Non-Pharmacological Interventions for Emotional Symptoms in COPD Centered on Anxiety and Depression: An Evidence Synthesis Study

Jie Yu,* Jianmei Fu,* Shujuan Zhao, Shuting Zhang, Rui Huang, Tong Li, Yulan Li Department of Respiratory and Critical Care Medicine, Hebei CNPC Central Hospital, Langfang, Hebei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yulan Li, Department of Respiratory and Critical Care Medicine, Hebei CNPC Central Hospital, No. 51, Xinkai Road, Guangyang District, Langfang, Hebei, 065000, People’s Republic of China, Email [email protected]: Emotional symptoms, particularly anxiety and depression, are common in COPD patients but are often under-managed. This study aimed to synthesize evidence on non-pharmacological interventions for these symptoms in COPD. An umbrella review of guidelines, systematic reviews, and expert consensus was conducted. Literature searches were performed in databases including PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CNKI, Wan Fang Data, and VIP, as well as guideline repositories (eg, GIN, NICE, GOLD) from January 1, 2000, to August 3, 2025. Inclusion criteria focused on moderate-to-severe COPD patients with anxiety/depression, non-pharmacological interventions, and evidence-based literature types (guidelines, systematic reviews, expert consensus). Literature quality was assessed using AGREE II for guidelines, AMSTAR 2 for systematic reviews, and JBI tools for expert consensus. Evidence was summarized and graded using the JBI evidence pre-grading system (2014). From 1812 identified records, 13 articles (4 guidelines, 2 expert consensuses, 7 systematic reviews) were included. Physical exercise training was the most strongly recommended intervention (Level 1a evidence, strong recommendation). Pulmonary rehabilitation, cognitive-behavioral therapy (including group, individual, and telephone-based formats), and psycho-educational interventions also showed consistent benefits (Level 1a-5b, strong recommendations). Evidence for mindfulness and relaxation techniques was less consistent. A total of 26 evidence statements were synthesized across six domains: psychological assessment, psychological interventions, exercise/nutrition, management models, special interventions, and other methods. A range of non-pharmacological interventions, particularly exercise and structured psychological therapies, can be effective for anxiety and depression in COPD and should be considered for integration into comprehensive care. Future research should address long-term effectiveness and cost-effectiveness.Keywords: COPD, emotional symptom clusters, non-pharmacological interventions, cognitive behavioral therapy, pulmonary rehabilitation