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Eleonora Volpato,1,2 Paolo Banfi,2 Francesco Pagnini1,3 1Department of Psychology, Universita’ Cattolica del Sacro Cuore, Milan, Italy; 2IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 3Department of Psychology, Harvard University, Cambridge, MA, USACorrespondence: Eleonora Volpato, Department of Psychology, Università Cattolica Del Sacro Cuore, Via Nirone, 15 CAP. 20123, Milan, Italy, Email eleonora.volpato@unicatt.itIntroduction: The main aim was to gain insight into the experience of adult people with a diagnosis of at least 6-months of mild or moderate persistent asthma according to the Global Initiative for Asthma (GINA), and their emotions, beliefs, and expectations during the first wave of COVID-19.Methods: Qualitative semi-structured interviews using the Interpretative Phenomenological Analysis (IPA) were carried out by phone involving 31 people (mean age=58.2; SD=16.2). Interviews were audio recording, transcribed verbatim and analysed through thematic analysis.Results: Five superordinate themes and themes were dedicated to illness (symptoms of asthma; difficulties related to COVID-19), experienced emotions (lockdown period; medical changes; emotions COVID-19 related), beliefs (about asthma; about COVID-19), expectations (related to asthma; related to COVID-19) and behaviours (to protect; risk taken; adherence; contacts with General Practitioners; support). The prevalence of emotions such as fear, worry and anxiety emerged in the participants’ narratives. All are accompanied by a preference for action and problem solving. A sense of protection, connection to self and other, and commitment to life were revealed as central concepts for enhancing well-being even at a time of deterring.Discussion: The common threads of the presence of uncertainty and vulnerability open the outlook of a treatment that ensures greater continuity and ownership of care in the patient, preserving the sense of self-efficacy even in times of greater instability.Keywords: asthma, interpretative phenomenological analysis, COVID-19, clinical psychology

Valentina Poletti,1 Francesco Pagnini,1 Paolo Banfi,2 Eleonora Volpato1,2 1Department of Psychology, Università Cattolica Del Sacro Cuore, Milan, Italy; 2IRCCS Fondazione Don Gnocchi, Milan, ItalyCorrespondence: Valentina Poletti, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy, Email valentina.poletti@unicatt.itBackground: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitation. Besides its irreversibility, COPD is a treatable condition, and patients would strongly benefit from being adherent to their treatments. However, almost half of them are non-adherent, and, according to several recent studies, the way the patient perceives the disease might influence this variable.Aim: This systematic review provided a synthesis of studies about the relationships between illness perceptions (IP), cognitions, beliefs, and adherence in COPD.Methods: English language publications were searched in PubMed, Medline, Scopus, ResearchGate, PsycINFO, and Cochrane Library databases from November 2022 to February 2023, following PRISMA guidelines. The reference lists of eligible studies were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently.Results: A total of 14 studies were included. Adherence to treatment in COPD is confirmed to be low, using both self-report questionnaires and objective assessment systems. Most studies concluded that COPD is perceived as a moderate threat destined to last forever, even if many participants referred to little disease knowledge. This perception did not change between adherent and non-adherent groups. Those who considered more necessary to take their medicines and had a caregiver were more adherent and less concerned about their future. On the other side, forgetfulness, lack of trust in medications, and difficulties in understanding how to take them were perceived as the main causes of non-adherence. Other predictors of non-adherence, like depression, low self-efficacy, and severity of disease were confirmed.Conclusion: The systematic review highlights the variability of the relationship between IP, cognitions and beliefs, and COPD treatment adherence. A new level of awareness of the relationship between patients’ subjective point of view and treatment adherence may inform future treatment options and promote a more personalized intervention.Keywords: illness perception, COPD, adherence to treatment, illness cognition, illness belief

Eleonora Volpato,1,2 Stefania Toniolo,1 Francesco Pagnini,1,3 Paolo Banfi2 1Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; 2Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 3Department of Psychology, Harvard University, Cambridge, MA, USACorrespondence: Eleonora Volpato Email eleonora.volpato@unicatt.itBackground: Almost half of the people with chronic obstructive pulmonary disease (COPD) do not adhere to the prescribed treatments and report anxiety and depression as comorbidities, resulting in higher rates of exacerbations, hospitalizations, and worse clinical outcomes.Objective: This systematic review provided a synthesis of studies about the relationships between anxiety, depression, and adherence in people affected by COPD.Methods: English language publications were searched in the PUBMED, SCOPUS, PsycInfo, Web of Science, PsycArticles, and Cochrane Library databases from December 2020 to March 2021, following PRISMA guidelines. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently.Results: A total of 34 studies (23 quantitative and 2 qualitative studies, 9 reviews) were included. The relationship between depression and treatment adherence was significant and negative. Adherence to both rehabilitation, psychological, and antidepressant pharmacological treatments in depressed patients was linked to a decreased risk of hospitalization. Moreover, depressed patients compliant with an antidepressant were more likely to adherent to COPD maintenance inhalers. On the other hand, the associations between anxiety and adherence were poorly investigated and high heterogeneity characterized the studies, leading to a weak and variable relationship as well as too few interventions.Conclusion: The systematic review highlights the variability in estimates of the relationship between depression, anxiety, and treatment adherence in COPD. It could be explained by methodological differences across the included studies. This suggests that standardization is critical to improving the precision of the estimates. Recommendations for future research include attention to causal inferences, an exploration of mechanisms to explain the relationships between both anxiety and depression and adherence in COPD, and a comprehensive, systematic approach.Keywords: chronic obstructive pulmonary disease, adherence, compliance, anxiety, depression, systematic review

Francesco Pagnini,1,2 Eleonora Volpato,1,3 Silvia Dell’Orto,1 Cesare Cavalera,1 MariaFrancesca Spina,3 Paolo Banfi3 1Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; 2Department of Psychology, Harvard University, Cambridge, MA, USA; 3Pneumological Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, ItalyCorrespondence: Francesco PagniniDepartment of Psychology, Università Cattolica del Sacro Cuore, Via Nirone, 15, CAP, Milan, 20123, ItalyTel +39 339 1942425Email francesco.pagnini@unicatt.itBackground: Illness expectations are cognitive schemas, both explicit and implicit, describing how symptoms are expected to be in the future. They can be particularly relevant to disease in a mind/body framework. Asthma is a condition in which the psychological aspects can highly influence the body, but no study has directly explored these specific expectations, and no dedicated assessment tools are available.Methods: We developed a questionnaire to assess the illness expectations, together with an ad hoc version of the Implicit Association Test (IAT). We tested its factorial structure, and the internal and test–retest validity, recruiting a sample of 183 asthmatic people. We also explored the convergent validity and the correlations with objective and subjective clinical assessments.Results: Data suggested a three-factorial structure of the questionnaire into expectations about future symptoms, change in current health status, and rigidity of these expectations. The questionnaire showed good psychometric properties and strong associations with the other considered outcomes, including implicit expectations. The implicit evaluation, however, lacked test–retest reliability.Conclusion: The questionnaire is a valid tool to assess illness expectations in people with asthma. The two expectation scales are highly related, and the implicit expectations are moderately associated with the explicit ones. The lack of stability related to IAT results may reflect a lack of stability of the implicit expectations. The implications for the mind/body framework still need to be fully explored.Keywords: illness expectations, mind/body connection, asthma, placebo, nocebo