title: Case series: the application of "third wave" cognitive behavioural therapies in difficult to treat asthma.
abstract: OBJECTIVE
  This paper provides for the first time cases of individual psychological therapy undertaken in tertiary, difficult to treat asthma services using "third wave" cognitive behavioural therapy (CBT) approaches.
  
  
  METHODS
  These cases were selected to represent common psychological presentations in difficult to treat asthma clinics, namely denial of severity and over-identification with asthma. Assessment, formulation, intervention and results are outlined.
  
  
  RESULTS
  Case 1 demonstrated change from severe to mild depression and anxiety, reduction in shame and improved well-being. Case 2 demonstrated improvements in well-being and psychological symptoms. Both interventions were experienced by the patients as highly satisfactory.
  
  
  CONCLUSIONS
  It is concluded that a psychological understanding of patients' presentations can open up new avenues for intervention. Further research into the potential utility of third wave cognitive therapies in difficult to treat asthma is warranted.
authors.affiliation: a Birmingham Regional Severe Asthma Service, Birmingham Heartlands Hospital , Birmingham , UK .
authors.forename: Jodie Louise
authors.initials: JL
authors.lastname: Fellows
authors.affiliation: b Difficult Airways Disease Service, University Hospital Southampton , Southampton , UK .
authors.forename: Laura
authors.initials: L
authors.lastname: Flower
authors.affiliation: c Clinical Sciences, Liverpool School of Tropical Medicine , Liverpool , UK , and.
authors.forename: John
authors.initials: J
authors.lastname: Blakey
authors.affiliation: b Difficult Airways Disease Service, University Hospital Southampton , Southampton , UK .
authors.forename: Ramesh
authors.initials: R
authors.lastname: Kurukulaaratchy
authors.affiliation: d School of Psychology, University of Birmingham , Birmingham , UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Howard
authors.affiliation: a Birmingham Regional Severe Asthma Service, Birmingham Heartlands Hospital , Birmingham , UK .
authors.forename: Adel
authors.initials: A
authors.lastname: Mansur
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001249:Asthma / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008603:Mental Health
keywords: ACT; CFT; acceptance and commitment therapy; brittle asthma; cognitive behavioural therapy; compassion focussed therapy; mindfulness; psychology