O'Hayer C Virginia, Smith Patrick J, Drescher Christopher F, Bruschwein Heather, Nurse Chelsi N, Kushner Hallie M, Ingle Krista, Stephen Michael J, Hoag Jeffrey B
Thomas Jefferson University Hospital - Dept of Psychiatry & Human Behavior, 33 S. 9th St, Suite 210, Philadelphia, PA, 19107 USA.
University of North Carolina - Chapel Hill - Dept of Psychiatry, 317D MacNider Hall 333 S. Columbia st, Chapel Hill, NC, 27514 USA.
Gen Hosp Psychiatry. 2024 Nov-Dec;91:212-222. doi: 10.1016/j.genhosppsych.2024.11.011. Epub 2024 Nov 26.
Psychological distress, including anxiety and depression, is common among adults with CF, associating with poor quality of life, lung function, and healthcare utilization. This 3-year, multi-site, telehealth-delivered randomized trial sought to determine whether Acceptance and Commitment Therapy (ACT with CF) is superior to supportive psychotherapy (SP), in improving psychological functioning for adults with CF.
One hundred twenty-four adults with CF and elevated anxiety and/or depressive symptoms were recruited coincident with the first COVID lockdown, from Thomas Jefferson University Hospitals, University of Virginia, Augusta University, Duke University Medical Center, and social media. Participants were randomized to 6 weeks of either ACT with CF or SP, delivered via Zoom. They completed measures of psychological functioning: depression (BDI-II), anxiety (BAI), cognitive fusion (CFQ-13), acceptance and committed action (AAQ-II); and barriers to adherence at baseline, post-treatment, and at 3-months follow-up. Biobehavioral outcomes, including CF severity and treatment burden, were gathered using EMR data.
Participants were young adults (mean age 25 years [SD = 12]), female (75 %), on CFTR modulators (67 %), psychotropic medication(s) (60 %), with previous psychotherapy engagement (72 %). Treatment effects were evaluated using analysis of covariance, controlling for baseline levels of respective outcomes, age, biological sex, and FEV. ACT demonstrated greater improvements in psychological functioning at 6-weeks (mean score = 57.3 [51.6, 63.0]) relative to SP (mean score = 67.8 [62.2, 73.5], Cohen's d = 0.59, P = .017), with largest improvements in cognitive fusion (CFQ-13) and acceptance and committed action (AAQ-II). Treatment improvements in psychological functioning persisted at 3-months (ACT: 59.7 (53.5, 65.9) vs. SP: 69.0 [62.6, 75.4], Cohen's d = 0.40, P = .041), with ACT demonstrating continued improvements in the CFQ-13 and AAQ-II. Negative affect scores were not consistently improved on our mean-rank composite outcome variable (Cohen's d = 0.22, P = .170), despite post hoc reductions in BDI-II scores (ACT: -7.4 [-9.4, -5.4] vs. SP: -4.5 [-6.4, -2.6], P = .040). Improvements in psychological flexibility (CFQ-13 and AAQ-II) were also robustly associated with reductions in negative affect (B = -0.45, P < .001). Individuals in ACT with greater baseline barriers to medication adherence reported greater reductions in barriers after treatment (P = .026). Individuals with lower baseline FEV/FVC ratios (e.g. ≤ 65 %) demonstrating greater improvements in ACT compared with SP (ACT: 7.3 [1.7, 12.8] vs. SP: 1.3 [-3.2, 5.8], P = .036 for interaction).
ACT with CF was superior to SP in improving psychological functioning among adults with CF and elevated psychological distress, with additional benefits in secondary biobehavioral outcomes in a subset of individuals with greater medical burden. Improvements in psychological flexibility strongly associated with reductions in negative affect.
gov ID #NCT04114227 Supported by the Boomer Esiason Foundation.
心理困扰，包括焦虑和抑郁，在成年囊性纤维化（CF）患者中很常见，与生活质量差、肺功能及医疗保健利用相关。这项为期3年的多中心远程医疗随机试验旨在确定接受与承诺疗法（针对CF的ACT）在改善成年CF患者心理功能方面是否优于支持性心理治疗（SP）。
在首次新冠疫情封锁期间，从托马斯·杰斐逊大学医院、弗吉尼亚大学、奥古斯塔大学、杜克大学医学中心以及社交媒体招募了124名有CF且焦虑和/或抑郁症状加重的成年人。参与者被随机分为接受6周针对CF的ACT或SP治疗，通过Zoom进行。他们完成了心理功能测量：抑郁（BDI-II）、焦虑（BAI）、认知融合（CFQ-13）、接受与承诺行动（AAQ-II）；并在基线、治疗后及3个月随访时完成了依从性障碍测量。使用电子病历数据收集生物行为结果，包括CF严重程度和治疗负担。
参与者为年轻成年人（平均年龄25岁[标准差=12]），女性（75%），使用CFTR调节剂（67%），服用精神药物（60%），曾接受过心理治疗（72%）。使用协方差分析评估治疗效果，控制各结果的基线水平、年龄、生物学性别和第一秒用力呼气容积（FEV）。与SP（平均得分=67.8[62.2,73.5]，科恩d值=0.59，P=0.017）相比，ACT在6周时心理功能改善更显著（平均得分=57.3[51.6,63.0]），在认知融合（CFQ-13）以及接受与承诺行动（AAQ-II）方面改善最大。心理功能的治疗改善在3个月时持续存在（ACT：59.7[53.5,65.9] 对比SP：69.0[62.6,75.4]，科恩d值=0.40，P=0.041），ACT在CFQ-13和AAQ-II方面持续改善。尽管BDI-II得分事后有所降低（ACT：-7.4[-9.4,-5.4] 对比SP：-4.5[-6.4,-2.6]，P=0.040），但我们的平均排名综合结果变量上的消极情绪得分并未持续改善（科恩d值=0.22，P=0.170）。心理灵活性（CFQ-13和AAQ-II）的改善也与消极情绪的降低密切相关（B=-0.45，P<0.001）。在针对CF的ACT中，基线药物依从性障碍较大的个体在治疗后报告障碍减少更多（P=0.026）。基线FEV/FVC比值较低（如≤65%）的个体与SP相比，在ACT中改善更大（ACT：7.3[1.7,12.8] 对比SP：1.3[-3.2,5.8]，交互作用P=0.036）。
针对CF的ACT在改善成年CF患者及心理困扰加重患者的心理功能方面优于SP，在部分医疗负担较重的个体的次要生物行为结果方面有额外益处。心理灵活性的改善与消极情绪的降低密切相关。
gov ID #NCT04114227 由布默·埃西亚森基金会资助。
