Effectiveness of cognitive behavioural therapy in reducing anxiety in adults and children with asthma: A systematic review

Objective: Asthma and anxiety are known to interact, leading to exacerbations for both conditions. This systematic review summarised evidence regarding the effectiveness of cognitive behavioural therapy (CBT) in reducing anxiety in individuals with asthma, with results presented separately for adults and children. Data sources: PRISMA and CRD guidance were followed to conduct and report the current review. Three major electronic databases (Ovid Medline, PsycINFO, and EMBASE) and manual searches were used to find relevant published and unpublished research. Study selections: Sixteen trials (12 adult- and four child-focused) met inclusion criteria, and were evaluated with adapted quality criteria. Both controlled trials and repeated-measures designs were eligible. All CBT intervention formats were eligible (group, individual, computerised, and self-help). Nine studies (eight adult and one child) focused upon participants with either an anxiety diagnosis or with above-threshold anxiety scores on a validated measure at baseline. Results: The review provides tentative preliminary support for the use of CBT for anxiety in adults with asthma, with the evidence base for interventions with children appearing promising, but under-developed. Studies were more likely to indicate beneficial effects where anxiety-focused (rather than illness-focused) intervention protocols were utilised, asthma-related education was provided and where the trials focused on individuals with likely clinical levels of anxiety at baseline. Conclusion: Whilst further high-quality research is needed, available evidence is supportive of anxiety-focused CBT interventions tailored to target the particular mechanisms thought to maintain this comorbidity in asthma.