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CBT for Breathlessness — SCE Palliative Medicine MCQ

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ModerateRespiratory SymptomsCBT for BreathlessnessSCE Palliative Medicine

A 68‑year‑old man with advanced COPD has severe breathlessness despite maximal medical therapy, pulmonary rehabilitation, low‑dose morphine, and use of a hand‑held fan. A clinical psychologist is now involved. Which psychological intervention is evidence‑based for targeting breathlessness?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Cognitive behavioural therapy addressing catastrophic thoughts, activity avoidance, and the anxiety‑breathlessness cycle

Option E is correct. NICE guideline NG115 (2018; last updated 2019) advises that for people with COPD who experience frightening breathlessness, a cognitive behavioural component should be included in self‑management plans to help manage anxiety and cope with breathlessness ([nice.org.uk](https://www.nice.org.uk/guidance/ng115/chapter/Recommendations?utm_source=openai)). This reflects evidence that CBT addressing catastrophic thoughts, the anxiety‑breathlessness cycle and activity avoidance reduces distress, even if it does not directly reduce the breathlessness sensation. The other options—hypnotherapy, psychoanalysis, EMDR, and respiratory EMG biofeedback—lack specific evidence in breathlessness management and are not recommended in UK respiratory or palliative care guidance.

Reference: NICE guideline NG115 'Chronic obstructive pulmonary disease in over 16s: diagnosis and management' (Recommendations and Rationale sections), 2018/19; NICE, UK. https://www.nice.org.uk/guidance/ng115/chapter/Recommendations#managing-stable-copd