Thoughts & behaviours

Can thoughts and behaviours help us to better understand anxiety and depression in people with PH?

A study has shown that thoughts and behaviours, as well as breathlessness, are associated with anxiety and depression in adults with pulmonary hypertension. Clinical Psychologist Dr Gregg Rawlings, who led the research in collaboration with the PHA UK, the University of Sheffield and Cardiff University, talks us through the findings…

There are many research studies showing that people living with a long-term health condition, including pulmonary hypertension, are at a greater risk of experiencing difficulties with anxiety and depression. It is very important for us to understand the cause of this as it would help us to better identify those who would benefit from receiving additional support, such as through screening measures. It will also help improve our understanding of how pulmonary hypertension, anxiety, and depression interact with each other; and help to develop effective interventions.

We know that the way we think (also known as our cognitions) and how we behave (our behaviours), can have a positive or negative impact on our mood. For example, if I stayed inside for several days and did not speak to anyone, I know that I would likely not feel great about myself or motivated to do things that I enjoy. On the other hand, if I met up with some friends to have a chat, had a nice meal, and enjoyed the fresh air, I know that my mood and thoughts would be more positive.

Our research study set out to investigate whether symptoms of anxiety and depression are related to how adults with pulmonary hypertension think (their cognitions) and behave (their behaviours).

We re-analysed data that was collected for a previous study conducted in collaboration with the PHA UK, the University of Sheffield and Cardiff University. In this study, adults with pulmonary hypertension took part in an intervention that investigated whether a form of psychological therapy, known as Cognitive Behavioural Therapy (CBT), was helpful for people experiencing symptoms of anxiety. Participants completed a series of questionnaires including questions about anxiety, depression, and thoughts and behaviours that have been related to mood in other people. We used data from those questionnaires for the current study.

The main findings suggest that people’s demographics (such as age and gender) were not related to anxiety and depression.

This means that anyone with pulmonary hypertension can experience difficulties with their mood and it is not just isolated to one group of people.

Difficulties with breathing were related to both anxiety and depression. This is particularly important as breathing difficulty, also known as dyspnoea, is one of the most common symptoms of pulmonary hypertension. And, based on our study, it may be a risk factor for feelings of anxiety and low mood.

Finally, individuals’ cognitions predicted anxiety whereas their behaviours did not. In contrast, individuals’ behaviours predicted depression, whereas their cognitions did not.

These results show the importance of understanding cognitions and behaviours for anxiety and depression in people with pulmonary hypertension. The findings can also help to guide what support is most likely to be helpful. For example, if someone is experiencing anxiety, helping that person to understand how their thinking is related to their mood, and challenging some of their unhelpful thoughts and worries, could be helpful. For someone experiencing depression, supporting them to change unhelpful behaviours may be most helpful.

A message from Dr Rawlings

Many PHA UK members took part in the initial study that led to these findings, and to the production of our self-help programme for worry and anxiety.

“I would like to thank all those who took part in the study. By participating in the project and sharing your expertise and lived knowledge, you have helped us to better understand anxiety and depression in the context of pulmonary hypertension. The study findings have been published in a scientific journal and are available for people to read all around the world.

The information and experiences you shared have also helped other people with PH access more support, as the intervention to help people live better with anxiety, worry and panic in pulmonary hypertension has since been made widely and freely available [See p32]. We have even been contacted by researchers outside of the UK wanting to translate the booklets into another language so they can be used by people who do not speak English. Working with the PHA UK has been a very positive experience. It is clear to see how much the charity cares about their members and strives to offer them support. It is especially inspiring to see the voices of their members help to shape the work the charity is involved in.”

The results also add to the growing evidence suggesting that offering psychological treatments to people with pulmonary hypertension could be helpful. The mental health of people with pulmonary hypertension is an important agenda. We must continue to have such conversations to raise awareness, increase support and reduce barriers that people face when they seek help.

More research is needed to help us better understand the relationship between mental wellbeing and pulmonary hypertension, and to continue developing effective treatments that can be easily accessed.

Dr Gregg Rawlings is a registered Clinical Psychologist, an Honorary Research Fellow at The University of Sheffield, and a lecturer in the Division of Psychology at Nottingham Trent University.