2.3 Telehealth Psychological Support Intervention
This intervention utilized evidence-based Cognitive Behavioral Therapy (CBT) skills [24-25] for depression and anxiety (Figure 1). The 4-session intervention focused on self-care (e.g., relaxation training), coping skills (e.g., cognitive reframing), exercises to improve mood, and individual, emotional challenges (e.g., extreme fear of the virus). In Session 1, individuals were asked to describe their stressful experiences with the pandemic and consider coping strategies that had been useful, identify their own resilience skills (e.g., call a friend for support), and protective factors (e.g., family support, reducing time watching the news).
Initially, there was tremendous fear about the pandemic, and pwCF and caregivers were engaging in a lot of catastrophic thinking. Therapists encouraged a focus on the present moment and emphasized how well-prepared they were to deal with COVID, given their CF experience with infection control. A toolkit of cognitive behavioral skills was built and used flexibly to promote psychological and physical health (Figure 1). CBT skills included: cognitive reframing (facilitating positive thoughts), relaxation training, increasing positive emotions, and getting physical exercise. One exercise, “catching joy” [26], asked them to identify 3 moments of joy each day and record them in WhatsApp; these joyful moments were discussed in the next session. Importance of maintaining normal routines was reinforced, which included getting up and dressed, performing CF treatments, getting good sleep, and identifying activities that increased positive mood (e.g., cooking a favorite dish, listening to music).
During the 1st session, individuals were asked to describe a recent stressful experience with COVID and effects of the lockdown. Next, they were asked about coping with this stressor, and discussed new strategies they could use. Time was also spent identifying the “upsides” of the lockdown (i.e., reframing), having more time for CF treatments, watching movies as a family, and for parents, spending more time with their children. In general, increasing positive emotions and adaptive thinking were fostered to counter negative thoughts, and self-efficacy and resilience were encouraged.