An investigation of the association between catastrophic thoughts and anxiety in people with respiratory diseases

The purpose of this study was to investigate whether the cognitive model of panic may explain the high levels of anxiety that have been reported amongst people with Chronic Obstructive Pulmonary Disease (COPD) (Carr et al, 1994). In previous research, cognitive variables, assessed on general measures of catastrophizing (such as the Agoraphobic Cognitions Questionnaire), have been shown to be strongly predictive of anxiety in people with COPD, regardless of severity or duration of the respiratory disease. One of the aims of this study was to develop a questionnaire to elicit specific cognitions in response to a range of COPD-related symptoms presented in different situations. Favourable reliability and validity were demonstrated for the questionnaire, and its completion by 37 people with COPD produced a range of cognitions of differing severity. High levels of anxiety (assessed using the Hospital Anxiety and Depression scale) were found in the group (more than 27%). More severe catastrophic thoughts were found to be strongly predictive of greater anxiety, particularly for specific anxiety ratings on the new questionnaire, and this relationship was more significant when cognitions and anxiety wore elicited by symptoms presented in 'unsafe' situations. Severity and duration of illness were not significant predictors of anxiety, but social support was strongly predictive of generalized anxiety. In the light of the adverse consequences of anxiety with regards to appropriate coping with respiratory disease, an exploration of the use of cognitive techniques in therapy is suggested.