A community-based cluster randomized controlled trial published in Scientific Reports (2025) found that group Cognitive Behavior Therapy (CBT) delivered by trained village doctors produced both significant reductions in anxiety and depression symptoms and meaningful improvements in quality of life among chronic obstructive pulmonary disease (COPD) patients in Xuzhou, China.  

Study Design and Interventions 

The trial enrolled 443 participants with stable COPD and comorbid anxiety or depression across 18 randomly selected community clinics. Patients were randomized to receive either CBT plus usual care or usual care alone. Twenty-seven village doctors completed three days of structured CBT skills training before delivering eight group sessions over two months.

The group sessions primarily involved helping participants understand COPD and its underlying causes and prognosis, psychoeducation about anxiety and depression, and cognitive restructuring of automatic thoughts like, “With COPD, I can’t have a good life.” The village doctors also taught participants relaxation, breathing, and mindfulness exercises.

Participants in a group CBT therapy session

Psychological and Quality-of-Life Outcomes

At 6-month follow-up, patients in the CBT group showed meaningfully better outcomes across all psychological and quality-of-life measures compared to those receiving usual care alone. Psychological outcomes were measured using the Chinese version of the Hospital Anxiety and Depression Scale (HADS). Depression scores (HADS-D) averaged 7.87 in the CBT group versus 10.20 in the control group. Anxiety scores (HADS-A) averaged 8.23 in the CBT group versus 10.71 in the control group. Quality of life, measured by the St. George’s Respiratory Questionnaire (SGRQ), improved by an average of 15.69 points in the CBT group compared to control. All psychological and quality-of-life outcomes reached statistical significance (p<0.001).

Importantly, 98.7% of participants attended all 11 CBT sessions, reflecting strong engagement with treatment.

Also noteworthy is the fact that the village doctors achieved an average CBT competency score of 5.5 out of 6 on the Cognitive First Aid Rating Scale (CFARS), a measure used to evaluate general practitioners’ ability to deliver CBT. All practitioners met the threshold for professional proficiency after three days of training.

Commentary from Dr. Judith Beck 

“The findings reinforce that CBT is both teachable and scalable,” said Dr. Judith Beck, Beck Institute President. “This study offers compelling evidence that when frontline healthcare workers receive proper training, they can deliver high-quality CBT that meaningfully reduces suffering—and meets patients where they are.”

This trial adds to growing evidence supporting the efficacy of CBT delivery in primary care and community-based settings. With approximately 99.9 million COPD patients in China, many with undertreated psychological symptoms, village doctor-led CBT represents a novel, evidence-based treatment delivery system for addressing the mental health burden of chronic respiratory disease.

Reference: 

Zhang, M., Zhang, P., Dong, Z., Zhang, W., Liu, Y., Qiao, C., … & Chen, Y. (2025). Effectiveness of village doctors led cognitive behavioral therapy for COPD patients in a randomized controlled trial. Scientific Reports.

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