title: A randomised controlled feasibility trial of Group Cognitive Behavioural Therapy for people with severe asthma.
abstract: OBJECTIVE
  Evidence for the efficacy of Cognitive Behavioural Therapy (CBT) in asthma is developing but it is not known if this translates to benefits in severe asthma or if a group approach is acceptable to this patient group. This study aimed to assess the feasibility and acceptability of Group-CBT in severe asthma.
  
  
  METHODS
  This was a two-centre, randomised controlled parallel group feasibility study. Eligible participants (patients with severe asthma and a clinically significant diagnosis of anxiety and/or depression - Hospital Anxiety and Depression Scale (HAD) score greater than 8 for the anxiety or depression sub-scale) received Group-CBT in weekly sessions for eight consecutive weeks and usual care or usual care only. Follow-up was for 16 weeks and end points were: Asthma Quality of Life Questionnaire, Asthma Control Questionnaire, HAD, Dyspnoea-12, EuroQual-5D and EuroQuol-VAS.
  
  
  RESULTS
  51 patients were randomised: 36% (51 out of 140) consent rate and attrition at week 16 was 12. Screening logs indicated that study take-up was influenced by patients living long distances from the treatment centre and inability to commit to the weekly demands of the programme. Drop-out was higher in Group-CBT compared due to inability to commit to the weekly programme because of poor health. Participants who contributed to focus group discussions reported that Group-CBT contributed to a better understanding of their illness and related approaches to anxiety management and acceptance of their asthma condition. Although weekly face-to-face sessions were challenging, this was the preferred method of delivery for these participants.
  
  
  CONCLUSIONS
  This feasibility study shows that Group-CBT warrants further investigation as a potentially promising treatment option for patients with severe asthma. It has been possible but not easy to recruit and retain the sample. Options for a less demanding intervention schedule, such as less frequent face-to-face visits and the use of web-based interventions, require careful consideration.
authors.affiliation: a School of Nursing , Midwifery and Social Work, University of Manchester , Manchester , UK.
authors.forename: Janelle
authors.initials: J
authors.lastname: Yorke
authors.affiliation: b Department of Behavioural Medicine, School of Psychological Sciences and Health , University of Strathclyde , Glasgow , Scotland , UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Adair
authors.affiliation: c Consultant Clinical Psychologists, Psychological Service , Royal Brompton and Harefield NHS Foundation Trust , London , UK.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Doyle
authors.affiliation: d Department of Applied Psychology, Therapies , University of Salford , Salford , UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Dubrow-Marshall
authors.affiliation: c Consultant Clinical Psychologists, Psychological Service , Royal Brompton and Harefield NHS Foundation Trust , London , UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fleming
authors.affiliation: e North West Lung Centre University Hospital South Manchester , Manchester , UK.
authors.forename: Leanne
authors.initials: L
authors.lastname: Holmes
authors.affiliation: c Consultant Clinical Psychologists, Psychological Service , Royal Brompton and Harefield NHS Foundation Trust , London , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Menzies-Gow
authors.affiliation: e North West Lung Centre University Hospital South Manchester , Manchester , UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Niven
authors.affiliation: a School of Nursing , Midwifery and Social Work, University of Manchester , Manchester , UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Pilling
authors.affiliation: c Consultant Clinical Psychologists, Psychological Service , Royal Brompton and Harefield NHS Foundation Trust , London , UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Shuldham
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D001249:Asthma / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D004417:Dyspnea / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group; D011788:Quality of Life; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
keywords: Psychological; anxiety; breathlessness; cognitive behavioural therapy; depression; quality of life