This two-phase exploratory pilot study investigates the impact of a Mindfulness-Based Stress Reduction (MBSR) program on patients with chronic obstructive pulmonary disease (COPD) undergoing pulmonary rehabilitation. Phase 1, conducted from 2015 to 2018, explored the potential clinical effects of the intervention. It included a mixed-gender intervention group and a control group composed exclusively of male participants.

In the context of a doctoral research project, Phase 2 was initiated in 2024 to expand the control group by including female participants, thereby improving gender balance and ensuring more robust comparative clinical analysis. All participants were enrolled in a multidisciplinary outpatient pulmonary rehabilitation program at the time of inclusion.

The aim of the study is to evaluate the potential effects of MBSR on psychological symptoms, disease-specific quality of life, perceived stress, and medication adherence in patients with COPD.

The intervention consists of a standardized 8-week MBSR program developed by Jon Kabat-Zinn, including weekly 2.5-hour group sessions, one day-long silent retreat, and daily home practice (approximately 45 minutes per day). Participants are followed for 12 months.

Clinical outcomes are assessed at baseline, post-intervention (10 weeks), 6 months, and 12 months and include:

Anxiety and depression (Hospital Anxiety and Depression Scale - HADS)

Disease-specific quality of life (Chronic Respiratory Questionnaire - CRQ)

Perceived stress (Perceived Stress Scale - PSS)

State and trait anxiety (State-Trait Anxiety Inventory - STAI, Spielberger)

Medication adherence (Morisky Medication Adherence Scale - MMAS)

This study contributes to the growing body of research supporting mindfulness-based interventions as complementary care within pulmonary rehabilitation for chronic respiratory diseases.

This pilot study was designed to extend supportive care for people with COPD by evaluating a non-pharmacological mindfulness-based intervention in the context of pulmonary rehabilitation. COPD is often accompanied by psychological distress and poor adherence to treatment, which can negatively impact patient outcomes. Mindfulness-Based Stress Reduction (MBSR) has shown promise in chronic disease populations, but evidence in COPD remains limited.

The study follows a two-phase exploratory design. In phase 1, the potential clinical effects of integrating MBSR into a hospital-based rehabilitation programme were explored. Although promising, the control group consisted only of men, which limited the validity of clinical comparisons with the mixed intervention group.

To remedy this limitation, phase 2 was launched as part of a doctoral research project. The aim is to strengthen methodological robustness by balancing the control group with female participants. All the participants are involved in a structured outpatient pulmonary rehabilitation programme, which provides a stable framework for evaluating the effects of MBSR.

The study is examining changes in psychological outcomes, quality of life and behavioural measures such as medication adherence. The results will help guide future controlled trials evaluating mindfulness-based interventions in respiratory care.

Inclusion Criteria:

• a confirmed diagnosis of COPD with airflow obstruction, based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria , regardless of age, - participation in a pulmonary rehabilitation program either at hospital or at home with a physiotherapist, in accordance with GOLD recommendations
• ability to read and write in French
• availability of easy transportation to attend weekly classes.

Exclusion Criteria:

• severe exacerbation of COPD within the previous four weeks prior
• presence of any active oncological disease.