Development and evaluation of an internet-based cognitive behavioral therapy intervention for anxiety and depression in adults with cystic fibrosis (eHealth CF-CBT): an international collaboration
Open accessAbstract
INTRODUCTION: Individuals with cystic fibrosis (CF) are at increased risk for anxiety and depression, with negative consequences for adherence, health, and quality of life. New approaches to prevent and treat anxiety and depression that are tailored to the concerns of this population are needed. A CF-specific internet-based cognitive-behavioral therapy (CBT) intervention was developed to increase access to evidence-based mental health care and decrease cost and burden of care for people with CF. OBJECTIVE: To evaluate the usability and acceptability of "eHealth CF-CBT," an internet-based program integrating therapist-guided online self-management modules with in-person or virtual sessions. METHODS: = 16) and CF health care providers (N = 16) systematically tested all sessions of the eHealth CF-CBT program, provided qualitative feedback, and completed measures including eHealth Impact Questionnaire (eHIQ), and System Usability Scale (SUS). RESULTS: Patient and provider ratings of their overall impression of the eHealth CF-CBT program were high, with scores (mean; SD) of 8.3; 0.6 and 8.2; 0.8 respectively on a 10-point scale. Mean ratings of usability by patients (77.0/100) and providers (73.4/100) surpassed the SUS cut point for good favorability. Ratings (pooled mean; SD) on the assessed eHIQ domains Motivation and Confidence to Act (71.3; 10.0), Information and Presentation (78.9; 9.6), and Identification (62.0; 15.1) were positive, as were assessments of specific elements of session content and format. CONCLUSIONS: eHealth CF-CBT is the first therapist-guided internet-delivered CBT-based intervention for adults with CF. Initial evaluation with key stakeholders demonstrated high levels of acceptability and usability and provided input that was integrated to strengthen the program. Effectiveness testing in the Netherlands will be the next step, as well as future international adaptation and dissemination.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Pilot data from online CF-CBT studies demonstrate that the online CF-CBT program was both feasible and acceptable.
“Pilot data from these studies also demonstrate that the online CF-CBT program was both feasible and acceptable (27).”
From Virtual monitoring in CF – the importance of continuous monitoring in a multi-organ chronic condition (2023) · cites this paper as [27]
The Results section (Acceptability and usability survey results; page not provided) reports favorable acceptability ratings and above-average usability scores for eHealth CF-CBT. But the Discussion describes this as beta testing and says a pilot study was still forthcoming. The paper therefore does not establish that pilot studies had demonstrated the program's feasibility. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
SUS: A 'Quick and Dirty' Usability Scale
(1996) · Usability Evaluation In Industry · doi:10.1201/9781498710411-35 · Cited by 8,989 · see citing works
Usability Evaluation In Industry
(1996) · CRC Press eBooks · doi:10.1201/9781498710411 · Cited by 4,400 · see citing works
Update on Key Emerging Challenges in Cystic Fibrosis
Jennings, M. T., Riekert, K. A., & Boyle, M. (2014) · Medical Principles and Practice · doi:10.1159/000357646 · Cited by 3,667 · see citing works
Zhou, S.-J., Zhang, L.-G., Wang, L.-L., Guo, Z.-C., Wang, J.-Q., Chen, J.-C., Liu, M., Chen, X., & Chen, J.-X. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01541-4 · Cited by 1,464 · see citing works
(2013) · Journal of Usability Studies archive · Cited by 1,357 · see citing works
Depression and Anxiety in Hong Kong during COVID-19
Choi, E. P. H., Hui, B. P. H., & Wan, E. Y. F. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17103740 · Cited by 905 · see citing works
Quittner, A. L., Goldbeck, L., Abbott, J., Duff, A., Lambrecht, P., Solé, A., Tibosch, M. M., Bergsten Brucefors, A., Yüksel, H., Catastini, P., et al. (2014) · Thorax · doi:10.1136/thoraxjnl-2014-205983 · Cited by 524 · cited 3× · see citing works
“Moreover, untreated depression and anxiety in people with CF were found to have negative consequences for health-related quality of life (HrQoL), adherence, medical outcomes and healthcare costs (Quittner et al., 2014; Smith et al., 2010; Verkleij et al., 2018).”
BackgroundQuittner, A. L., Abbott, J., Georgiopoulos, A. M., Goldbeck, L., Smith, B., Hempstead, S. E., Marshall, B., Sabadosa, K. A., & Elborn, S. (2016) · Thorax · doi:10.1136/thoraxjnl-2015-207488 · Cited by 450 · cited 6× · see citing works
“The implementation of annual screening for depression and anxiety (Quittner et al., 2016) in US and European Centers provides a tremendous opportunity to intervene in response to early signs of distress and prevent negative psychological and health outcomes (Smith et al.”
BackgroundMethodInfluentialDetermining what individual SUS scores mean
(2009) · Journal of Usability Studies archive · doi:10.5555/2835587.2835589 · Cited by 412 · see citing works
Safren, S. A., O’Cleirigh, C. M., Tan, J. Y., Raminani, S. R., Reilly, L. C., Otto, M. W., & Mayer, K. H. (2009) · Health Psychology · doi:10.1037/a0012715 · Cited by 394 · see citing works
Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update
Saiman, L. M., Siegel, J. D., LiPuma, J. J., Brown, R. F., Bryson, E. A., Chambers, M. J., Downer, V. S., Fliege, J. D., Hazle, L., Jain, M., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/676882 · Cited by 389 · see citing works
How Stress Management Improves Quality of Life After Treatment for Breast Cancer.
Antoni, M. H., Lechner, S. C., Kazi, A., Wimberly, S. R., Sifre, T., Urcuyo, K. R., Phillips, K. K., Glück, S., & Carver, C. S. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.6.1152 · Cited by 350 · see citing works
Antoni, M. H., Lechner, S. C., Diaz, A., Vargas, S. E., Holley, H., Phillips, K. K., McGregor, B., Carver, C. S., & Blomberg, B. B. (2008) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2008.09.005 · Cited by 248 · see citing works
The Need for a Mental Health Technology Revolution in the COVID-19 Pandemic
Figueroa, C. A., & Aguilera, A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00523 · Cited by 227 · see citing works
Smith, B. A., Modi, A. C., Quittner, A. L., & Wood, B. L. (2010) · Pediatric Pulmonology · doi:10.1002/ppul.21238 · Cited by 185 · see citing works
Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT
Thompson, N. J., Walker, E. R., Obolensky, N., Winning, A., Barmon, C., DiIorio, C., & Compton, M. T. (2010) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2010.07.031 · Cited by 185 · cited 2× · see citing works
“…conditions, including diabetes, COPD, HIV/AIDS, epilepsy, and cancer (Antoni et al., 2006, 2009; Cully et al., 2010; Laperriere et al., 2005; Thompson et al., 2010; Safren et al., 2009; Soo and Lam, 2009), until recently, there were no interventions tailored to address the unique needs of…”
BackgroundWei, N., Huang, B.-C., Lu, S.-J., Hu, J.-B., Zhou, X.-Y., Hu, C.-C., Chen, J.-K., Huang, J.-W., Li, S.-G., Wang, Z., et al. (2020) · Journal of Zhejiang University-SCIENCE B · doi:10.1631/jzus.b2010013 · Cited by 173 · cited 1× · see citing works
“Due to COVID-19, in a period when anxiety and depression are possibly increased (Choi et al., 2020; Wei et al., 2020; Zhou et al., 2020), there is currently an especially high need for internet interventions from home, to reduce exposure to infection.”
BackgroundSelf-Reported Physical and Psychological Symptom Burden in Adults with Cystic Fibrosis
Sawicki, G. S., Sellers, D. E., & Robinson, W. M. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2007.06.005 · Cited by 119 · see citing works
Kelly, L., Ziébland, S., & Jenkinson, C. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.06.008 · Cited by 84 · see citing works
Kelly, L., Jenkinson, C., & Ziébland, S. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.03.012 · Cited by 76 · see citing works
Quittner, A. L., Abbott, J., Hussain, S. B., Ong, T., Uluer, A., Hempstead, S. E., Lomas, P., & Smith, B. A. (2020) · Pediatric Pulmonology · doi:10.1002/ppul.24949 · Cited by 58 · see citing works
Abbott, J., Elborn, J. S., Georgiopoulos, A. M., Goldbeck, L., Marshall, B. C., Sabadosa, K. A., Smith, B. A., & Quittner, A. L. (2015) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2014.12.015 · Cited by 56 · see citing works
LaPerriere, A. R., Ironson, G. H., Antoni, M. H., Pomm, H., Jones, D. L., Ishii, M., Lydston, D., Lawrence, P. J., Grossman, A. B., Brondolo, E. N., et al. (2005) · Journal of Health Psychology · doi:10.1177/1359105305049772 · Cited by 55 · see citing works
Stress management training in diabetes mellitus
Soo, H., & Lam, S. (2009) · Journal of Health Psychology · doi:10.1177/1359105309341146 · Cited by 54 · see citing works
Cognitive-Behavioral Therapy for Chronic Cardiopulmonary Conditions
Cully, J. A., Stanley, M. A., Deswal, A. M., Hanania, N. A., Phillips, L. L., & Kunik, M. E. (2010) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.09m00896blu · Cited by 42 · see citing works
Mental Health screening in cystic fibrosis centres across Europe
Abbott, J., Havermans, T., Järvholm, S., Landau, E., Prins, Y., Smrekar, U., Staab, D., Verity, L., & Verkleij, M. (2018) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2018.09.003 · Cited by 40 · see citing works
Maintaining mental health and function for the long run in cystic fibrosis
Smith, B. A., Georgiopoulos, A. M., & Quittner, A. L. (2016) · Pediatric Pulmonology · doi:10.1002/ppul.23522 · Cited by 39 · see citing works
Self-citationVerkleij, M., de Winter, D., Hurley, M. A., & Abbott, J. (2018) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2018.02.005 · Cited by 37 · see citing works
Talboom-Kamp, E. P. W. A., Tossaint-Schoenmakers, R., Goedhart, A., Versluis, A., & Kasteleyn, M. J. (2020) · JMIR Formative Research · doi:10.2196/17060 · Cited by 32 · see citing works
Friedman, D., Linnemann, R. W., Altstein, L. L., Islam, S., Bach, K., Lamb, C., Volpe, J., Doolittle, C., John, A. S., O’Malley, P. J., et al. (2017) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2017.02.011 · Cited by 30 · see citing works
Haley, V. B., DiRienzo, A. G., Lutterloh, E. C., & Stricof, R. L. (2013) · Infection Control and Hospital Epidemiology · doi:10.1086/674389 · Cited by 20 · see citing works
Neijenhuijs, K. I., van der Hout, A., Veldhuijzen, E., Scholten-Peeters, G. G. M., van Uden‐Kraan, C. F., Cuijpers, P. J., & Leeuw, I. M. V. (2019) · Journal of Medical Internet Research · doi:10.2196/13408 · Cited by 17 · see citing works
Ammerlaan, J., van Os‐Medendorp, H., Nijhof, N., Maat, B., Scholtus, L. W., Kruize, A. A., Bijlsma, J. W. J., & Geenen, R. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.10.009 · Cited by 16 · see citing works
Mueller, A., Georgiopoulos, A. M., Reno, K., Roach, C. M., Kvam, C. M., Quittner, A. L., Lomas, P., Smith, B. A., & Filigno, S. S. (2020) · Health & Social Work · doi:10.1093/hsw/hlaa009 · Cited by 14 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Rayment J. Chapter 1: what is cystic fibrosis? Sher Y. Georgiopoulos A.M. Stern T.A. Facing Cystic Fibrosis: A Guide for Patients and Their Families 2020 Massachusetts General Hospital Psychiatry Academy Boston 1 8
Cited by
Sorted by citations
Needs of people with rare diseases that can be supported by electronic resources: a scoping review
Long, J. C., Best, S., Easpaig, B. N. G., Hatem, S., Fehlberg, Z., Christodoulou, J., & Braithwaite, J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-060394 · Cited by 47 · see citing works
Smith, B. A., Georgiopoulos, A. M., Mueller, A., Abbott, J., Lomas, P., Aliaj, E., & Quittner, A. L. (2021) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2021.08.027 · Cited by 40 · see citing works
A bibliometric analysis on global eHealth
Tian, H., & Chen, J. (2022) · Digital Health · doi:10.1177/20552076221091352 · Cited by 35 · see citing works
Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention
Georgiopoulos, A. M., Christon, L., Filigno, S. S., Mueller, A., Prieur, M. G., Boat, T. F., & Smith, B. A. (2020) · Pediatric Pulmonology · doi:10.1002/ppul.24977 · Cited by 26 · see citing works
Friedman, D., Smith, B. A., Bruce, A., Schwartz, C. E., Lee, H., Pinsky, H., Gootkind, E., Hardcastle, M., Shea, N., Roach, C. M., et al. (2022) · Pediatric Pulmonology · doi:10.1002/ppul.26101 · Cited by 22 · see citing works
Vagg, T., Shanthikumar, S., Ibrahim, H., O'Regan, P., Chapman, W. W., Kirwan, L., Ranganathan, S., & Plant, B. J. (2023) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2023.05.012 · Cited by 18 · see citing works
Special issue on digital health interventions in chronic medical conditions: Editorial
Baumeister, H., Ebert, D. D., & Snoek, F. (2022) · Internet Interventions · doi:10.1016/j.invent.2021.100457 · Cited by 13 · see citing works
“…2021; Geirhos et al., 2021; Terhorst et al., 2021; Terpstra et al., 2021), cystic fibrosis (Geirhos et al., 2021; Nap-van der Vlist et al., 2021; Verkleij et al., 2021), asthma (Bonnert et al., 2021) and coronary artery disease (Bendig et al., 2021) as well as chronic medical conditions in…”
BackgroundVerkleij, M., Georgiopoulos, A. M., Barendrecht, H., & Friedman, D. (2023) · Pediatric Pulmonology · doi:10.1002/ppul.26438 · Cited by 13 · see citing works
Shahrokhian, N., Hassanzadeh, S., Razini, H. H., & Ramshini, M. (2022) · International journal of Sport Studies for Health · doi:10.5812/intjssh.122504 · Cited by 18 · see citing works
Me, myself, and I: A systematic review of cystic fibrosis and self‐concept
Harrigan, M., Jessup, M., Bennett, K., & Mulrennan, S. A. (2024) · Pediatric Pulmonology · doi:10.1002/ppul.26916 · Cited by 10 · see citing works
Treatment of Psychological Symptoms in Patients with Cystic Fibrosis
Campagna, G., Tagliati, C., Giuseppetti, G. M., & Ripani, P. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13195806 · Cited by 9 · see citing works
Semonella, M., Marchesi, G., Andersson, G., Dekel, R., Pietrabissa, G., & Vilchinsky, N. (2024) · Digital Health · doi:10.1177/20552076231225082 · Cited by 7 · see citing works
Editorial: The psychological challenges of respiratory disease
Volpato, E., Banfi, P. I., & Verkleij, M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1213963 · Cited by 4 · see citing works
Hogea, L., Bernad, B.-C., Costea, I., Levai, C. M., Marinca, A., Papavă, I., & Anghel, T. (2025) · Healthcare · doi:10.3390/healthcare13091084 · Cited by 5 · see citing works
Rozov, T., da Silva, M. T. N., Ribeiro, M. Â. G. D. O., Damaceno, N., Santana4, M. A. P. S., Maróstica, P. J. C., Melotti, R. D. C. N. C., Martins, V. D. C., Riedi, C. A., Souza, E. L., et al. (2025) · Jornal Brasileiro de Pneumologia · doi:10.36416/1806-3756/e20240416 · Cited by 2 · see citing works
Rakitzi, S. (2023) · Springer eBooks · doi:10.1007/978-3-031-27837-2_2 · Cited by 2 · see citing works
Who Am I? Self-concept in Adults with Cystic Fibrosis: Association with Anxiety and Depression
Harrigan, M., Mulrennan, S. A., Jessup, M., Waters, P., & Bennett, K. (2024) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-024-10023-7 · Cited by 2 · see citing works
Vagg, T., Deasy, K. F., Chapman, W. W., Ranganathan, S. C., Plant, B. J., & Shanthikumar, S. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1196442 · Cited by 1 · see citing works
European Respiratory Society International Congress 2021: highlights from best-abstract awardees
Ramakrishnan, S., Beaufils, F., Brandt, J. D., Viney, K. A., Bradley, C., Cottin, V., Hassan, M., & Cruz, J. (2022) · Breathe · doi:10.1183/20734735.0176-2021 · Cited by 1 · see citing works
Depressive Episode Due to Another Medical Condition
Rakitzi, S. (2023) · Springer eBooks · doi:10.1007/978-3-031-27837-2_16
Telehealth interventions in Mental Health: a Systematic Review (Preprint)Preprint
Torres-Silva, E. A., Pereira-Montiel, E., Arenas, D. A. M., Uribe, A., Montoya, M. A. A., & Florez-Arango, J. F. (2023) · doi:10.2196/preprints.52249
The Efficacy of an Online Act Intervention for Anxiety: An Outcome Randomized Control TrialPreprint
Tulbure, B. T., Tirica, Ș., Dolot, L. I., Marian, Ș., Sălăgean, N., & Rusu, A. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4651512
Rakitzi, S., Spinou, A., & Giannaki, K. (2025) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-025-00611-3
Friedman, D., Quittner, A. L., Bruce, A. S., Smith, B. A., He, J., Chaudhary, N., Boutwell, A., Wei, R., Mullen, T. M. D., Roach, C. M., et al. (2026) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsag006
Vagg, T., Doherty, R., Ranganathan, S., & Plant, B. J. (2026) · Journal of Medical Internet Research · doi:10.2196/86194
Smith, B. A., Barker, D., Georgiopoulos, A. M., Schechter, M. S., Mohan, M. P., Singh, L., Mutti, G., & Quittner, A. L. (2026) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2026-004611
- Authors
- Verkleij, M., Georgiopoulos, A. M., & Friedman, D.
- Affiliations
- Amsterdam University Medical Centers (NL)
- Massachusetts General Hospital (US)
- Corresponding author
- Verkleij, Marieke
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 24
- Pages
- 100372
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC8010637
- OpenAlex
- W3131488986
- Cited by
- 26
- References
- 34
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 8 · 2022: 5 · 2021: 2 · 2020: 1
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- NCFS
- Vertex Pharmaceuticals Inc
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cystic fibrosis, internet-based cognitive behavioral therapy, anxiety, depression, e-health, usability, acceptability, access to mental health care, System Usability Scale, stakeholder feedback
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
