Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, New York, USA.
Pediatr Pulmonol. 2022 Nov;57(11):2781-2790. doi: 10.1002/ppul.26101. Epub 2022 Aug 17.
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.
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.
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).
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.
囊性纤维化（CF）特定的认知行为疗法干预（CF-CBT）是与 CF 社区合作开发的，旨在推进预防心理健康护理。三个中心的多学科提供者接受了 CF-CBT 的培训，以对该试点进行评估，该试点评估了综合护理模式的可行性/可接受性和初步效果。
8 节 CF-CBT 以面对面和音频远程医疗的方式提供给 14 名患有轻度抑郁和/或焦虑症状的成年人。对退出、参与度、家庭作业完成情况、治疗满意度和治疗保真度的评估为可行性/可接受性评估提供了信息。心理健康结果包括抑郁、焦虑、生活质量（修订后的囊性纤维化问卷 [CFQ-R]）、感知压力和应对。初步效果是通过 Cohen's d 度量的前后平均变化分数的效应大小（ES）来评估的。
共进行了 108 次治疗；13 名成年人完成了干预；1 人提前退出。参与度、家庭作业完成情况和治疗接受度评价较高（平均值=30；标准差=2，范围为 27-32 分，满分 32 分）。保真度得分范围从 85.7%到 93.6%。大 ES 变化反映了抑郁症状（-0.83）、CFQ-R（活力量表：1.11）和放松技巧（0.93）的改善；CFQ-R 角色功能（0.63）、紧张感（0.62）、应对信心（0.70）和 CF 特定应对（0.55）中等 ES；焦虑症状（-0.22）、感知压力（-0.25）、行为激活（0.29）和 CFQ-R 几个领域，包括情感功能（0.29），较小的 ES。CFQ-R 的两个子量表减少（身体形象、饮食担忧）。
结果表明 CF-CBT 的可行性和可接受性及其与基于团队的 CF 护理的整合具有良好的效果，尤其是对抑郁。CF-CBT 的多中心随机对照试验将进一步检验 CF 特定综合护理模式的有效性。
