The potential of psychological intervention to decrease the risk of anxiety and depression in pulmonary fibrosis

Emotional distress in pulmonary fibrosis remains under-recognised and poorly addressed. This study assessed changes in anxiety and depressive symptoms following an individualised psychological intervention. Single-centre, single-arm before-and-after observational study of an individualised psychological intervention delivered in routine ILD care, combining acceptance and commitment therapy, humanistic-existential techniques, and psychophysiological interventions. Anxiety and depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS) before and after the intervention. Patient- and caregiver-reported experience measures (PREMs) were collected. Response was analysed across characteristics defined before any analysis of outcome data (age, sex, disease severity [ILD-GAP], frailty [CFS], time since diagnosis, and baseline HADS). Thirty patients were included (50.0% women; mean age 71.0 years). At baseline, 76.7% scored ≥8 on HADS-anxiety and 76.7% on HADS-depression, indicatingclinically relevant symptom risk. Six patients discontinued (lung transplantation, palliative care, or death; n = 2 each). Among 24 evaluable patients, mean HADS-anxiety decreased from 11.3 to 6.6 (mean difference 4.7; 97.5% CI 2.6–6.9; p < 0.001) and HADS-depression from 10.7 to 5.5 (mean difference 5.2; 97.5% CI 3.2–7.2; p < 0.001). HADS-anxiety score improved in 19 patients, was unchanged in 3 and worsened in 2; HADS-depression score improved in 20, was unchanged in 2 and worsened in 2. No patient worsened in HADS category. No differences in response were detected by age, sex, disease severity, frailtyor time since diagnosis. Patient- and caregiver-reported experience scores were high (totalscore 9.4 [SD 0.7] in patients and 9.5 [SD 0.7] in caregivers). In this uncontrolled study, an individualised psychological intervention was associated with reduced anxiety and depressive symptoms and a lower proportion of patients at risk of clinically relevant anxiety and depression in pulmonary fibrosis. These findings suggest the potential of psychological care within routine ILD follow-up and require confirmation in randomised controlled trials. An individualised psychological intervention delivered within a specialist ILD clinic was associated with reduced HADS-anxiety and HADS-depression scores and with a lower proportion of patients at risk of clinically relevant anxiety and depression, with no patient worsening in HADS category; the intervention was well accepted by patients and caregivers. No differences in response were detected by disease severity, frailty, time since diagnosis, age or sex, suggesting that eligibility for psychological care should not be restricted by disease stage, functional impairment or time since diagnosis. These findings are exploratory and require confirmation in larger multicentre randomised trials before informing clinical practice.