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Cognitive Rehabilitation and Exposure Therapy for Veterans with Hoarding Disorder

患有囤积症退伍军人的认知康复和暴露疗法

基本信息

批准号：
10179338
负责人：
Catherine Ayers
金额：
--
依托单位：
VA SAN DIEGO HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-10-01 至 2021-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10179338
关键词：
Activities of Daily Living Aftercare Age Area Behavior Therapy Bipolar Disorder Caring Case Management Chronic Client Cognitive Cognitive Therapy Compulsive Hoarding Cost Savings Decision Making Development Diagnosis Diagnostic and Statistical Manual of Mental Disorders Disease Distress Elderly Enrollment Executive Dysfunction Exposure to Fire - disasters Formulation Funding Health Care Costs Healthcare Systems Impairment Individual Interruption Intervention Investigation K-Series Research Career Programs Life Link Longevity Measures Mediating Mediator of activation protein Medical Methods Neurocognitive Obsessive compulsive behavior Outcome Participant Patients Population Problem Solving Provider Quality of life Randomized Controlled Trials Research Sampling Schizophrenia Services Severities Sorting - Cell Movement Source Symptoms System Testing Time Treatment outcome Veterans Work active lifestyle care systems cognitive rehabilitation cognitive training cost disability disability burden efficacy evaluation executive function falls family burden flexibility follow-up functional disability hazard improved innovation middle age mortality risk motivational enhancement therapy novel older patient prevent primary outcome public health relevance reduce symptoms response secondary outcome skills training targeted treatment treatment adherence treatment choice treatment effect trial comparing

项目摘要

DESCRIPTION (provided by applicant): As a new addition to the Diagnostic and Statistical Manual-5 (DSM-5), Hoarding Disorder (HD) is defined by persistent difficulty parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep or dispose of. Clutter accumulates and fills living areas to prevent normal use of space, resulting in distress and/or disability. Hoarding symptoms cause significant impairment, increased medical problems, and poor quality of life for our Veterans, particularly our older Veterans. Providers treat Veterans for other medical or psychiatric complaints yet frequently miss an important source of disability and burden on our system. This insidious condition is costly to the VA system as patients continue to decompensate and need greater amounts of care over the lifespan. Given that over 6% of the population has HD, a higher proportion than are diagnosed with schizophrenia or bipolar disorder, further research on the mechanism and efficacy of an appropriate treatment is desperately needed. Current behavioral intervention methods for HD range from ineffective to relatively small gains. Case management is typically used to treat HD, which produces inadequate outcomes and clients resurface in systems of care. Cognitive-behavioral therapy (CBT) for HD includes multiple components (assessment: 2-3 sessions, case formulation: 2 sessions, skills training: 2-3 sessions, combined exposure and cognitive therapy: 15-20 sessions, and motivational interviewing: throughout) and yields poor responses rates (i.e. <20% symptom reduction) in older adults. Outcomes in midlife HD patients are not much better, with symptom reduction rates ranging from 14-29% in HD symptoms following a lengthy course (4-9 months) of CBT for HD. Executive dysfunction (ED) is linked to both HD symptom severity and poor outcomes of CBT for HD. Decision making, categorization, problem solving, inhibition, planning, organization, and cognitive flexibility difficulties are evident in HD patients across th lifespan, particularly in older patients. The VA has funded the development of an integrated behavioral treatment (Cognitive Rehabilitation and Exposure/Sorting Therapy; CREST) that targets both neurocognitive functioning and the core symptoms of HD (VA Career Development Award; Ayers PI). This treatment includes Compensatory Cognitive Training (CCT) to improve executive functioning and is combined with exposure therapy (ET) that targets avoidance of discarding/not acquiring. Preliminary results suggest that CREST is a highly feasible and acceptable treatment that doubles outcome rates compared to CBT for HD. Our proposed study will further develop this innovative intervention while testing whether it works through the mechanisms it targets and examining outcome moderators that may identify which patients are more likely to benefit. We propose to conduct a randomized controlled trial comparing six months (26 sessions) of CREST to six months of ET alone, in 136 participants with HD. Assessments will be administered at baseline, during treatment (sessions 7, 13, 21), post-treatment, and 3 and 6-month follow-up. The primary objective is to evaluate whether CREST significantly reduces hoarding symptoms and improves functional capacity and quality of life when compared to exposure therapy alone. We will also examine the impact of treatment mediators; treatment adherence, changes in executive functioning, avoidance, and symptom severity on outcomes. Age and executive functioning will also be explored as potential moderators. Finally, by repeatedly measuring treatment targets, we will examine time to maximum treatment effect. By providing a treatment for many Veterans with HD, we can alter the course of their symptom trajectory and negative consequences, resulting in both reduced burden on the healthcare system and improved quality of life for Veterans.

描述（由申请人提供）：作为《诊断和统计手册 5》(DSM-5) 的新增内容，囤积症 (HD) 的定义是，由于与丢弃相关的痛苦、渴望保存和/或难以决定保留或处置什么，而导致持续难以与财产分开。杂物堆积并填满生活区域，妨碍空间的正常使用，导致痛苦和/或残疾。囤积症状会对我们的退伍军人，特别是老年退伍军人造成严重损害，增加医疗问题，并降低生活质量。提供者为退伍军人治疗其他医疗或精神疾病，但经常忽视残疾和我们系统负担的重要根源。这种潜在的疾病对退伍军人管理局系统来说代价高昂，因为患者持续失代偿，并且在一生中需要更多的护理。鉴于超过 6% 的人口患有 HD，这一比例高于被诊断为精神分裂症或双相情感障碍的比例，因此迫切需要进一步研究适当治疗的机制和功效。当前 HD 的行为干预方法从无效到相对较小的收益。病例管理通常用于治疗亨廷顿舞蹈病，这种治疗效果不佳，并且患者会重新出现在护理系统中。 HD 的认知行为疗法 (CBT) 包括多个组成部分（评估：2-3 次课程、病例制定：2 次课程、技能培训：2-3 次课程、联合暴露和认知治疗：15-20 次课程以及动机访谈：贯穿始终），并且对老年人的反应率较差（即症状减轻 <20%）。中年 HD 患者的治疗效果也好不到哪儿去，经过长时间（4-9 个月）的 HD CBT 治疗后，HD 症状的症状减轻率为 14-29%。执行功能障碍 (ED) 与 HD 症状严重程度和 HD 认知行为治疗的不良结果有关。 HD 患者在整个生命周期中，尤其是老年患者，决策、分类、解决问题、抑制、计划、组织和认知灵活性方面的困难都很明显。 VA 资助开发了一种综合行为治疗（认知康复和暴露/分类疗法；CREST），该疗法针对神经认知功能和 HD 的核心症状（VA 职业发展奖；Ayers PI）。这种治疗方法包括改善执行功能的补偿性认知训练（CCT），并与旨在避免丢弃/不获取的暴露疗法（ET）相结合。初步结果表明，CREST 是一种高度可行且可接受的治疗方法，与 CBT 治疗 HD 相比，其结果率提高了一倍。我们提出的研究将进一步开发这种创新干预措施，同时测试它是否通过其目标机制发挥作用，并检查可能确定哪些患者更有可能受益的结果调节因素。我们建议在 136 名 HD 参与者中进行一项随机对照试验，比较 6 个月（26 个疗程）的 CREST 与单独 6 个月的 ET。评估将在基线、治疗期间（第 7、13、21 节）、治疗后以及 3 个月和 6 个月的随访进行。主要目的是评估与单独暴露疗法相比，CREST 是否显着减少囤积症状并提高功能能力和生活质量。我们还将研究治疗中介因素的影响；治疗依从性、执行功能的变化、回避和症状严重程度对结果的影响。年龄和执行功能也将作为潜在的调节因素进行探讨。最后，通过反复测量治疗目标，我们将检查达到最大治疗效果的时间。通过为许多患有 HD 的退伍军人提供治疗，我们可以改变他们的症状轨迹和负面后果，从而减轻医疗保健系统的负担并提高退伍军人的生活质量。

项目成果

期刊论文数量（12）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Treatment Recruitment and Retention of Geriatric Participants With Hoarding Disorder.

患有囤积症的老年参与者的治疗招募和保留。

DOI：
10.1080/07317115.2015.1032467
发表时间：
2015
期刊：
Clinical gerontologist
影响因子：
2.8
作者：
Ayers,CatherineR;Dozier,MaryE;Mayes,TinaL;Espejo,EmmanuelP;Wilson,Ariel;Iqbal,Yasmeen;Strickland,Katrina
通讯作者：
Strickland,Katrina

Psychometric Evaluation of the Saving Inventory-Revised in Older Adults.

老年人储蓄库存的心理测量评估-修订。