(331) UPLIFT: Preliminary results of a web-based group mental health intervention study in CF

Background: Compared to the general population, rates of anxiety and depression are higher among people with cystic fibrosis (PWCF). Anxiety and depression can negatively impact adherence and disease self-management, leading to worse physical health outcomes. A structured intervention that incorporates mindfulness practices into Cognitive-Behavioral Therapy (CBT), known as UPLIFT (Using Practice and Learning to Increase Favorable Thoughts), previously has been successful in reducing comorbid psychiatric symptoms in patients with epilepsy [1]. As this intervention is performed in a group setting, it provides the benefits of cost-effectiveness and social support, and its web-based delivery method reduces infection risk. The primary goal of this study was to determine the effectiveness of an adapted version of UPLIFT for PWCF in reducing their symptoms of anxiety and depression.

Methods: Six participating CF programs recruited English-speaking cognitively unimpaired patients 18(+) years of age with scores of 5-14 on the General Anxiety Disorder (GAD)-7 and/or 5-19 on the Patient Health Questionnaire (PHQ)-9 and who reported no suicidal ideation. The lead study coordinator contacted interested patients by phone to review the study and e-consent. Subjects were randomly assigned into 1 of 2 groups: UPLIFT or the treatment-as-usual control group. Groups of 6-8 subjects randomized to UPLIFT participated in 8 weekly 1-hour sessions led by 2 trained facilitators, supervised by a clinical psychologist. All subjects completed online self-assessments related to anxiety, depression, health-related quality of life (HRQOL), self-efficacy, knowledge and skills, and disease management prior to treatment (T_x)-start (Baseline), at T_x-end, and at 6 and 12-months-post-T_x; CF program research coordinators completed concurrent surveys of clinical CF measures. Our primary analysis will use linear mixed modeling of longitudinal scores of anxiety and depression as outcomes and time, group, and their interactions as predictors, accounting for intrasubject correlations and possible demographic covariates. Secondary analyses will explore changes in primary outcomes at T_x-end and 12-month-post-T_x and in measures of disease management, HRQOL, and CF health.

Results: Eighty-five subjects over 4 study cohorts completed the e-consent; 19 completed no study activities, 1 withdrew after baseline, and there was 1 death. Study groups did not differ significantly on age, gender, or baseline anxiety, depression, lung function, or nutritional status (Table 1). The median number of UPLIFT sessions attended was 7 (IQR 5-8) and 88% of subjects attended at least 4 sessions. Sixty-one (94%) subjects completed T_x-end assessments; 56 (84%) completed 6-month-post-T_x assessments. The 12-month-post-T_x data will be collected from Cohort 4 in July 2022 and the final full database will be analyzed for presentation at NACFC.

Conclusions: UPLIFT is a mindfulness-and-CBT web-based group intervention that has shown benefits in patients with epilepsy. If successful in CF, UPLIFT could provide a safe and cost-effective option for remote delivery of mental health services that could prevent escalation of anxiety and depression among PWCF.

Acknowledgements: Supported by CFF Grants SCHECH15A0 & SCHECH19A0

References: Thompson NJ, Patel AH, Selwa LM, et al. Expanding the efficacy of Project UPLIFT: Distance delivery of mindfulness-based depression prevention to people with epilepsy. J Consult Clin Psychol 2015; 83(2): 304-13.