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The feasibility of a group stress management Liver SMART intervention for patients with end-stage liver disease: A pilot study

  • Devika R. Jutagir (a1), Rebecca M. Saracino (a1), Amy Cunningham (a1), Kelly A. Foran-Tuller (a1), Mary A. Driscoll (a1), William H. Sledge (a1), Sukru H. Emre (a2) (a3) and Dwain C. Fehon (a1) (a3)...



Structured, empirically supported psychological interventions are lacking for patients who require organ transplantation. This stage IA psychotherapy development project developed and tested the feasibility, acceptability, tolerability, and preliminary efficacy of an 8-week group cognitive behavioral stress management intervention adapted for patients with end-stage liver disease awaiting liver transplantation.


Twenty-nine English-speaking United Network for Organ Sharing–registered patients with end-stage liver disease from a single transplantation center enrolled in 8-week, group cognitive-behavioral liver stress management and relaxation training intervention adapted for patients with end-stage liver disease. Patients completed pre- and postintervention surveys that included the Beck Depression Inventory II and the Beck Anxiety Inventory. Feasibility, acceptability, tolerability, and preliminary efficacy were assessed.


Attendance rate was 69.40%. The intervention was rated as “good” to “excellent” by 100% of participants who completed the postintervention survey in teaching them new skills to relax and to cope with stress, and by 94.12% of participants in helping them feel supported while waiting for a liver transplant. No adverse events were recorded over the course of treatment. Attrition was 13.79%. Anxious and depressive symptoms were not statistically different after the intervention.

Significance of results

The liver stress management and relaxation training intervention is feasible, acceptable, and tolerable to end-stage liver disease patients within a transplant clinic setting. Anxious and depressive symptoms remained stable postintervention. Randomized controlled trials are needed to study the intervention's effectiveness in this population.


Corresponding author

Author for correspondence: Dwain C. Fehon, Department of Psychiatry, Yale School of Medicine, 20 York Street, Fitkin 603, New Haven, CT 06510. E-mail:


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