Teaching with a Twist: Anxiety and COPD

Posted on February 28, 2019   |   

This article was written by Stephanie Williams, BS, RRT. Stephanie is the Director of Community Programs and Volunteer Management for the COPD Foundation.

I love riddles. I love to figure them out, I love to create them. But there is one riddle that I encounter often as a respiratory therapist that I wish we could solve for everyone with COPD: which came first, trouble breathing or anxiety?

Teaching with a Twist: Anxiety and COPD - 1We see people asking about anxiety on COPD360social a lot. People ask if anxiety is ‘normal’ or if anxiety can make breathing worse. Some people ask if anxiety can cause breathing problems or if breathing problems cause anxiety. I think those are really good questions. You may be wondering these same things yourself. For any number of reasons, you may not have talked with your doctor about these questions, but I would encourage you to mention them to your healthcare team. Anxiety and breathing problems are so common, it would be more surprising to find someone with COPD who doesn’t experience some anxiety.

I remember a personal situation from a few years ago, when I was at work as an RT in a hospital. I was having a medical issue that made it hard for me to get my breath. My boss instructed me to go to the ER where I was treated for the issue, but I will never forget how my anxiety was dismissed and minimized. The nurses told me that I should “calm down” because I was making the situation worse. I was irritated because they obviously didn’t understand how it felt to struggle for air. I told them that they would be anxious, too, if they couldn’t get their breath. I will never forget that incident. It changed the way I interacted with anxious patients after that.

Dealing with anxiety is no joke. Anxiety and stress can absolutely have an impact on your breathing. They can make you feel as though you can’t get your breath. They can make you feel like someone has turned the oxygen off in the room where you are. Feeling anxious can make your heart rate go up and can make you have trouble sleeping, among other things. The key is recognizing it as anxiety and being able to break the vicious cycle it can cause.

In the same way that anxiety can cause difficulty breathing, you need to know that the difficulty breathing can cause anxiety, too. Sometimes, you may notice a cycle of shortness of breath, anxiousness, leading to increased shortness of breath, more anxiousness, and so on. That anxiety is your body’s way of letting you know something is going on, an alert response to a stressful situation

Teaching with a Twist: Anxiety and COPD - 2If you are feeling short of breath due to your lung condition, then this is the time to take your rescue inhaler. This medicine will help you to open your airways and begin to take deeper, more fulfilling breaths. One thing to remember: if you notice that you are needing your rescue inhaler more frequently than usual, you need to call your doctor and let them know that your maintenance medication routine is not keeping you in the “Green Zone” on your My COPD Action Plan. Taking your rescue medication more frequently can be a sign of a developing exacerbation.

So, what are some things you can do to help when you are feeling anxious?

  1. Do some pursed lip breathing (PLB). Take a breath in through your nose while counting to two, and then pucker your lips and blow out while counting to four. Repeat this process again and again until your breath becomes more normal.
  2. Practice mindfulness or grounding techniques. There are lots of different techniques that are described on YouTube or other places on the Internet, but here are two of my favorites:
    • a. Crazy counting – When I find myself feeling anxious, I like to refocus my energy on something else and will count to 100 by fours or to 101 by using only odd numbers. By doing this routine activity in an unusual way, it encourages my brain to think about the math task instead of the situation that is causing my anxiety. If I can redirect my mind, I find that I usually feel better and can regain some control over the anxious feeling.
    • What did I eat for dinner? To mix things up a little bit, I sometimes ask myself to recall what I had for dinner last night, the night before, etc. This one really helps me focus on something else. There are lots of other topics you might use that will challenge your recall in an anxious moment.
  3. Talk it out. Talking about the anxiety can take some of its power away. Find someone you can call when you start to experience anxiousness. Talking it out can help you identify patterns or triggers for the anxiety that might help you avoid future situations. And if you talk with someone else who experiences anxiety like you do, it can help you to know there are others who understand what you are going through.

The bottom line is that you are not alone in dealing with anxiety and COPD. Your doctor can help you find a treatment plan for anxiety that happens frequently or is severe in that it impacts your functioning. Let your healthcare team know that you are experiencing anxiety so they can help set you in the right direction.

Teaching with a Twist: Anxiety and COPD - 1

Now the Twist – The MOVIE STAR NAME GAME

Here’s how it works:

I will give the name of a movie, and the next person will name an actor/actress in that movie. The next person will give another movie that actor/actress was in, and the next will list another actor or actress in that movie.

For instance, if I gave you the movie “Planes, Trains, and Automobiles”

  • Person 2 – “Steve Martin”
  • Person 3 – “Father of the Bride”
  • Person 4 – “Diane Keaton”
  • Person 5 – would list another of Diane Keaton’s movies, etc.

So here you go – The movie is “Field of Dreams”

Who can name an actor from that movie?


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  • Tom Hanks
  • Tom Hanks wasn't in Field of Dreams. Are you possibly thinking of A League of Their Own?

    But back to Field of Dreams..... Kevin Costner

  • Kevin Costner - one of my favorite actors

    • Good topic Stephanie.
      My own experience with anxiety.... Years ago, I really struggled for a very long time with anxiety, and the panic attacks that seemed to go along with it. One of the things I learned from a therapist was not to fight it; fighting it really seemed to give it more energy. Instead the suggestion was to let it wash over me; relax into it. Basically, that means I release the tension in my body that seems to fuel the anxiety. I never really felt comfortable talking with friends, family or co-workers about it because I felt embarrassed
      I mostly have it under control these days, however I avoid driving on highways, where everyone is driving 65-70 miles an hour and the exit ramp might be miles away.
    • Jean, thank you for sharing your experience. I had a wonderful therapist who told me something similar. She described it as a wave, and described to me how it will hit harder if I try to fight it. If I recognize the anxiety for what it is and ride with the wave, the impact is lessened. This has stuck with me for many years. I’m glad you feel relieved of it more days than not. <3
  • Something that's helped me a lot is learning about the Worry Monster. The worry monster comes to you slowly, but if you let him, he can become bigger and more fierce with every minute. You can learn to control the worry monster with self-talk, thinking logically about what is worrying you, what is REALLY worrying you, and what's most likely to happen, not something that is your worst fear. You can conquer the worry monster and control him, without losing control to him.
  • Depression and anxiety are very common among COPD patients. The suggestions given in the blog are very good, and if they help you manage and control your anxiety, please use them. Sometimes those tips and tricks aren't quite enough and you really need the services of a professional to help you learn how to manage and control your anxiety and depression, just like you learn to control your COPD.

    Cognitive behavioral therapists are trained to help people with situations like this and they can be very helpful. Usually, they'll also have a connection with a psychiatrist who can prescribe, and, most importantly, can monitor medications with the help of the therapist. Most of us want to live without medications as much as possible, but if you need them to help you get to a point where you can begin to manage and control the anxiety, please take them. Let your therapist know that you want to get off them as soon as possible, and they can help enormously. I see someone every month and have for nearly 20 years. She's incredibly helpful in keeping my head on straight. I highly recommend it!
    • I agree completely Jean! Seldom is it as simple as.... "Just do this and all will be well. "
      The support of a good mental health professional is priceless.

    • Thank you Jean and Jean053 for your comments. A good therapist is certainly key in managing and maintaining good mental/emotional health.
      There shouldn't be any stigma or negative feelings about getting help. If you need to see a specialist, please do! It can make all the difference in the world in how you feel :)
  • Kevin Costner
  • Pollyanna - Jane Wyman
  • Anxiety and COPD are the correlated.
  • Anxiety and COPD often create a cycle of breathlessness. Feelings of breathlessness can provoke panic, which can make you feel more anxious and can make it even harder to breathe. If you get caught up in this breathlessness-anxiety-breathlessness cycle, you may have a hard time distinguishing the symptoms of anxiety from the symptoms of COPD.

    Having some anxiety when you have a chronic disease can be a good thing. It can prompt you to follow your treatment plan, pay attention to your symptoms, and know when to seek medical attention. But too much anxiety can severely impact the quality of your life.

    You may end up going to the doctor or the hospital more often than you need to. You may also avoid enjoyable social and leisure activities that can cause breathlessness, such as walking the dog or gardening.

    • So true....
      I myself get caught up in that cycle and sometimes, if I’m not caught up IN the cycle, I can sometimes get caught up worrying about and being fearful about “the next” bout of anxiety.
      I’ve struggled with anxiety for years, but the last 5 years since my COPD got very bad, it’s really gotten out of control...
      Purses lip breathing helps but otherwise not too much helps...
      I’m going to try counting by 4’s!
      Everyone’s suggestions here have been helpful!