5 Ways COPD Affects Your Mood—and How You Can Cope

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Having chronic obstructive pulmonary disease, or COPD, isn’t just tough on your body. It can be equally tough on your mind. In fact, COPD increases a person’s risk for depression nearly twofold. And being anxious or depressed sets the stage for worse symptoms and more time spent in the hospital, according to an Advances in Respiratory Medicine paper.

That’s partly because depression and anxiety get in the way of healthy behaviors—everything from taking your meds to showing up to doctor appointments to getting out for a walk or saying yes to social events, explains Jamie Garfield, M.D., a professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, in Philadelphia. “People with COPD are more likely to have anxiety and depression, and people with anxiety and depression are more likely to have increased severity, exacerbations, and mortality from COPD,” she says. “They spiral on each other.”

Meet the Experts: Jamie Garfield, M.D., a professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, in Philadelphia; Inna Khazan, Ph.D., a Boston-based clinical-health psychologist and faculty member at Harvard Medical School.

There’s no magic bullet for COPD or the emotional challenges that come with it. But there are things you can do to feel more empowered, both physically and psychologically. And that, in turn, can make it easier to manage your mental health. Here’s a look at five thoughts and scenarios you might deal with, and what you can do to cope with each of them.

1. You can’t do things like you used to.

Everyday activities get harder when you have COPD. Going food-shopping and carrying groceries back into your house can feel like an gold-medal event when you’re short of breath. And you might not have the energy to join in events with your family or friends if you’re struggling with fatigue.

“There’s a big difference in what an average day is like for a person with healthy lungs versus someone with COPD,” says Inna Khazan, Ph.D., a Boston-based clinical-health psychologist and faculty member at Harvard Medical School. “They feel like they can’t participate in life the way that they once did.”

But there are ways that you can train your body to do more. Enter pulmonary rehabilitation, a type of physical therapy aimed at improving the endurance of people with lung disease. “Patients are taught tools and skills to make the best of what they’ve got, like developing breathing and relaxation techniques for when dyspnea [labored breathing] gets in the way,” Dr. Garfield says.

More endurance means you’ll have more physical stamina to, say, enjoy a stroll around the block on a sunny day, push a giggly toddler on a swing set, or just get the laundry done with a little more ease. And that can have a major impact on your mood. COPD patients who did pulmonary rehab for just three weeks had a significant drop in feelings of depression and anxiety, found a European Respiratory Review analysis of 11 studies on non-pharmacological treatments for psychological distress. “You’re doing something that’s under your control, which reduces helplessness,” Dr. Khazan explains.

2. You feel ashamed about your COPD.

For many, there’s a sense of guilt that comes with having COPD that isn’t attached to other chronic illnesses (like rheumatoid arthritis or osteoporosis, for instance). “A lot of people believe they brought COPD on themselves, since it’s mostly related to tobacco use, but also even for some environmental exposures,” Dr. Garfield says. “There’s a lot of shame around the diagnosis for some.”

One way to manage these feelings is by talking with a mental-health professional who works with lung-disease patients. Talk therapy approaches like cognitive behavioral therapy (CBT), which teaches you how to respond differently to negative or unwanted thoughts, are a proven mental-health booster for people with COPD, concluded a systematic review and meta-analysis of 20 studies published in the journal Psychotherapy and Psychosomatics.

Dr. Khazan emphasizes mindfulness when practicing CBT with her patients. “If a negative thought comes into your mind, you can’t just stop the thought,” she says. “The idea is to learn how to respond to difficult thoughts or feelings in a way that’s healthy and that acts in your own best interest,” she explains.

For example, say you planned to go on an outing with your family that you thought you’d have the capacity for. But on the day of the event, you wake up feeling more breathless than usual. Instead of telling yourself that you’re worthless, or that the day is ruined because you can’t go, you’d take a step back to reframe the situation. “You might say to yourself, ‘I’m not feeling my best. I don’t know how this will impact my day. But I’m going to make the best of it, because this thing is important to me,’” Dr. Khazan says. That might mean being honest with your family about your symptoms before going to the outing, and then doing as much as you can, knowing that you might need to take a rest sooner than expected.

3. Feeling out of breath sends you spiraling.

It’s easy to go into panic mode when your chest starts to feel heavy or tight. Aside from being physically uncomfortable, you’re now worrying about how you’ll get through whatever task you’re trying to complete—not to mention what this might mean for the rest of your day or week.

That anxiety can actually speed up your breathing and worsen your symptoms, and in turn further impact your mood, explains Dr. Khazan. So when those symptoms start to flare up, it helps to have relaxation exercises at the ready to slow your breathing back down and harness a feeling of calm and control. Practices like deep breathing (often taught at pulmonary rehab), biofeedback, progressive muscle relaxation, visualizing a soothing image, and meditation can all be helpful, and have been shown to improve feelings of depression and anxiety in COPD patients, the European Respiratory Review analysis showed.

Biofeedback, a mind-body technique that teaches you how to control body functions like heart rate and breathing, is Dr. Khazan’s go-to for her patients. “It helps people maximize their oxygen ability to reduce physiological symptoms,” she explains. A therapist or pulmonary rehab therapist can teach you exercises that you can practice daily, both when you’re feeling good and during stressful moments when your symptoms flare.

4. Your family and friends are helpful, but they don’t grasp what it’s like.

“COPD can sometimes create isolation,” Dr. Garfield says. Even if you’re lucky enough to have supportive family members or friends, they probably don’t fully understand what having COPD feels like. That’s where a support group can come in. “It’s important to connect with others who have the disease. And because people with COPD aren’t necessarily bumping into each other in the street, it can be hard to find each other,” Dr. Khazan says.

Your doctor may be able to recommend a local support group to attend. Or check out the American Lung Association’s Better Breathers Club, which connects members with COPD and other lung conditions at in-person and virtual events nationwide, while sharing tools and resources that you can use to help you feel your best.

5. Life just feels duller.

No longer having the capacity to do some of the things you enjoy—travel to far-flung locales, or play tennis on Saturdays, for example—can easily make life feel colorless and drab. One way to cope is by taking a step back and finding other meaningful ways to fill those same needs. “Yes, you may have very real limitations,” Dr. Khazan says. “But think: What is important to me, and how can I live according to my values?

If you love immersing yourself in different cultures, say, you could watch more foreign films, or cook your way through an international cookbook. If you thrive on friendly competition with friends, invite them over for weekend Scrabble games. “There may be some changes that are needed,” says Dr. Khazan. “But it’s possible to make those changes and continue living in a way that feels purposeful to you.”

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