Interaction between asthma and anxiety: a systematic review of cognitive-behavioural therapies and a qualitative exploration of young people’s experiences.
Aims: There is a well-established link between asthma and anxiety, leading to exacerbations
for both conditions. National guidelines and policy documents recommend the provision of
psychological interventions for this comorbidity, although evidence for their effectiveness is
inconclusive. This thesis had two objectives: a) to evaluate cognitive-behavioural therapy
(CBT) interventions for reducing anxiety in adults and/or children with asthma, given that
CBT has a stronger evidence base for relevant respiratory and mental health conditions, b) to
explore the lived experience of the interplay between childhood asthma and anxiety directly
from the affected population in order to identify specific thinking and behaviour patterns that
may maintain this comorbidity.
Method: The first journal article outlined a systematic review. Three major electronic
databases and manual searches were used to find relevant published and unpublished
research. Trials meeting inclusion criteria, primarily utilising validated anxiety measures and
employing both cognitive and behavioural techniques, were evaluated using adapted quality
criteria. The second empirical article implemented interpretative phenomenological analysis
(IPA) to explore the mechanisms maintaining the interplay between asthma and anxiety as
experienced by 11 young people (aged 11-15) living with the comorbidity.
Results: Fourteen trials met the inclusion criteria for the systematic review. The reviewed
trials showed reasonable preliminary support for the effectiveness of CBT for anxiety in
individuals with asthma across the age range. The favourable results were largely maintained
long-term. The empirical article revealed three super-ordinate themes: i) ‘the influence of
asthma’ by inhibiting valued activities or developmental tasks, triggering catastrophic
thinking and leading to a generalisation of asthma coping strategies to managing anxiety; ii)
‘the influence of anxiety’ by affecting appropriate medication use and triggering
hyperventilation-induced asthma exacerbations; and iii) ‘the interaction between asthma and
anxiety’ by forming an unhelpful positive feedback loop and triggering symptom confusion.
Conclusions: The systematic review discussed the moderate overall study quality and called
for more methodologically robust research, examining CBT models tailored to this
population and utilising clinically representative samples. The empirical article pointed to
possible maintaining mechanisms identified, which lend themselves to a cognitive-behavioural
framework, potentially including mindfulness-based interventions, and may be
used to tailor psychological treatments