, and deep relaxation, are associated with reduced energy expenditure, decreased ventilation,
GENERAL GUIDELINES FOR TREATING PSYCHOSOCIAL ASPECTS OF COPD
As the patient comes to realize that changes in his emotional state increase his incapacity and disability, he may protect himself through isolation, denial, and repression. In addition, his fear of alienating those who provide access to medical care may lead to an inability to express anger or resentment, and assumption of either a passive-dependent or passive-aggressive role. As the patient encounters the severe problems associated with the more advanced stages of disease, he may believe he
INITIAL PSYCHOSOCIAL EXAMINATION
The dual purpose of the psychosocial examination is to give the patient the opportunity to talk about problems and to relate information necessary to the formation of a treatment plan. If mutual understanding and rapport are established in the initial examination, the patient is likely to develop a long-lasting sense of confidence in the physician.
The initial examination also affords the physician an opportunity to contribute to the development of the patient's attitude about his disease. It is
PATIENT AND FAMILY EDUCATION
To educate the patient and his family about COPD, it is important to identify psychological and social situations that tend to contribute to disability and insufficiency. This can be done by including family members in office visits or by visiting the patient's home. The Visiting Nurse Association and Home Health Programs are valuable in extending contacts into the patient's home and can also provide ongoing education for those patients and families experiencing particular difficulty in coping
COMMENT
This paper reviews the interaction of the COPD patient's physical state with his psychosocial assets and psychological state. It stresses the importance of identifying and treating concomitant emotional changes. Subsequent parts will focus on treatment modalities that aim at modifying affect and behavior, as well as strengthening the ability of the patient to cope with COPD.
REFERENCES (21)
- et al.
Life change, coping ability, and chronic intrinsic asthma
J Psychosom Res
(1973) - et al.
Correlation of psychophysiological variables with vocational rehabilitation outcome in chronic obstructive pulmonary disease patients
Chest
(1975) - et al.
Physical, symptomatic and psychological improvement in patients receiving comprehensive care for chronic airway obstruction
J Chronic Dis
(1971) - et al.
Chronic obstructive airway diseases: Current concepts in diagnosis and comprehensive care
JAMA
(1975) American Lung Association: Report of the Task Force on Comprehensive and Continuing Care for Patients with Chronic Obstructive Pulmonary Disease
(1975)- et al.
Psychosocial aspects of care in the chronic obstructive pulmonary disease patient
Heart and Lung
(1973) - et al.
Response to group treatment in patients with severe chronic lung disease
Inter J Group Psychother
(1971) - et al.
Multidiscipline treatment of chronic pulmonary insufficiency: Psychologic aspects of rehabilitation
Psychosom Med
(1973) - et al.
Group psychotherapy in patients with severe diffuse obstructive pulmonary syndrome
Am Rev Respir Dis
(1969) - et al.
Long-term adjustment, prognosis and death in irreversible diffuse obstructive pulmonary syndromes
Psychosom Med
(1969)