Virtual, Group Adaptation of a Cystic Fibrosis (CF) Specific Cognitive Behavioural Therapy for Adults With CF: An Exploration of Effectiveness, Feasibility, and Participant Experiences.

BACKGROUND: CF is a genetic, life-limiting, chronic disease that affects approximately 4300 Canadians (~70,000 to 100,000 patients worldwide; Cystic Fibrosis Canada, 2018; Cystic Fibrosis Worldwide, n.d.; Sawicki et al., 2011). People with cystic fibrosis (pwCF) demonstrate high rates of depression and anxiety (Quittner et al., 2014) and the corresponding deleterious impact on functioning is alarming (e.g., decreased lung function and worse adherence to critical life prolonging therapies; Smith et al., 2010; Yohannes et al., 2012). While evidence-based psychological approaches for depression and anxiety, such as cognitive behavioral therapy (CBT), are effective in reducing depression and anxiety symptoms that are co-morbid with other chronic illnesses (e.g., diabetes, COPD, and cancer; Uchendu & Blake, 2016; Williams et al., 2020; Shi et al., 2019; Gandy et al., 2013; López-López et al., 2019), there is a need to design tailored treatments to address the specialized needs of pwCF. To this end, Friedman, Georgiopoulos, and colleagues developed CF-CBT, an innovative, effective, 8-session, individually delivered CF-specific CBT-based intervention program to promote emotional well-being for adults with CF (Friedman et al., 2022a; Friedman et al., 2022b). Virtual delivery of CF-CBT in a group format is one way to address the potentially prohibitive costs of mental health treatment while also addressing infection control guidelines for pwCF, which preclude in-person groups (Saiman et al., 2014)). CF-CBT has been recently modified (i.e., session structure, activities) for group delivery; however, feasibility, acceptability, effectiveness of, and patient experiences with this mode of delivery have yet to be investigated.

PARTICIPANTS: G*Power 3.1 was used to calculate the study sample size based upon on secondary analyses (i.e., t-test). Assuming 80% power, an alpha of 0.05, and an effect size of 0.5 (medium), a sample size of at least 27 participants would be needed. The investigation aims to recruit 28-30 participants to address attrition. Participants with CF will be recruited from CF clinics in British Columbia, Canada. Participants will be consecutively enrolled into groups upon completing pre-program measures. The investigators will seek to have a 2:1 women to men ratio to address gender variations in mental health symptoms and disorders.

HYPOTHESES:

Primary hypothesis:

1. Virtual, group CF-CBT will be feasible and acceptable, as indexed by low rates of drop out and high rates of adherence and satisfaction.