Clinically Anxious Asthma Patients

: The Role of Catastrophic Cognitions

Abstract

Background
Epidemiological studies have established a strong link between asthma and anxiety disorders especially panic disorder. In addition, asthma patients with psychological distress have been reported to disclose more impaired quality of life than patients with healthier mental functioning. Severity of asthma alone fails to predict impaired quality of life and suggests that psychological factors may play a significant role in counteracting wellbeing.
The cognitive model of panic (Clark, 1986), developed in psychiatric populations
emphasizes the importance of catastrophic cognitions in precipitating and maintaining panic. The first objective of the study was to apply the assumptions of the cognitive model of panic in a sample of clinically anxious asthma patients to investigate whether illness specific catastrophic cognitions of physical sensations have an impact on asthma quality of life. The second objective of the study was to explore and identify the illness specific catastrophic cognitions, in terms of physical, mental and social cognitions, and their behavioural outcomes of patients with asthma and clinical levels of anxiety.
The results of this study can inform the development of screening measures and
therapeutic interventions specifically designed for asthma patients with heightened psychopathology.
Methods
The study fell into two phases: the quantitative and qualitative phase. The first phase was a within subjects cross sectional study using questionnaire data from patients with different levels of physician-diagnosed asthma and clinical levels of anxiety. Following ethical approval, 77 patients were screened with the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) for clinical levels of anxiety, and were recruited from three respiratory departments within the UK. For the second phase of the study, 15 clinically anxious asthma patients were randomly selected from the original sample of the quantitative phase, to attend semi-structured interviews that took place in the Respiratory Units of Birmingham and Manchester NHS Hospitals
Results
All patients participated in the quantitative phase were between the ages of 19 and 72 years (mean 43.83) and had an average level of clinical anxiety of 14.06 (a score of 11indicated the baseline for clinical levels). Illness specific catastrophic cognitions of physical symptoms made a unique statistical contribution to the prediction of impairment of quality of life of asthma patients (13=.243, p=0.031) even when disease and demographic variables were accounted for. The sample of the qualitative phase consisted of 9 females and 6 males with a mean score of age of 46.5 years. The average level of clinical anxiety for this sample was 15.13. Patients revealed a number
of catastrophic cognitions from which the most prevalent physical catastrophic
cognitions concerned thoughts of dying {n=9/15} and becoming ill (n=8/15); thoughts of becoming panicky (n=11/15) and being unable to control thinking (n=5/15) were the cognitions mostly reported by the participants about their mental state. Feelings of embarrassment (n=7/15) and fear of negative evaluation from others (7/15) were the most prevalent social catastrophic cognitions. Finally, investigation of the behavioural tactics employed by the participants revealed that the majority of patients displayed high levels of agoraphobic behaviour and cognitive avoidance
Discussion and Conclusion
This study is the first to date to investigate the role of catastrophic cognitions in asthma quality of life and to identify the illness specific catastrophic cognitions and the behavioural outcomes of asthma patients with clinical levels of anxiety. Results indicated that the assumptions of the cognitive model of panic can provide some explanation about the effects of anxiety on quality of life of asthma patients.
Maladaptive behavioural patterns and emotional distress caused by catastrophic
cognitions can affect greatly the quality of life of asthma patients in addition to the physical impairments imposed by their illness. However, further inspection of the interview data showed that perhaps the relationship between anxiety and catastrophic thinking is not so direct as suggested by the cognitive hypothesis of anxiety. Other factors may be related to the development, severity and maintenance of catastrophic cognitions in asthma such as perceptions of asthma and panic control. The present findings represent an important foundation in predicting asthma patients' cognitive and behavioural patterns that may significantly affect their quality of life. Implications for therapeutic interventions and future research are discussed.

Date of Award	Oct 2023
Original language	English
Awarding Institution	Coventry University
Sponsors	Birmingham Heartlands and Solihull NHS Trust, University Hospitals Coventry and Warwickshire NHS Trust & University Hospital of South Manchester
Supervisor	Donald Pennington (Supervisor), Louise Wallace (Supervisor) & Carol Percy (Supervisor)