Digital cognitive behavioural therapy improves anxiety and asthma control
A new study shows that internet-delivered cognitive behavioural therapy (ICBT) can effectively reduce asthma-related anxiety in adults with asthma. Participants who received ICBT reported less anxiety related to their asthma, better asthma control, higher quality of life, and fewer avoidance behaviours compared to those who received standard care. Lung function was not affected by the treatment, indicating that it is safe and can be used as a complement to medical asthma treatment.
“Clinical and population-based studies consistently demonstrate a strong link between asthma and anxiety, highlighting the importance of offering treatment for asthma-related anxiety”, says Professor Catarina Almqvist Malmros at the Department of Medical Epidemiology and Biostatistics, who initiated studies to develop and evaluate internet-delivered psychological treatment.
Anxiety affects up to one-third of adults with asthma and is associated with poorer health outcomes and reduced quality of life. People with asthma-related anxiety may unnecessarily restrict their daily lives out of fear of asthma symptoms, for example by avoiding physical activity, social situations, or travel. This type of anxiety is not always addressed in asthma care, despite its significant impact on how the disease is experienced.
A randomised controlled trial was conducted with 90 adults with asthma and pronounced asthma-related anxiety. Participants were randomly assigned to either eight weeks of internet-delivered cognitive behavioural therapy (ICBT) or standard care with access to web-based medical information about asthma. The treatment included texts and exercises to help participants understand and manage their anxiety, along with regular feedback from a psychologist.
Changes in asthma-related anxiety, asthma control, quality of life, and lung function were monitored. Those who received ICBT reported significantly less anxiety related to their asthma, better asthma control, higher quality of life, and fewer avoidance behaviours compared to those who received standard care. Lung function was unaffected, supporting the safety of the treatment and its potential as a complement to medical asthma care.
“The study’s findings show that asthma-related anxiety can be treated through a structured and accessible intervention, which can not only improve quality of life and everyday confidence but also reduce the symptom burden of asthma”, says Marianne Bonnert, psychologist and researcher at the Department of Clinical Neuroscience and first author of the study.
An important next step is to investigate whether internet-delivered CBT can also help children and adolescents living with asthma and anxiety related to their condition. A study is currently underway where the treatment has been adapted for children and adolescents aged 8–17 and their parents.
The goal is to provide early support to young people who might otherwise develop long-term limitations in daily life due to anxiety and avoidance. In the long term, researchers hope to contribute to more age-appropriate and accessible psychological treatment as part of asthma care for children and adolescents.
The study represents an interdisciplinary collaboration between clinical psychologists and asthma specialists from Karolinska Institutet, Karolinska University Hospital and Uppsala University. It was financed by the Swedish Research Council, the Swedish Heart-Lung Foundation, the Swedish Asthma and Allergy Association's Research Fund and Region Stockholm. See the study for any reported conflicts of interest.
Publication
Online cognitive behaviour therapy for asthma-related anxiety: a randomised controlled trial, Marianne Bonnert, Stephen Nash, Erik M Andersson, Sten Erik Bergström, Jenny Görling, Christer Janson, Josefin Särnholm, Catarina Almqvist. Thorax, online 6 January 2026, doi:10.1136/thorax-2025-223886.