Dr. Fabiola Rossetto
Clinical Psychologist,
expert in Palliative Care, Piazza Armerina (En)


In COPD there is an important psychological component and it is the task of psychological support to provide help to the patient and family members to accept the diagnosis and live with it in the best possible way. Interventions include: psychoeducation to create compliance, support groups for caregivers and individual therapy for stress management, deriving from the difficulties that the disease entails.


The purpose of this article is to evaluate the importance of psychological intervention in patients with COPD. The impact of the disease on the psychological sphere is manifested by a reduction of the QoL. Attention must be paid to patients and their caregivers through interventions that act on adaptation to the disease and on the search for personal and social resources to identify effective problem solving techniques. The best therapeutic adherence can be obtained thanks to empathic relationship models in a reciprocal exchange that allows the patient to be an active protagonist in the treatment.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease characterized by persistent respiratory symptoms and airflow limitation, which is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. The most common respiratory symptoms include dyspnea, cough and/or sputum production. It can be characterized by acute periods with worsening respiratory symptoms. The main risk factor is inhaled cigarette smoke, but other environmental exposures, genetic abnormalities, abnormal lung development and premature aging also contribute. It can be associated in most patients with concomitant chronic diseases, which increase mortality and morbidity. Based on the most recent Gold Guidelines, several COPD severity classification systems are available (Gold, 2019).

COPD is a major health problem worldwide. The growth in the number of smokers and the increase in the number of elderly people are the main factors responsible for the increased prevalence of the disease worldwide. According to the results of the third National Health and Nutrition Examination Survey, life expectancy is reduced by 5.8 years in 65-year-old men with GOLD stage 4 COPD and by another 3.5 years if they continue to smoke (Nhanes III, 2009).

Furthermore, the Covid-19 pandemic has entailed a particular risk for people with COPD, accentuating some critical issues and causing a general psychological malaise, generated by fear and feelings of loneliness.

Being a chronic disease, it negatively affects the mental well-being of patients who are affected by it, causing an increase in anxiety and mood disorders.

In 2006, the American Thoracic Society and the European Respiratory Society defined pulmonary rehabilitation as a multidisciplinary intervention aimed at patients with chronic respiratory diseases to reduce symptoms and optimize functional status. The program is multidisciplinary and includes physical and psychosocial function (ATS/ERS, 2006).

Pulmonary rehabilitation is the set of interventions based on patient assessment with personalized therapies capable of improving the physical and psychological condition of people suffering from chronic respiratory diseases and promoting adherence to programs for the patient’s well-being (McCarthy et al.2015).

These patients experience psychological, social, cognitive and neuropsychological dysfunction; they usually become anxious and fearful, exhibiting social withdrawal, anger, more dependency in ADLs/IADLs, and the fear and anxiety in turn causing more dyspnea.

In this case, patients have not only physical but also relational needs, requiring listening, clarity, physical and emotional contact, sharing and understanding of their moods. Psychological support is configured as a resource during the entire disease process with a person-centred approach (Rogers, 1951).

The psychologist intervenes recognizing the patient’s needs, helping him in the great path of physical and psychological change that he will inevitably have to manage with the disease. Psychological activity offers a protected space, important for the patient, in which to recognize existing difficulties and promote the adaptation process. In this way it becomes possible to acquire the necessary tools to deal with the discomfort induced by the disease and in particular, it allows to learn, recognize and deal with negative emotions, dysfunctional thoughts, maladaptive behaviors and internalize effective problem solving methods.

The stress of pathology management also acts on caregivers, in fact the caregiver’s burden can lead the family to have high levels of Expressed Emotion which represents a high and intense emotional response to the situation (Vaughn, 1988). Some interventions can help families to make sense of what they are experiencing and not feel alone, such as psychoeducational interventions to increase knowledge about the disease and support groups with the aim of psychologically supporting those who care, avoiding isolation and advocating for re-motivation. Psychological support appears particularly important for families, in order to maintain an attitude of trust, get in touch with their emotions and dedicate time to themselves.

For patients with serious psychological disorders it is possible to intervene with a brief strategic individual therapy which allows to build interventions based on pre-established objectives and on the specific characteristics of the problem using very efficient and effective flexible techniques (Watzlawick, Nardone, 1997).

An important contribution that allows the patient to be placed at the center of treatment comes from the progressive development of Narrative Medicine. The Consensus Conference, promoted by the Istituto Superiore di Sanità, marked a fundamental step with the aim of producing recommendations for the future development and implementation of the NBM. This methodology focuses attention on the sick person, understood as a subject with psychological, social, existential needs, which can be documented through the tool of narration (Consensus Conference, 2015).

The improvement of health status, physical and psychological symptoms and QoL derives from a multidisciplinary help that combines medical, psychological, social interventions and lifestyle re-education.

An empathetic relationship with the COPD patient in a setting of trust and understanding is a step forward that can maximize the effectiveness of the therapeutic treatment.


American Thoracic Society, EuropeanRespiratory. ATS/ERS statement on pulmonaryrehabilitation. Am J RespirCrit Care Med. 2006;173:1390-1413.

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Iniative for Chronic Obstructive Lung Disease (GOLD) 2019.

Higher Institute of Health, CNMR-National Center for Rare Diseases, Consensus Conference. Guidelines for the use of Narrative Medicine in the clinical-care setting, for rare and chronic-degenerative diseases. The Quaderni di Medicina, Il Sole24Ore Sanità, Annex to n.7, Milan, 2015.

McCarthy B, Casey D, Devane D, Murphy K, Murphy E, LacasseY. Pulmonaryrehabilitation for chronicobstructivepulmonarydisease. Cochrane DatabaseSyst Rev2015;2(2): CD003793

Rogers,Carl. (1951). Client-CenteredTherapy:ItsCurrent Practice, Implications and Theory. London: Constable.

Shavelle RM, Paculdo DR, Kush SJ, Mannino DM, Strauss DJ. Life expectancy and years of life lost in chronic obstructive pulmonarydisease : findingsfrom the NHANES III Follow-up Study. Int J Chron ObstructPulmonDis. 2009;4:137.

Vaughn, C. E. (1988). Introduction to the concept of expressed emotion, in Proceedings of the international conference “Schizophrenia and the family: compared models”. ARS News, 2(3), 6-11.

Watzlawick P., Nardone G. (1997), Brief strategic therapy, Cortina Raffaello, Milan.

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