AGORAPHOBIC AVOIDANCE, ANXIETY SENSITIVITY, AND EMOTIONAL DISTRESS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A NARRATIVE REVIEW OF BIDIRECTIONAL MECHANISMS AND CLINICAL IMPLICATIONS

Abstract

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition frequently complicated by significant psychological comorbidities, including anxiety disorders and panic-spectrum symptoms. Prevalence rates of anxiety and panic disorder in COPD patients substantially exceed those in the general population, contributing to diminished quality of life, increased exacerbation frequency, greater perceived dyspnea severity, prolonged hospitalizations, and elevated healthcare utilization. This narrative review synthesizes evidence on the interplay among agoraphobic avoidance, anxiety sensitivity (particularly its physical concerns dimension), catastrophic misinterpretations of bodily sensations, and emotional distress in COPD. Key findings indicate that agoraphobic avoidance—manifesting as evasion of physical exertion, public spaces, or situations perceived as escape-restrictive—operates not merely as a consequence of dyspnea-related fear or panic but as a maintaining factor. Bidirectional relationships emerge: elevated anxiety sensitivity and emotional distress predict avoidance behaviors, while avoidance perpetuates catastrophic beliefs, interoceptive hypervigilance, physical deconditioning, and intensified psychological symptoms. These mechanisms align with cognitive-behavioral models of anxiety maintenance and have direct implications for integrating targeted psychological interventions—such as exposure-based strategies and cognitive restructuring—into standard COPD management, including pulmonary rehabilitation. Limitations of existing research and directions for future longitudinal and interventional studies are discussed.