Self-Help Therapy Books Show Promise for Depression in Pulmonary Hypertension Patients

Living with pulmonary hypertension (PH) presents numerous challenges beyond the physical symptoms. This serious condition, which affects blood pressure in the lungs, often comes with debilitating symptoms like shortness of breath, fatigue, chest pain, and dizziness. Perhaps less visible but equally significant is the mental health burden that frequently accompanies PH, with depression affecting between 28% and 58% of patients.

A recent study offers hope for addressing this overlooked aspect of PH care. Researchers developed and tested a set of self-help therapy booklets designed explicitly for people with pulmonary hypertension who experience depression, finding encouraging results that could make mental health support more accessible to this vulnerable population.

Understanding the Mental Health Challenge

The connection between pulmonary hypertension and depression runs deeper than simply feeling sad about having a chronic illness. The overlap between PH symptoms and depression symptoms creates a complex web of physical and mental challenges. Both conditions can cause fatigue, lack of energy, and difficulty concentrating, making it hard to distinguish where the physical illness ends and the mental health struggle begins.

The European Society of Cardiology recognizes this connection and recommends psychological support for individuals with PH. However, finding appropriate mental health care can be difficult for many patients, particularly those in areas with limited resources or those who face barriers to accessing traditional therapy.

The Self-Help Approach

Recognizing these challenges, researchers developed a four-week self-help intervention based on cognitive behavioural therapy (CBT) principles. The intervention consisted of four booklets, each designed to be completed weekly, with content specifically tailored to address depression in people living with pulmonary hypertension.

The first booklet introduced the concept of depression in PH patients, providing education about the condition and introducing basic CBT concepts. The second focused on replacing inactivity with meaningful activities, taking into account the physical limitations that people with PH face. The third booklet taught strategies for identifying and challenging unhelpful thoughts, while the fourth provided guidance on maintaining mental wellness and preventing setbacks.

What made this intervention unique was its specific focus on pulmonary hypertension. Rather than using generic depression materials, the researchers incorporated case studies, quotes from healthcare professionals familiar with PH, and strategies that acknowledged the particular challenges faced by people with this condition.

Testing the Intervention

The study involved 68 adults with pulmonary hypertension from around the world who reported difficulties with depression. Participants were randomly assigned to either receive the self-help booklets immediately or to a waiting list control group that would receive the materials later.

The results were encouraging. People who used the self-help booklets showed significant improvements in their depression scores compared to those in the control group. The effect size was considered medium, suggesting a meaningful clinical benefit. Additionally, participants experienced improvements in their health-related quality of life, though these benefits became apparent only at the one-month follow-up rather than immediately after completing the intervention.

On an individual level, the results were particularly striking. At the start of the study, 72% of participants in the treatment group scored above the clinical threshold for depression. After completing the four-week intervention, this number dropped to just 28%, and remained at 36% one month later.

What Participants Valued

Feedback from participants revealed several key strengths of the intervention. Most importantly, people valued that the materials were specifically designed for pulmonary hypertension patients rather than being generic depression resources. This tailored approach helped participants feel understood and validated in their unique struggles.

Participants reported that the intervention provided them with practical tools to manage their depression, increased their understanding of how depression affects their lives, and motivated them to become more active. Many said they planned to revisit the booklets and continue using the strategies they learned.

The self-help format was also appreciated by many participants. Being able to work through the materials at home, in private, and at their own pace made the intervention accessible to people who might not otherwise seek or be able to access traditional therapy.

Limitations and Considerations

While the results are promising, the study had some limitations. The research included only 68 participants, which is relatively small for this type of study. The researchers had hoped to recruit 77 people but fell short of this target, suggesting that recruitment for this type of research can be challenging.

The study also had a higher dropout rate in the intervention group compared to the control group. Some participants found the intervention stressful or overwhelming, particularly when combined with their existing health challenges and daily responsibilities. This suggests that while self-help interventions can be effective for many people, they may not be suitable for everyone.

Additionally, the study lasted only four weeks with a one-month follow-up. Longer-term studies would be helpful to understand whether the benefits persist over time and whether people continue to use the strategies they learned.

Implications for Care

The success of this intervention has important implications for how healthcare providers approach depression in pulmonary hypertension patients. Self-help interventions like this could serve as a first step in a stepped-care approach, where patients begin with lower-intensity interventions and progress to more intensive treatments only if necessary.

This approach aligns with efficient healthcare delivery, providing the minimum amount of treatment necessary to achieve desired outcomes. For some patients, the self-help booklets may be sufficient to manage their depression symptoms. In contrast, others may benefit from using the materials as a stepping stone to more intensive therapy.

The intervention also demonstrates the potential for charitable organizations to play a role in providing mental health support. The study was conducted in collaboration with the Pulmonary Hypertension Association UK, and the booklets have since been made available free of charge to people with the condition.

Looking Forward

This research adds to the growing evidence that targeted, condition-specific mental health interventions can be effective for people with chronic physical health conditions. The success of the pulmonary hypertension-specific approach suggests that similar interventions could be developed for other chronic conditions where depression is common.

The study also highlights the importance of addressing mental health as an integral part of caring for people with chronic physical conditions. For too long, physical and psychological health have been treated as separate issues, but research like this demonstrates the interconnected nature of physical and psychological well being.

As healthcare systems continue to grapple with the increasing demand for mental health services, interventions like this self-help program offer a scalable way to provide support to vulnerable populations. While not a replacement for traditional therapy when needed, such interventions can help bridge the gap between the high demand for mental health services and the limited availability of resources.

The research provides hope that with thoughtful development and testing, accessible mental health interventions can make a meaningful difference in the lives of people living with chronic conditions like pulmonary hypertension. By addressing both the physical and mental aspects of these conditions, healthcare providers can offer more comprehensive care that genuinely supports the individual as a whole.


Stark, A. S., Rawlings, G. H., Gregory, J. D., Armstrong, I., Simmonds‐Buckley, M., & Thompson, A. R. (2025). A randomized controlled trial of self‐help cognitive behavioural therapy for depression in adults with pulmonary hypertension. British Journal of Health Psychology, 30(3), e12800.