summarizes the components of the CBT
intervention. The CBT intervention was based on a manualized
group approach developed by Stanley et al.,22
tested previously by Kunik et al.14 The original therapy
manual was modified by cutting down the number of
components (from 7 to 6) and sessions (from 8 to 7) and
lengthening the session from 1 to 2 h, in order to allow for
more time to work on each component. The primary aim of
the intervention was to help patients modify beliefs and
change behavioral patterns that perpetuate or maintain
psychological and somatic symptoms.
The participants attended 7 weekly 2 h group sessions at
the university outpatient clinic (Department of clinical
psychology, University of Bergen, Norway). In each of the
treatment groups, there were 4e6 participants (5 on
average). Participants in the CBT intervention were phoned
one and three months after post-treatment assessment,
and encouraged to maintain behavioral changes instigated
by the therapy. The group sessions were facilitated by
a Masters-level psychology student. The sessions were
videotaped, and a specialist in clinical psychology monitored
the adherence and competence of the two student
therapists on the basis of the video recordings.
Control group. In addition to standard care for COPD,
participants in the control group received telephone
contact with the study personnel every two weeks in the
intervention period of seven weeks, in order to monitor
their psychological status and assess suicidal ideation. The
telephone calls lasted 5e10 min, and no interventions
beyond assessment of symptom level and basic information
about symptoms of anxiety and depression were
delivered. The telephone contact with the participants in
control group was facilitated by the student therapists
who also conducted the CBT treatment. There was no
monitoring of telephone contact, but the student therapists
received detailed written instructions for the telephone
calls.