Individuals with cystic fibrosis (CF) are at high risk for depression and/or anxiety. Not only do these symptoms negatively affect quality of life, depression and anxiety may also compromise an individual’s adherence to treatment recommendations and have negative consequences for long-term health.
The Cystic Fibrosis Foundation guidelines recommend routine screening for and treatment of depression and anxiety in individuals with CF. Cognitive-behavioral therapy (CBT) represents an evidence-based intervention focused on teaching coping skills and is effective for the prevention and treatment of depression and anxiety; however, patients with CF often encounter barriers to accessing this type of intervention, and treaters in the community are often not familiar with CF and the specific challenges faced by patients with this chronic illness. In addition, recent experiences with the COVID-19 pandemic highlighted the need for behavioral interventions that can be delivered remotely.
In order to provide more tailored mental health care to patients with CF, Deborah Friedman, PhD and Anna Georgiopoulos, MD partnered with patients in the CF community and developed a CF-specific cognitive-behavioral therapy intervention (CF-CBT). Using semi-structured interviews with patients, Friedman and Georgiopoulos were able to identify core themes related to the lived experiences of those with CF. The most frequently cited CF-related stressors included treatment burden, illness uncertainty, and financial and insurance issues. Resilience was also an important theme, with participants describing strategies they use to cope with CF. Patients’ experiences were incorporated into the program’s intervention manual and patient workbook.
CF-CBT specifically addresses the emotional challenges of coping with CF, the stressors related to disease management, and the barriers to accessing care. Rather than receiving mental health services from providers outside of the CF clinic, the CF-CBT intervention consists of 8 45-minute modules that can be flexibly delivered in the outpatient CF clinic, on the inpatient unit, or by telephone, by multidisciplinary members of the CF care team, an approach that minimizes additional costs and burden of care to patients.
Preliminary studies have demonstrated that CF-CBT can be successfully delivered by multidisciplinary providers as part of an integrated model of care (Friedman et al, 2022). However, recent experiences with the COVID-19 pandemic highlighted the need for behavioral interventions that can be delivered remotely. Verkleij and colleagues (2023) modified the CF-CBT intervention described above to be delivered as an 8-session therapist-guided internet-delivered program in Dutch. Of the 10 adults with CF included in this pilot study, 90% of the participants experienced improvements in depression and anxiety symptoms. This eHealth CF-CBT demonstrated feasibility, usability, acceptability, with all of the participants completing all of the sessions.
While effective treatments for depression and anxiety are available, patients with chronic medical illnesses, such as cystic fibrosis, may experience barriers to accessing care and may be particularly sensitive to the additional burdens associated with pursuing treatment. Thus, it is essential to develop models of psychiatric care that can be more seamlessly integrated with medical specialty programs. CF-CBT can easily be incorporated into CF specialty clinics and can be delivered in a variety of settings by multidisciplinary team members with expertise in the treatment of CF. Preliminary studies of CF-CBT, as well as an internet-based adaptation of this intervention, show feasibility, as well as efficacy.
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Friedman D, Smith BA, Bruce A, Schwartz CE, Lee H, Pinsky H, Gootkind E, Hardcastle M, Shea N, Roach CM, Miller C, Polineni D, Salathe M, Quittner AL, Georgiopoulos AM. Feasibility and acceptability of a CF-specific cognitive-behavioral preventive intervention for adults integrated into team-based care. Pediatr Pulmonol. 2022 Nov; 57(11):2781-2790.
Friedman D, Kaskas MM, Quittner AL, Smith BA, Georgiopoulos AM. Patient engagement in the development of CF-CBT: A cystic fibrosis-specific cognitive-behavioral intervention for adults. Front Psychol. 2022 Oct 7;13:937189.
Verkleij M, Georgiopoulos AM, Barendrecht H, Friedman D. Pilot of a therapist-guided digital mental health intervention (eHealth CF-CBT) for adults with cystic fibrosis. Pediatr Pulmonol. 2023 Jul;58(7):2094-2103.
