Introduction 
In the United States, approximately 90,000 adolescents and young adults (AYAs) are diagnosed with cancer each year.  Cancer survivors (AYACS) are more likely to experience depression compared to healthy peers. Digital adaptations of Cognitive-Behavioral Therapy (CBT) exercises are a promising tool to help individuals manage depressive symptoms in their daily lives, but existing adaptations have not been tailored to AYACS. This study engaged AYACS in a CBT exercise to inform its adaptation for use in a digital depression self-management tool. 

Methods  
Eligible AYACS (diagnosed with cancer between ages 12-39, currently aged 15-39, and 1+ month post-treatment) were identified via medical record review. During the CBT activity, participants chose a difficult experience related to their cancer experience they were willing to share and consider their thoughts, emotions, and behaviors at the time. Participants identified potential alternate responses and considered how they may have changed their emotions about the situation. Participants were also encouraged to provide support and suggestions to other group members. Finally, participants were asked to reflect on their experience of engaging in this CBT activity and provide suggestions for how it should be adapted for delivery via a digital depression self-management tool tailored to AYACS. 

Results  
Eight AYACS (ages 15–37, 75% non-Hispanic white, 75% female) engaged in the CBT activity. Thematic analysis indicated that 1) AYACS often grapple with complex emotions; 2) AYACS need a variety of ways to tell their stories; and 3) AYACS use adaptive and maladaptive strategies to cope with cancer-related distress. Overall, participants suggested that the tool incorporates opportunities for peer support, assistance in telling their story in smaller components, and providing resources to navigate relationships after cancer.   

Discussion  
AYACS provided critical insights into ways in which a CBT exercise can be tailored to this population for depression self-management. Findings informed the development of exercises to include in the first prototype of a digital depression self-management tool tailored to AYACS.