Adapted Tele-Behavioral Activation Targeted to Increase Physical Activity in Depression

项目摘要 在提供循证干预措施以改善促进身体健康方面存在根本差距。 抑郁症患者的活动。尽管在随机对照试验中证明了其有效性，但运动（即， 增加身体活动）在现实世界的临床环境中很少被用作抑郁症的治疗。 我们提出的干预措施通过开发一种更简短的干预措施来解决以前研究中的缺点 以及通过远程治疗提供干预，这两种方法都旨在减少干预依从性的障碍。 长期目标是改善抑郁症患者的治疗效果和身体健康， 增加身体活动。该项目的总体目标是对一个经过调整的 行为激活干预，旨在改善抑郁症的治疗结果，具体通过 针对身体活动。中心假设是，这种干预可以发展为抑郁症 个人，并通过远程治疗提供可行。为了填补知识和未满足需求方面的差距， 我们将追求以下两个具体目标：1）完善和评估现有的，手动的行为 激活干预，具体针对身体活动为基础的活动，通过收集焦点小组， 对参与者、部分完成者和非发起者进行半结构化访谈和离职调查，以及2） 确定干预措施的可行性和可接受性，并对以下方面进行初步分析： 通过测量招募和保留、干预依从性和评估变化来衡量干预效果 抑郁症状和体力活动分别作为远端和近端干预结果。我们 还使用基于RDoC的标准评估干预措施的作用机制， 目的，分析达到抑郁症缓解所需的最少完成治疗疗程数。 成功完成拟议的研究旨在通过提供以下经验证据来推动该领域的发展 缩短既定的行为激活干预措施，并证明从 和干预交付的病人从现实世界的临床实践，从而扩大了 干预的范围和影响以及信息的可扩展性。该项目还通知随后的R 01赠款， (a)对对照组和（B）a进行精细干预的随机对照试验 随后的项目测试实施科学原则-即多种干预者 （无执照与有执照的硕士水平），设置（在家里与嵌入式初级保健干预） 和交付平台（视频与电话）-以便创建可扩展和可持续的干预措施 已纳入现有有偿服务提供机制。目前的项目有可能 增加病人，特别是社会经济地位低的病人或农村地区的病人获得护理的机会， 在COVID-19大流行期间提供干预措施，并通过以下措施改善抑郁症治疗效果： 体育活动对那些坚持体育锻炼特别重要但也特别具有挑战性的人群来说。

Project Summary There is a fundamental gap in delivery of evidence-based interventions to improve the promotion of physical activity in individuals with depression. Despite its proven efficacy in randomized control trials, exercise (i.e., increasing physical activity) is rarely used as a treatment for depressive disorders in real-world clinical settings. Our proposed intervention addresses shortcomings in previous research by developing a briefer intervention and delivering the intervention via teletherapy, both of which aim to reduce barriers to intervention adherence. The long-term goal is to improve treatment outcomes and physical health of persons with depression through increasing physical activity. The overall objective of this project is to conduct a pilot study of an adapted Behavioral Activation intervention that aims to improve depression treatment outcomes by specifically targeting physical activity. The central hypothesis is that such an intervention can be developed for depressed individuals and is feasible to deliver through teletherapy. In order to fill the gap in knowledge and unmet need, we will pursue the following two specific aims: 1) Refine and evaluate an existing, manualized behavioral activation intervention that specifically targets physical activity-based activities by gathering focus group and semi-structured interviews and exit surveys from participants, partial-completers and non-initiators and 2) Determine the feasibility and acceptability of intervention delivery and conduct a preliminary analysis of intervention efficacy by measuring recruitment and retention, intervention adherence, and evaluating changes in depressive symptoms and physical activity as distal and proximal intervention outcomes, respectively. We also evaluate the intervention’s mechanism of action using RDoC-based criteria and include an exploratory aim, analyzing minimum number of completed therapy sessions needed to achieve depression remission. Successful completion of the proposed study aims move the field forward by providing empirical evidence for shortening established Behavioral Activation interventions and demonstrating feasibility of recruitment from and intervention delivery to patients referred from real-world clinical practice, thus expanding the intervention’s reach and impact and informing scalability. This project also informs subsequent R01 grants to (a) conduct a randomized control trial with the refined intervention against a control group and (b) a subsequent project testing implementation science principles – i.e. multiple kinds of interventionists (unlicensed versus licensed master’s level), settings (interventionist at home versus embedded in primary care) and delivery platforms (video versus telephone) – so as to create a scalable and sustainable intervention embedded in existing reimbursable service delivery mechanisms. The current project has the potential to increase care access for patients, especially those with low SES or in rural areas, provide a safe mechanism of intervention delivery during the COVID-19 pandemic, and improve depression treatment outcomes through physical activity in populations for whom its adherence is especially important but also especially challenging.