Managing Chronic Obstructive Pulmonary Disease (COPD) & Anxiety

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1 Managing Chronic Obstructive Pulmonary Disease (COPD) & Anxiety Chronic Obstructive Pulmonary Disease & Anxiety Many of us will, at some time, have a serious physical illness. Both the illness, and the treatment for it, can affect they way we think and feel. For example, experiencing a bad bout of flu can leave us feeling quite miserable and physically weak; it may also take some time to return to our normal self. Having 1

2 a more serious illness, such as heart disease or Chronic Obstructive Pulmonary Disease (COPD) is understandably frightening. Managing illness and physical limitations can create a lot of worry to family members, friends and to ourselves resulting in a lot of distress. When we have a physical illness we may also drop out of activities we like to do and stay at home more. This can result in loss of confidence and feelings of frustration and loneliness, causing even more stress. Anxiety, depression and low quality of life are common among people with COPD. COPD is an illness in which it is especially important to reduce fears that people may have and develop their confidence. This information booklet is for anyone who suffers from COPD, his or her relatives and friends. The booklet looks at: The emotional effects of COPD for you and your caregiver How you can help yourself to cope with COPD Others who can help Coping with COPD may leave you feeling afraid, depressed, angry, or alone. You may feel anxious about the future or blame your condition on yourself. You may even deny that you're ill and ignore your treatment plan. These feelings are normal, but they don't have to overwhelm you. Recognising your feelings and developing a positive attitude will help you feel more in control of your life. 2

3 It s scary when you can t breathe It is usual for people with COPD to worry about their condition. Shortness and difficulty in breathing is a major symptom associated with times when breathing gets worse and makes you feel unwell (known as acute exacerbation ) of COPD. These exacerbations may be caused by a viral infection (which will not need antibiotics) or a bacterial infection (which may need antibiotics). The more difficulty in breathing the higher increase of distress. Breathlessness can feel very threatening and trigger anxiety. Anxiety makes us breathe faster, so this makes breathing difficulties feel worse. When you feel short of breath, your neck, shoulder, and chest muscles tense. You become anxious and begin to breathe faster. Your breathing muscles tire and trap air in your lungs. Then breathing becomes even more difficult, and your chest may feel tight. Anxiety increases, until you may start to panic. When we feel panicky we sometimes over-breathe. This is not dangerous but over time, it can make you feel more unwell. Why do I feel so ill? When our body thinks it is in danger, an automatic mechanism springs into action. This is called the fight or flight mechanism. This can be very useful if there is immediate danger, it gets our bodies ready to fight or run away, without us having to think about it. It is a normal reaction and not dangerous. A hormone called adrenalin causes the physical changes. But if this reaction is triggered by breathlessness it is not very helpful and just makes us feel ill. 3

4 Physiological Changes Changes in blood pressure Skin blood diverted away to lungs and heart Body fluids diverted into bloodstream to increase blood volume Breathing becomes faster and more shallow Heart rate increases to increase blood flow and energy to muscles. Digestive system slows down all energy diverted to fighting muscles. Hair stands on end Sweating increases Involuntary urination. System shuts down as energy is diverted to muscles Resulting Symptoms Faintness / Dizziness Headaches / Neck aches Paleness Dry Mouth Shortness of breath or choking sensation Palpitations (pounding heart) Butterflies in the stomach / nausea Goose bumps Clammy hands Frequent desire to go to the toilet Muscles tense ready for action hormone (adrenaline) release to maintain this Shaky and aching limbs Finally body worn out Excessive tiredness due to constant energy demands If you simply stay put and do nothing, the feelings will start to subside. Our bodies simply cannot keep releasing adrenalin constantly. This might take 15 minutes and you might feel exhausted for longer but it will happen. 4

5 Anxiety and Negative Thoughts When we experience these unpleasant physical signs of panic, it tends to trigger have constant worrying thoughts such as fearing the worst things will happen to us. When we are anxious we tend to focus on negative things rather than positive things. For example, I can t breathe properly, I might stop breathing, Something terrible is going to happen, I m going to lose control, or maybe I will have a heart attack rather than I know panic can t really harm me, my breathing will get back to normal in a few minutes These negative thoughts can make the anxiety worse and may even trigger it! Anxiety and Avoidance Behaviour (escaping from the situation) It is natural to try and avoid or get away from situations that make us feel anxious. Some situations are difficult to deal with and will make us feel very panicky. When we are panicky we will feel uneasy and experience uncomfortable physical sensations as mentioned earlier. Our first reaction is to escape. We may take some specific action to make ourselves feel safer. If we fear that we may choke we may reduce food intake, If we feel we may collapse, we may hold on to something or someone. If we fear that not concentrating on our breathing might stop us breathing, we may use continuous oxygen or deliberately try to over breathe. We may avoid similar situations in the future that make us feel panicky. All the above are known as safety behaviours. They reduce anxiety in the short term but in the long-term they maintain the problem, as we never get a chance to learn what we can do, we never get a chance to learn that our unpleasant symptoms are not dangerous. Avoiding situations can become a habit and we may begin to avoid more and more situations. As a result we may feel bad for nothing and be unable to do some things. We may also miss out on things that we would have enjoyed. 5

6 A vicious circle can result: A vicious circle becomes established when we become very sensitive to the physical sensations of anxiety. Then we worry and start thinking about such alarming possibilities as heart attacks or losing control. This makes us feel more anxious and apprehensive, and our symptoms and fears in turn get worse. We get confidence by doing things. AVOIDANCE means stopping doing things and leads to LOSS OF CONFIDENCE. Loss of confidence means ANXIETY and can bring about feelings of failure. Avoidance can spread to MORE and MORE situations A Vicious Cycle Worrying thoughts If I m out of breath, I ll damage myself & it s dangerous Lost confidence I can t breathe properly, I couldn t do it, I feel exhausted Physical Symptoms Increased breathing, chest tightens, heart rate racing, feeling hot Avoidance Sitting down, not doing anything More worry about physical symptoms I can t breathe properly, I am having a heart attack, I am going to die 6

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