ACT, therapy aiming at adjustment, seen to aid mental health with CF
Small study compared 6 weeks of online ACT and psychotherapy sessions
Acceptance and commitment therapy (ACT), which helps people accept feelings and adjust behavior, was better than supportive psychotherapy for adults with cystic fibrosis (CF) facing mental health challenges, a small study found.
In the trial (NCT04114227) sponsored by Thomas Jefferson University in Philadelphia and with sessions conducted online, researchers also observed that ACT benefits lasted for several months, especially in addressing barriers to treatment and adapting to challenges.
The study, “ACT with CF: A randomized trial of acceptance and commitment therapy vs supportive psychotherapy for adults with cystic fibrosis,” was published in the journal General Hospital Psychiatry.
Cystic fibrosis is known to affect a person’s mental health and well-being
Depression and anxiety are up to three times as common in people with CF as in the general population, and problems with mental health can persist even when patients perceive gains in lung health in response to CFTR modulators, medications used to treat CF.
This study compared ACT and supportive psychotherapy to see which better works to improve mental health in adults with CF. Supportive psychotherapy, also called talk therapy, uses dialogue with a mental health professional to help people identify emotions and reduce their psychological distress.
ACT is an approach to psychotherapy that aims to get people to accept emotions instead of avoiding them. It teaches that difficult feelings are natural and shouldn’t stop anyone from moving on in life, and not to get locked into a line of thinking.
“ACT aims to increase psychological flexibility: acceptance of painful feelings, thoughts, sensations, and to engage in valued action,” the researchers wrote.
The study included 124 mostly young adults with CF (mean age, 25; 70% female), who were experiencing symptoms of depression and/or anxiety. About two-thirds (67%) were taking CFTR modulators. They were recruited during the COVID-19 pandemic at various U.S. university hospitals or universities and through social media, and they randomly were assigned to six weeks of ACT or supportive psychotherapy via Zoom.
An easing in measures of anxiety, depression seen after 6 ACT sessions
After six weekly sessions, each lasting 50 minutes, the ACT group scored better, on average, on measures of psychological functioning than the other group (57.3 vs. 67.8 points). Psychological functioning took into account measures of depression and anxiety, among others, with lower scores indicating less psychological distress. Benefits lasted for three months after the final session (59.7 vs. 69 points), the researchers noted.
Symptoms of depression over the previous two weeks, measured by the Beck Depression Inventory (BDI-II), also eased more in the ACT group. Scores for these adults dropped by an average of 7.4 points compared with 4.5 points for those in the supportive psychotherapy group. In the BDI-II, lower scores indicate less severe symptoms.
While no significant differences were evident between the two groups in anxiety reduction, those in the ACT group showed the largest improvements in cognitive fusion and acceptance and committed action. Cognitive fusion refers to the tendency to become too attached (fused) to a rigid line of thought, including those that are negative or harmful. An example given in the study is convincing yourself you’ve too many daily treatments to possibly take, and then possibly shunning efforts at better treatment adherence.
Therapy adherence can be a problem for people with CF, which affects multiple organs and “requires a complex and time-consuming daily treatment regimen, including pancreatic enzymes, airway clearance, and medications (oral, inhaled, and/or nebulized),” the researchers wrote.
Movements toward more flexible thinking were linked to reductions in negative affect, which refers to experiencing negative emotions and a having poor sense of self-value. Here, negative affect was measured by combining depression and anxiety scores.
Possibility that ACT might best benefit those with ‘psychological flexibility’
Because findings showed that “the more psychological flexibility an individual demonstrated at baseline [the study’s start], the more improvement resulted with ACT,” the researchers noted that “assessment of psychological flexibility may be a useful determinant of who will benefit most from ACT with CF.”
ACT also helped patients overcome barriers to medication adherence, especially those with greater barriers at the study’s start. Additionally, patients with lower lung function at baseline benefited more from ACT than with supportive psychotherapy.
While the study ran “during an unprecedented time of change for people living with CF,” the researchers wrote, “telehealth-delivered ACT with CF improved psychological flexibility in just 6 sessions, during a global pandemic, with sustained improvements 3 months after the final session.”
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