Integrating cognitive behavioral therapy into specialty care for adolescents with cystic fibrosis: a feasibility trial.

OBJECTIVE

Created to advance cystic fibrosis (CF) mental health care delivery, CF-cognitive behavioral therapy (CBT) is being implemented across North America. An adolescent version (CF-CBT-A) was developed with stakeholder input. To assess the feasibility/acceptability of CF-CBT-A delivered via telehealth by CF care-team providers, we designed a one-arm feasibility trial at 3 CF Centers examining attrition, engagement, homework completion, and treatment satisfaction.

METHODS

Adolescents with CF identified by routine screening with at least mild depression and/or anxiety symptoms received CF-CBT-A. Retention rate (proportion enrolled completing all 9 sessions) and treatment satisfaction (proportion of Client Satisfaction Questionnaire-8 ratings above scale midpoint) were considered good at ≥70% and excellent at ≥80%. Pre-post change in measures of depression, anxiety, psychological stress, and coping (CF Coping Self-Efficacy; CF-CSE) were summarized with Cohen's d metric of effect sizes.

RESULTS

Twelve participants (12-17 years; M = 13) enrolled, with 92% retention. Engagement was rated at the highest level, and homework was partially/fully completed for 94% and 74% of sessions, respectively. All adolescent and caregiver acceptability ratings were >Client Satisfaction Questionnaire-8 mid-point. Large effect sizes showed promising improvements in anxiety (-1.01) and coping: CF-CSE Relaxation Skills (2.00), Active Stress Management (1.09), and Acceptance/Communication (1.70). Effect sizes were moderate for depression (-0.64), CF-CSE Daily Self Care (0.68), and adolescent-reported psychological stress (-0.51). Effect sizes were small for caregiver-reported adolescent stress (-0.26).

CONCLUSIONS

Results support the feasibility and acceptability of CF-CBT-A integrated into CF care, with preliminary evidence of positive impacts. Further research is needed to establish effectiveness and optimal implementation by CF teams to improve access to CF-specific evidence-based mental health care for adolescents.