Cognitive Behaviour Therapy for Adults With Allergy.

Background Adults with severe allergy often experience distress but research exploring psychological interventions for this group has not been carried out. Cognitive Behaviour Therapy has previously been found to reduce distress in mothers of children with severe allergy. Indeed, there are two allergy specialist clinics in the UK which offer interventions to children and families with severe allergy. Initial investigations have shown these clinics to be beneficial. It is clear that a study is needed to explore the feasibility of a CBT intervention for adults with severe allergy in order for further research to be conducted and to improve outcomes for this group.

The feasibility study will involve recruiting adults with severe allergy and inviting them to screening interview phone call. If suitable for the study, participants will be randomly allocated to an intervention or control group. Those in the intervention group will be invited to attend a single session 6 hour workshop focusing on adapted CBT for allergy. There is evidence that single session workshops can be beneficial in managing anxiety. The workshop in the current study will either be face to face groups or due to the Covid-19 pandemic, the workshops may be delivered on online platforms, such as Zoom. If delivered online, the workshop will likely to be split over two three hour sessions. Online delivery of the intervention may be more beneficial for those with disabilities, who may be at a higher risk of experiencing complications due to the Coronavirus i.e. those with allergy and asthma. Indeed, delivery online would lead to flexibility for participants who may be located across the UK without needing to travel long distances. Those who have long term health problems may prefer the flexibility of online delivery as this limits their need to travel. This may also suit parents who would not necessarily need childcare arrangements for an online workshop.

Those in the control group will be sent self-help information. Questionnaire measures will explore quality of life, coping style, anxiety, worry, stress and depression. Questionnaires will also explore personal goals for therapy and self-care behaviours. With questionnaire measures, reliable change and the proportion meeting 'clinical caseness' pre and post intervention will be explored to provide a signal of efficacy of the intervention. Changes between the groups will also be assessed. As the study is assessing feasibility, retention and uptake will be assessed. Feedback questionnaires at the end of the study, including free text responses and Likert Scale questionnaires, will also be collected to assess acceptability and to explore participant experiences of the study. Additionally, qualitative interviews with a small subsample of participants being followed up after three months will also be conducted to assess acceptability. The interviews will focus on participants experiences of living with an allergy and the experience of the workshop and research.

Aims of the study

The study's objective is to assess the feasibility and acceptability of a short term CBT group intervention for reducing anxiety and distress in those with severe allergy. The research questions are:

• Can appropriate participants be recruited and retained to the group intervention?
• How appropriate are the data collection procedures and outcome measures for the participants and purposes of the study?
• Are study procedures and workshop intervention suitable for and acceptable to participants?
• What is it like to attend a group intervention for people with severe allergy and anxiety/distress?
• Does the intervention provide a signal of efficacy to warrant a definitive trial?

Method Participants with allergy will be recruited through support groups and social media. Those who are interested in the study will be asked to complete a screening interview. If they meet inclusion criteria and consent to take part they will be randomly allocated into either an intervention or a control group. The intervention group will attend a single session day workshop based on CBT. The control group will be sent self-help materials. Due to the Covid-19 pandemic, the workshop may need to be delivered online. If delivered online, the workshop may be delivered over two sessions. Participants will be asked to complete feedback forms about their experiences in the group. At three month follow up, a small subsample of participants will be interviewed. The interviews will focus on participants experiences of living with an allergy and the experience of the workshop and research.

Results A possible outcome is that people with allergy and emotional distress either do or do not find the workshops an acceptable and feasible intervention. It will identify dropout rates and participant retention. It will also identify the potential for this intervention to reduce distress and anxiety and to improve coping skills in adults with severe allergy.

Implications If the outcome of the study is that CBT is an acceptable intervention for those with severe allergy and emotional distress, it adds weight to the argument that more research is needed to explore this on a larger scale. If the outcome measures are acceptable for this client group, they could be used in a future definitive trial.