Cognitive Behavioral Therapy Improves Dyspnea, Trial Shows

Findings from a recent clinical study (NCT05304793) show that cognitive behavioral therapy (CBT) can help patients with lung cancer manage dyspnea.^1,2

The behavioral program, Take a Breath (TAB), significantly improved breathlessness-related functioning and anxiety in patients.

The trial compared TAB to standard-of-care (SOC) treatment and had a total enrollment of 45 patients. TAB consisted of five 1-hour weekly individual sessions employing exposure-based interventions paired with pulse oximetry biofeedback, psychoeducation, and behavioral skills (eg, pursed lip breathing).

TAB was at least "mostly satisfactory" for 75% of participants. The accrual rate was 25.6%, with 60% of participants completing all sessions and an 88.7% homework completion rate. Intention-to-treat analysis revealed greater improvements in TAB than SOC for dyspnea-related functioning (Cohen's d = 0.82; P =.03) and anxiety (Cohen's d = 0.87; P <.01) at post treatment and follow-up. TAB outperformed SOC in improving depressive symptoms, health-related quality of life, sedentary time, and performance status over time (all P <.05).

In an interview with Targeted Oncology^®, Barbara L. Andersen, PhD, a researcher on the study and a distinguished university professor at The Ohio State University (OSU), as well as a member of the OSU Comprehensive Cancer Center, discussed the trial's findings and how CBT can help patients experiencing dyspnea.

Targeted Oncology: What was the rationale or unmet needs that prompted this line of research?

Barbara Andersen, MD, PhD: Lung cancer is the No. 2 cancer for both men and women. But less known is that [patients with lung cancer] have been amongst the least studied from a psychosocial standpoint. However, we have been able to do that with Ohio State’s Beating Lung Cancer in Ohio (BLCIO) cohort study of patients [with lung cancer] from stage 4 diagnosis through survivorship. And the significant problem—psychological difficulty—for those patients is depression. Considering physical symptoms, dyspnea really comes to mind.

What was the study's design and methodology?

The study was a randomized clinical trial where individuals receiving treatment, in the midst of targeted or immunotherapies, were accrued...and found to have significant problems with dyspnea. Patients were [randomly assigned] to receive a novel cognitive behavioral intervention focused on the problem of dyspnea or...to assessment only (usual care).

Could you expand more on the findings of the trial or of the study?

First, let me [explain] a little bit about the intervention, because that's important. Foci of the intervention were stress reduction, reducing stress, [and] helping patients cope with the sensations of dyspnea. Oftentimes, they feel like they can't breathe, but by giving them a pulse oximeter, they can check and find that their oxygen levels are adequate. When individuals have bouts of dyspnea, they're more apt to sit quietly, in essence, deconditioning themselves to activity. However, patients were taught strategies for coping (pursed lip breathing) and tolerate mild dyspnea symptoms. In short, the intervention was focused on physiologic responses, behavioral difficulties, and the stress associated with dyspnea.

The intervention was very successful. It reduced depressive symptoms, which I mentioned, are very common generally in patients with lung cancer. It improved their health-related quality of life, reduced their sedentary time in the chair, and they had improved performance status. The findings are of significant import and potentially practice changing as behavioral interventions are infrequently used to treat dyspnea.

What are the implications or major takeaways from the findings?

If you look at guidelines for treatment of dyspnea, oftentimes, opioids are prescribed, which have significant difficulties along with patients’ concerns about taking opiates. This [intervention] is a treatment [of] only 5 sessions, comparatively low cost, and yielding significant gains in tangible patient outcomes. This is a treatment that could readily be offered. It's not one that requires a PhD, but a well-trained individual to deliver this intervention and help patients cope.

What are the next steps in this line of research?

This was a relatively small trial, but even though it only had 45 patients, the effects were large, and so we were able to find significant differences. The principal investigator, Stephen Lo, [PhD], who was a graduate student at the time, is now at Dana-Farber Cancer Institute, Harvard, and continuing his research program, testing 2-session interventions, follow-up sessions with TAB, and others.

His was a great study. It's a great demonstration, particularly because the go-to treatment for many has been opioids. But that's been the most studied treatment, and it also has limited efficacy and significant risk profiles, neither of which characterize this intervention.

REFERENCES

1.Lo SB, Arrato NA, Presley CJ, McGinty HL, Otto MW, Andersen BL. Cognitive-behavioral treatment for breathlessness in lung cancer: a randomized controlled trial. Ann Am Thorac Soc. 2025;22(10):1579-1591. doi:10.1513/AnnalsATS.202406-580OC

2.Testing a cognitive behavioral model for reducing dyspnea in patients with lung cancer. ClincalTrials.gov. Updated October 31, 2024. Accessed November 21, 2025. https://clinicaltrials.gov/study/NCT05304793