e-Counseling for COPD

Chronic obstructive pulmonary disease (COPD) is the third leading cause of the death in the
US. Although COPD is mostly preventable, there is no cure. Thus, care of patients with COPD
is primarily focused on symptom palliation with the goal of improving quality of life for
both patients and their families. These goals are highly consistent with core principles of
palliative care. Dyspnea is the most distressing symptom for patients. Even optimal
disease-directed treatment provides only partial relief from dyspnea. Depression is
consistently associated with worse dyspnea, but the mechanisms underlying this relationship
are poorly understood. Since existing treatment for dyspnea has only limited success and
there is evidence that treating depression alleviates pain, we propose that by improving
mood, we may be more successful in alleviating dyspnea. Psychosocial-behavioral therapy
(PBT) which is focused on increasing pleasant events and improving problem solving skills
has been shown to have immediate and sustained effects on depressive symptoms in patients
with dementia and post-stroke holds tremendous promise for efficacy in advanced COPD.
Testing the use of novel technologies to provide efficacious interventions such as PBT to
patients with advanced disease is critical for translational palliative care research

Inclusion Criteria:

- COPD (FEV1/FVC < 70% & FEV1 <80%; current or past smoking >10pack-years)

- Depressed (PHQ-9 >=10)

- Ability to speak, read and write English

- Willingness to use computer or study-issued tablet device

Exclusion Criteria:

- Current non-nicotine substance abuse or dependence

- Psychotic disorder

- Active suicide ideation with intent and plan

- Alzheimer's/dementia

- Currently receiving any psychotherapy