Does Adding a Tailored Cognitive Behavioral Therapy (CBT) Mobile Skills App Mediate Higher Rates of Depression Recovery, Adjustment, and Quality of Life in OEF/OIF Veterans Compared to Standard CBT?

与标准 CBT 相比，添加定制认知行为治疗 (CBT) 移动技能应用程序是否可以提高 OEF/OIF 退伍军人的抑郁恢复率、调整率和生活质量？

• 批准号: 10175075
• 负责人: Judith Ann Callan
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10175075
• 关键词: Acute; Address; Affect; Aftercare; Anger; Anxiety; Certification; Cognitive Therapy; Depressed mood; Disease; Disease remission; Effectiveness; Freedom; Generations; Health Status; Healthcare; Home; Hospitals; Improve Access; Individual; Information Technology; Intervention; Life Style; Long-Term Effects; Measures; Mediating; Mental Depression; Mental disorders; Methods; Paper; Participant; Patients; Personal Satisfaction; Phase; Post-Traumatic Stress Disorders; Procedures; Psychotherapy; Quality of life; Randomized; Randomized Clinical Trials; Recovery; Reporting; Service delivery model; Site; System; Time; Training; Veterans; Work; cognitive benefits; comorbidity; depressive symptoms; evidence base; experimental arm; improved; innovation; mobile application; operation; population health; prevent; psychologic; skill acquisition; skills; skills training; smartphone Application; tool; treatment comparison

Cognitive Behavioral Therapy (CBT) is the leading evidence-based psychotherapy for depression, which affects 18.5% of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans (hereafter referred to as OEF/OIF). Yet, OEF/OIF Veterans had only a 30% average reduction in mean depression scores from the initial to later phase of treatment. This was true despite the rigorous training and certification procedures for VA CBT-D. Improving the rate of depression recovery and remission is vital to enhance OEF/OIF Veteran’s ability to improve work and home adjustment and overall quality of life. Broad access to all key ingredients of CBT, including skills practice (homework), is associated with improved and faster recovery from depression. OEF/OIF Veterans and patients with depression have reported many barriers (i.e., time, chaotic lifestyles, and low energy) to following through with their skills practice assignments. In the absence of targeted strategies/interventions to address the barriers that prevent CBT skills practice, OEF/OIF Veterans will remain unable to reap the full benefits/effects of CBT. With specific tailored interventions to address this gap in treatment, OEF/OIF Veterans will improve rates of recovery from depression, diminished home and work adjustment, and poor quality of life. Leveraging the technological savvy of this generation of Veterans to improve access to CBT skills practice is a logical tactic to address this gap in treatment. Smartphone apps have been identified as a useful widely-used tool to improve the effectiveness of psychological treatments. There is, however, a paucity of empirical studies on the use of mobile apps in the treatment of depressed OEF/OIF Veterans and in psychological treatment overall. The promising pilot results of a comprehensive tailored smartphone app for CBT skills practice for OEF/OIF Veterans (“CBT MobileWork-V”), leads us to propose a larger-scale randomized clinical trial (RCT) to measure the efficacy of CBT enhanced with CBTMobileWork-V (the experimental arm) for improving CBT understanding and skill acquisition and depressive symptoms, in OEF/OIF Veterans with depression compared to standard CBT-D. Specifically, over a 27-month period we propose to randomize 268 eligible OEF/OIF Veterans with depressive symptoms, to either CBT augmented with the comprehensive CBT skill training smartphone app CBT MobileWork-V or standard CBT-D with traditional skills practice methods (i.e., paper and pencil). The Specific Aims of this study are: Primary Aim 1) To assess whether CBT-D augmented with CBT MobileWork-V (hereafter referred to as CBT- D+) promotes greater CBT understanding and skill acquisition compared to traditional CBT-D. Primary Aim 2a) To examine the short-term effect in depressive symptoms after 12 weeks of CBT-D+ versus standard CBT-D. Primary Aim 2b) To examine the long-term effect in depressive symptoms at 6 months post treatment of the CBT-D+ intervention versus traditional CBT-D.

认知行为疗法 (CBT) 是针对抑郁症的领先循证心理疗法， 影响持久自由行动 (OEF)、伊拉克自由行动 (OIF) 和新行动的 18.5% 黎明（OND）退伍军人（以下简称OEF/OIF）。然而，OEF/OIF 退伍军人的平均分只有 30% 从治疗的初始阶段到治疗后期，平均抑郁评分降低。这是事实，尽管 VA CBT-D 严格的培训和认证程序。提高抑郁症康复率 缓解对于增强 OEF/OIF 退伍军人改善工作和家庭调整以及整体能力的能力至关重要 生活质量。 广泛接触 CBT 的所有关键要素，包括技能练习（家庭作业），与 改善并更快地从抑郁症中恢复过来。 OEF/OIF 退伍军人和抑郁症患者报告 进行技能练习时存在许多障碍（即时间、混乱的生活方式和精力不足） 作业。缺乏有针对性的策略/干预措施来解决阻碍 CBT 技能的障碍 在实践中，OEF/OIF 退伍军人仍然无法获得 CBT 的全部好处/效果。并根据具体情况量身定制 为了解决这一治疗差距，OEF/OIF 退伍军人将提高康复率 抑郁、家庭和工作适应能力下降以及生活质量差。 利用这一代退伍军人的技术头脑来提高获得 CBT 技能的机会 实践是解决这一治疗差距的合理策略。智能手机应用程序已被认为是有用的 广泛使用的工具来提高心理治疗的有效性。然而，目前还缺乏 关于使用移动应用程序治疗抑郁的 OEF/OIF 退伍军人和 整体心理治疗。全面定制的智能手机应用程序的试点结果令人鼓舞 针对 OEF/OIF 退伍军人的 CBT 技能实践（“CBT MobileWork-V”）促使我们提出更大规模的建议 随机临床试验 (RCT)，旨在衡量 CBTMobileWork-V 增强的 CBT 功效（ 实验组）以提高 CBT 理解和技能获取以及抑郁症状， 与标准 CBT-D 相比，OEF/OIF 患有抑郁症的退伍军人。具体来说，在 27 个月的时间里，我们 建议将 268 名符合条件且患有抑郁症状的 OEF/OIF 退伍军人随机分组，接受 CBT 增强治疗 使用综合 CBT 技能培训智能手机应用程序 CBT MobileWork-V 或标准 CBT-D 传统技能练习方法（即纸和铅笔）。本研究的具体目标是： 主要目标 1) 评估 CBT-D 是否通过 CBT MobileWork-V（以下简称 CBT- 与传统的 CBT-D 相比，D+）可促进更好的 CBT 理解和技能获取。 主要目标 2a) 检查 12 周 CBT-D+ 与 CBT-D+ 相比对抑​​郁症状的短期影响 标准 CBT-D。 主要目标 2b) 检查治疗后 6 个月对抑郁症状的长期影响 CBT-D+ 干预与传统 CBT-D 的比较。