Feasibility and acceptability of a CF‐specific cognitive‐behavioral preventive intervention for adults integrated into team‐based care

Abstract

Background A cystic fibrosis (CF)‐specific cognitive‐behavioral therapy intervention (CF‐CBT) was developed in partnership with the CF community to advance preventive mental health care. Multidisciplinary providers across three centers were trained to deliver CF‐CBT for this pilot assessing feasibility/acceptability and preliminary effectiveness of an integrated model of care. Methods The 8‐session CF‐CBT was delivered to 14 adults with mild depression and/or anxiety symptoms in‐person and via audio telehealth. Assessment of attrition, engagement, homework completion, treatment satisfaction, and treatment fidelity informed feasibility/acceptability assessment. Mental health outcomes included depression, anxiety, quality of life (Cystic Fibrosis Questionnaire‐Revised [CFQ‐R), perceived stress and coping. Preliminary effectiveness was evaluated with Cohen's d metric of effect sizes (ES) of pre‐post mean change scores. Results A total of 108 sessions were conducted; 13 adults completed the intervention; 1 discontinued early. Engagement, homework completion, and treatment acceptability were highly rated (mean = 30; SD = 2, range: 27–32 on a 32‐point scale). Fidelity scores ranged from 85.7% to 93.6%. Large ES changes reflected improvements in depressive symptoms (−0.83), CFQ‐R (Vitality scale: 1.11), and Relaxation Skills (0.93); moderate ES for CFQ‐R Role Functioning (0.63), Awareness of Tension (0.62), Coping Confidence (0.70) and CF‐specific Coping (0.55); and small ES for anxiety symptoms (−0.22), perceived stress (−0.25), Behavioral Activation (0.29), and several CFQ‐R domains, including Emotional Functioning (0.29). Two CFQ‐R subscales decreased (Body Image, Eating Concerns). Conclusions Results indicated feasibility and acceptability of CF‐CBT and its integration into team‐based CF care with promising effectiveness, especially for depression. A multicenter randomized controlled trial of CF‐CBT will further examine effectiveness of a CF‐specific integrated care model.

Pilot of a therapist‐guided digital mental health intervention (eHealth CF‐CBT) for adults with cystic fibrosis

“…eHealth CF‐CBT, an 8‐session therapist‐guided internet‐delivered program is the first eHealth intervention for depression and anxiety in awCF 19 . Originally, CF‐CBT was designed as an intervention for mild depression and anxiety symptoms screened in clinical care 23,24 . In this pilot, awCF with mild to moderate symptoms of depression/anxiety were included and showed improvements in depression and anxiety symptom scores, demonstrating that those with moderate scores could also benefit.…”

“…(5-9), "moderate" (10)(11)(12)(13)(14), "moderately severe" (15)(16)(17)(18)(19), and "severe" (20)(21)(22)(23)(24)(25)(26)(27). A minimal clinically important difference score (MID) of five points has been established.…”

“…1 eHealth CF-CBT was adapted from CF-CBT, a manualized 8-session CF-specific CBT intervention developed in the US with input from awCF and healthcare providers. 23,24 A multicenter pilot of CF-CBT integrated into CF team-based care found it to be feasible and highly acceptable, with promising preliminary effectiveness, including large effect size improvement in depression and small to large effect size improvements in anxiety, HRQoL, perceived stress, and coping skills. 24 CF-CBT was then adapted to an online platform with additional input from Dutch awCF and healthcare providers.…”

Patient engagement in the development of CF-CBT: A cystic fibrosis-specific cognitive-behavioral intervention for adults

“…Although the program will be further refined, results of these qualitative analyses indicate the acceptability of a CF-specific CBT-based mental health intervention for adults with CF that was designed to be integrated into routine CF care. CF-CBT was subsequently piloted, with positive preliminary findings regarding feasibility, acceptability, and effectiveness (Friedman et al, 2022), with additional changes made prior to an ongoing multi-center randomized waitlist-controlled trial. Qualitative results directly informed the content of CF-CBT, increasing its validity and potential to accurately reflect CF-specific experiences and accommodate CF-specific coping needs.…”

“…Flexibility in mode of delivery was also incorporated into the model to improve accessibility through optional telehealth visits and the ability to conduct sessions during an inpatient admission, as needed. After the CF-CBT intervention manual, patient workbook and training program for multidisciplinary providers were developed based on CF community input, the feasibility, acceptability, and efficacy of the program were examined in a multi-center pilot (Friedman et al, 2022) and an ongoing randomized waitlist-controlled trial. Clinical trials targeted adults with mild symptoms of depression and anxiety with the goals of promoting resilience, preventing the escalation of depression and anxiety, and reducing associated morbidity.…”