(333) What is the Impact of Journaling Therapy on Pediatric Patients with Cystic Fibrosis

Background: Individuals with cystic fibrosis often face many psychological difficulties on top of their medically complex care. Mental health issues such as anxiety, depression, and medical mistrust in patients with cystic fibrosis have been shown to be associated with worse adherence, pulmonary function test results, and many other health outcomes. [1] In this pilot trial, we hope to provide the pediatric cystic fibrosis population with journaling therapy strategies based off narrative therapy methodology to improve their mental and physical health outcomes.

Methods: Patients aged 12-17 who have diagnosed CF followed in CF clinic at CHLA were recruited into the study consisting of 8 weekly journaling prompts that included: introduction to narrative therapy, living with CF, treatment adherence, feeling different with CF, anxiety, limitations, depression, and interpersonal relationships. Baseline health data (such as BMI, number of hospitalizations and infections, and PFT data) and weekly surveys paired with the journaling prompts were provided to the patients via email. Pre- and Post-study survey results were also collected that included the Pediatric Symptom Checklist.

Results: A total of 8 patients were recruited as a part of this pilot study. 50% of participants completed the entirety of this study, and another 25% partially completed the study. The average score for the Pediatric Symptom Checklist was decreased by 5.5 points, and more importantly the post-study average (23.5±12.2) fell to less than 28, which is the cutoff for children ages 6-16 for being suggestive of significant behavioral or emotional problems. 100% of participants reported “I recommend other people with CF to write about the topics from this study” and “this study helped me express my feelings”. Subjective survey results indicated the study was enjoyable to participants and there was subjective improvement in participants’ feelings of anxiety/depression. Additionally, 100% of participants responded “Strongly Agree” to the statement “My writings helped my providers get to know me better” and “I recommend other people with CF to write about the topics from this study”.

Conclusions: This feasibility pilot study to implement a journaling intervention for patients with CF was very successful. Our expected level of participation and completion of the study was exceeded. Additionally, initial results are promising for improvement of general wellness as measured by the Pediatric Symptom Checklist, as well as participant subjective reports of benefit from the study. This study shows journaling to be a promising tool to improve mental and behavioral health measures in patients with CF.

Acknowledgements: This work was supported by the Cystic Fibrosis Foundation [grant CMHCO14-15].

References: [1] Quittner, Alexandra L, et al. “Prevalence of Depression and Anxiety in Patients with Cystic Fibrosis and Parent Caregivers: Results of The International Depression Epidemiological Study across Nine Countries.” Thorax, vol. 69, no. 12, 2014, pp. 1090–1097., doi:10.1136/thoraxjnl-2014-205983.