(298) Co-Designing an Acceptance and Commitment Therapy Telehealth Group Intervention for Adolescents with Cystic Fibrosis

Background: Adolescents with cystic fibrosis (CF) are at increased risk for anxiety and depression. Acceptance and Commitment Therapy (ACT) has been shown to be effective for addressing anxiety and depression in youth with chronic illness [1]. Infection risks prevent in-person group therapy for youths with CF, though group-based ACT may offer advantages of built-in peer support and intervention efficiency. ACT delivered in a telehealth group format has not been studied among youth with CF. We co-designed (with teens w/CF) a telehealth group therapy protocol—Teen’s Acceptance and Commitment Therapy Involving Cystic fibrosis (TACTIC) and evaluated user-centered implementation outcomes and measures of putative therapeutic mechanisms.

Methods: Using Human Centered Design principles, we systematically gathering input from teens with CF in an iterative co-design process. In total, 7 teens (3 female, 4 male; ages 14-18) participated in 2 sequential user-testing focus groups. Feedback from Group 1 (n = 3) informed adjustments to the TACTIC protocol prior to testing with Group 2 (n = 4). Draft TACTIC content was presented in focus groups and teens were asked to complete therapeutic activities (e.g., guided meditation, values card sort, group discussion) as if they were participating in a group therapy session. Teens rated the anticipated and actual difficulty of each activity. They provided preference ratings and summarized their perceived key takeaway points for each activity. Higher ratios of actual to anticipated difficulty and/or low accuracy of summary takeaway points indicated usability issues and prompted protocol adjustment. Upon completion of all focus group sessions, teens rated TACTIC on its overall appropriateness (i.e., suitability), acceptability, and feasibility using validated measures [2]. Teens also completed measures to assess TACTIC’s impact on valued living and psychological flexibility—putative mechanisms of action in ACT. Given the small sample, effects sizes (Hedges’ g) are reported (instead of significance values) to describe potential changes in these mechanisms pre-post co-design sessions.

Results: The co-design process resulted in a 6-session telehealth group therapy protocol. On average, participants rated TACTIC as highly appropriate (3.92/5), acceptable (4.29), and feasible (4.33). Moderate to large increases in self-reported valued living (Hedges’ g = .63) and psychological flexibility (Hedges’ g = 1.34) were observed pre-post study participation.

Conclusions: Our co-design process allowed us to refine and validate each therapeutic task and systematically integrate feedback from teens with CF into the group protocol. These user-testing results are promising for TACTIC’s likely acceptability, appropriateness, and feasibility. Preliminarily, the intervention appears to be influencing therapeutic mechanisms in the anticipated direction. A pilot randomized trial of TACTIC is underway and final results will be presented at the conference.

Acknowledgements: We are grateful to the teens who contributed to this study and the Cystic Fibrosis Foundation for funding this research (LIU20A0-I)

References: [1] Swain J, Hancock K, Dixon A, Bowman J. Acceptance and Commitment Therapy for children: A systematic review of intervention studies. J Contextual Behav Sci. 2015 Apr;4(2):73-85.

[2] Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, et al. Psychometric assessment of 3 newly developed implementation outcome measures. Implement Sci. 2017 Dec;12(1):108.