BACKGROUND Anxiety and depressive symptoms are common among individuals with cystic fibrosis (CF) and are associated with decreased lung function [3], quality of life [4], and treatment adherence [2]. However, CF-specific targeted psychotherapeutic interventions are lacking. This study examined whether Acceptance and Commitment Therapy (ACT) [7], delivered via telehealth, would address this need and improve clinical symptoms. Telehealth is ideal for CF patients, given exposure precautions and frequent hospitalization. ACT emphasizes acceptance, thereby reducing avoidance of anxiety and depressive symptoms associated with CF. It was hypothesized that our ACT with CF protocol [11] would also improve lung function among people with CF. METHODS Participants were 28 adults with CF and elevated clinical symptoms who completed 6 ACT with CF sessions. They completed measures of depression, anxiety, and cognitive fusion at baseline, post-intervention, and at a 3-month follow-up. Lung function was calculated 3 months pre- and 3 months post-treatment. RESULTS The majority of participants selected treatment via telehealth (n = 22; 79%). 96% of participants (n=27) completed all 6 sessions, with 93% (n=26) voicing a strong desire to continue treatment with ACT. 79% of the sample (n=22) indicated, after just 1 session of ACT with CF, that treatment seemed logical and feeling confident that it would reduce symptoms of anxiety and depression. ACT with CF was associated with a statistically significant reduction in a composite score of psychological distress from pre to post treatment, corresponding to a large standardized effect size, that was not sustained at 3 months. Telehealth-delivered ACT with CF was as effective as in-person. Reductions in cognitive fusion were strongly related to improvements in psychosocial functioning. This is particularly promising as it reflects the proposed mechanism of action of ACT. ACT with CF was also associated with increased FEV1/FVC ratio at post-treatment follow-up. CONCLUSIONS ACT with CF delivered via telehealth or in-person is a feasible and potentially effective treatment for improving anxiety and depressive symptoms, and increasing psychological flexibility via reductions in cognitive fusion. Due to the effect size associated with reduction in psychosocial distress, we are cautiously optimistic that ACT with CF will prove an effective treatment. Larger randomized controlled trials are needed to confirm the observed findings and further delineate the potential effects of ACT with CF on clinical outcomes among individuals with CF.

中文翻译：

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ACT with CF：一项远程医疗和面对面的可行性研究，以解决囊性纤维化患者的焦虑和抑郁症状

背景 焦虑和抑郁症状在囊性纤维化 (CF) 患者中很常见，并且与肺功能 [3]、生活质量 [4] 和治疗依从性 [2] 下降有关。然而，缺乏特定于 CF 的有针对性的心理治疗干预措施。这项研究检查了通过远程医疗提供的接受和承诺疗法 (ACT) [7] 是否可以满足这一需求并改善临床症状。鉴于接触预防措施和频繁住院，远程医疗是 CF 患者的理想选择。ACT 强调接受，从而减少对与 CF 相关的焦虑和抑郁症状的避免。假设我们的 ACT 与 CF 协议 [11] 也将改善 CF 患者的肺功能。方法 参与者是 28 名患有 CF 和临床症状升高的成年人，他们在 CF 课程中完成了 6 次 ACT。他们在基线、干预后和 3 个月的随访中完成了抑郁、焦虑和认知融合的测量。在治疗前 3 个月和治疗后 3 个月计算肺功能。结果 大多数参与者选择通过远程医疗进行治疗（n = 22；79%）。96% 的参与者 (n=27) 完成了所有 6 个疗程，93% (n=26) 表示强烈希望继续使用 ACT 治疗。79% 的样本 (n=22) 表明，在仅 1 次 ACT 与 CF 疗程后，这种治疗似乎合乎逻辑，并且对它会减轻焦虑和抑郁症状充满信心。ACT 与 CF 与心理困扰综合评分从治疗前到治疗后的统计学显着降低相关，对应于较大的标准化效应量，但在 3 个月时并未持续。带有 CF 的远程医疗提供的 ACT 与面对面一样有效。认知融合的减少与社会心理功能的改善密切相关。这是特别有希望的，因为它反映了 ACT 的拟议作用机制。ACT 与 CF 还与治疗后随访时 FEV1/FVC 比值增加有关。结论 通过远程医疗或面对面提供 CF 的 ACT 是一种可行且潜在有效的治疗方法，可改善焦虑和抑郁症状，并通过减少认知融合来增加心理灵活性。由于与减少社会心理困扰相关的效应大小，我们谨慎乐观地认为 ACT 与 CF 将证明是一种有效的治疗方法。