The significant effect of the psychotherapy and education
on reducing anxiety level in the present study was reflected
on the increase in exercise tolerance, which was evident after
treatment. The 6MWD test proved a reliable and reproducible
method for assessing exercise tolerance ; Eieser et al. proved the improvement in six MWD, was sufficient to produce
a significant difference from the baseline measurement
and when compared with controls (Table 3). This significant
effect of the psychotherapy and education on increasing the
exercise tolerance in patients with COPD was found in another
study which was partly sustained at 3 months after treatment.
Nevertheless, according to the study of Eiser et al. the
improvement in exercise tolerance, though highly statistically
significant, was not related to the HADS scores. Again, the positive outcome in our study is best attributed to the differences in style and content of the sessions, which produced interesting results in terms of improvement in cognitive style and coping mechanisms rather than just improving the exercise capacity. In agreement with our explanation, Sassi et al. found a significant improvement in the transitional dyspnea index in patients with COPD who received proper cognitive psychotherapy. He found that in 6 months after treatment with psychotherapy patients, with dyspnea for any cause, who were taught coping strategies by a psychotherapist, would respond better to treatment than patients who had general education sessions alone .
 
The significant effect of the psychotherapy and educationon reducing anxiety level in the present study was reflectedon the increase in exercise tolerance, which was evident aftertreatment. The 6MWD test proved a reliable and reproduciblemethod for assessing exercise tolerance ; Eieser et al. proved the improvement in six MWD, was sufficient to producea significant difference from the baseline measurementand when compared with controls (Table 3). This significanteffect of the psychotherapy and education on increasing theexercise tolerance in patients with COPD was found in anotherstudy which was partly sustained at 3 months after treatment.Nevertheless, according to the study of Eiser et al. theimprovement in exercise tolerance, though highly statisticallysignificant, was not related to the HADS scores. Again, the positive outcome in our study is best attributed to the differences in style and content of the sessions, which produced interesting results in terms of improvement in cognitive style and coping mechanisms rather than just improving the exercise capacity. In agreement with our explanation, Sassi et al. found a significant improvement in the transitional dyspnea index in patients with COPD who received proper cognitive psychotherapy. He found that in 6 months after treatment with psychotherapy patients, with dyspnea for any cause, who were taught coping strategies by a psychotherapist, would respond better to treatment than patients who had general education sessions alone .
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