Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease. Part I. Psychosocial and psychological considerations.

This is the first of a three-part series (to appear in consecutive issues) exploring the psychosocial and psychological concomitants of chronic obstructive pulmonary diseases (COPD), with emphasis on anxiety and depression. The reciprocal nature of dyspnea, anxiety and depression is clarified. Isolation, denial, and repression are the classic defenses of COPD patients and some, not all, patients can be aided by psychotherapy. This counseling many times may best he administered by the primary physician, if the patient requires additional long-term therapy, referral to a specialist is recommended. The following treatment modalities, in addition to basic medical therapy to facilitate respiration, also are discussed: breathing retraining, meditation, relaxation training, experimental use of biofeedback, behavior modification, goal setting, life-change monitoring, and education of patient and family in patient self-care. One section delineates the use of psychoactive medi-