A Pilot Study Examining Feasibility and Initial Efficacy of Remotely Delivered Cognitive Adaptation Training.
A Pilot Study Examining Feasibility and Initial Efficacy of Remotely Delivered Cognitive Adaptation Training.
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一项检验远程认知适应训练的可行性和初步效果的试点研究。
DOI：
10.1093/schizbullopen/sgad028
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Mintz,Jim
中科院分区：
文献类型：
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作者：
Velligan,DawnI;Li,Feiyu;Sebastian,Veronica;Kennedy,Cory;Mintz,Jim
认知适应训练（CAT）是一种基于证据的治疗方法，它使用环境支持，包括标志，短信，清单，智能药丸容器和物品的组织，以绕过认知和动机障碍，并在家庭或工作环境中提示适应行为。我们开发并测试了CAT的远程版本，以使治疗更广泛。由于CAT专注于在家庭环境中与个人合作以建立支持，因此CAT可能不像谈话疗法那样容易转化为有效的虚拟治疗。五十六名管理式护理的成员被分配或给予他们的治疗偏好为CAT或远程CAT（R-CAT）6个月。每月进行一次亲自或虚拟药丸计数，每2个月由独立评估者对习惯形成、症状、功能和满意度进行评估。使用重复测量的混合模型进行的分析侧重于预先计划的组内变化评价。R-CAT的依从性显著改善，CAT的功能显著改善，两组在6个月内的习惯形成和症状指标均显著改善。功能较高的个体似乎选择R-CAT。两组对治疗的满意度都很高。R-CAT似乎是一种潜在的有效治疗方法，特别是对于药物治疗。然而，与之前几十年的研究相比，只有不到20%的合格医疗补助接受者同意参加这项研究。这可能是由于在大流行期间和紧接大流行后的招募所致。
Cognitive Adaptation Training (CAT) is an evidence-based treatment that uses environmental supports including signs, text messages, checklists, smart pill containers, and the organization of belongings to bypass cognitive and motivational impairments and to cue adaptive behavior in the home or work environment. We developed and tested a remote version of CAT to make the treatment available more broadly. Because CAT is focused on working with the individual in their home environment to establish supports, CAT may not be as easy to translate into an effective virtual treatment as talk-therapies. Fifty-six members of managed care were assigned to or given their treatment preference for CAT or Remote CAT (R-CAT) for 6 months. In-person or virtual pill counts were conducted monthly and assessments of habit-formation, symptoms, functioning, and satisfaction were administered every 2 months by independent raters. Analyses using mixed models with repeated measures focused on pre-planned evaluations of within-group change. Adherence improved significantly in R-CAT, functioning improved significantly in CAT and both groups improved significantly on measures of habit-formation and symptoms across 6 months. Higher functioning individuals appeared to choose R-CAT. Satisfaction with treatment was very high in both groups. R-CAT appears to be a potentially effective treatment, particularly for medication follow-though. However, in contrast to decades of previous research, fewer than 20% of eligible Medicaid recipients agreed to participate in the study. This may have been due to recruitment during and immediately post-pandemic.