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

项目摘要 在以循证为基础的干预措施的提供方面存在着根本的差距，以改善对身体健康的促进 抑郁症患者的活动情况。尽管在随机对照试验中证明了它的有效性，但运动(即， 在现实世界的临床环境中，增加体力活动)很少被用来治疗抑郁症。 我们建议的干预措施通过开发一种更简短的干预措施来解决先前研究中的缺陷 以及通过远程治疗提供干预，这两项措施的目的都是减少坚持干预的障碍。 长期目标是通过以下途径改善抑郁症患者的治疗结果和身体健康 增加体力活动。这个项目的总体目标是进行一项适应于 旨在通过特定的方式改善抑郁症治疗结果的行为激活干预 以身体活动为目标。中心假设是，可以为抑郁症患者制定这样的干预措施 而且通过远程治疗是可行的。为了填补知识的空白和未得到满足的需求， 我们将追求以下两个具体目标：1)提炼和评估现有的、人性化的行为 激活干预，通过收集焦点小组和 来自参与者、部分完成者和非发起者的半结构化访谈和离职调查和2) 确定干预交付的可行性和可接受性，并进行初步分析 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的标准评估干预的行动机制，并包括探索性 目的：分析实现抑郁症缓解所需完成的最小疗程数。 成功完成拟议的研究目标，通过为以下方面提供经验证据，推动该领域向前发展 缩短既定的行为激活干预措施，并论证从 以及向来自真实世界临床实践的患者提供干预，从而扩大了 干预的范围和影响，并告知可伸缩性。该项目还通知后续的R01赠款 (A)对对照组进行改进干预的随机对照试验和(B)a 后续项目测试实施的科学原则--即多种干预者 (无执照与有执照的硕士级别)、环境(家庭干预者与嵌入初级保健的人) 和交付平台(视频与电话)-以创建可扩展和可持续的干预 嵌入现有的有偿服务提供机制。目前的项目有可能 增加患者的护理机会，特别是那些社会经济地位低或在农村地区的患者，提供安全的 新冠肺炎大流行期间的干预提供，并通过以下方式改善抑郁症的治疗结果 对坚持体育锻炼特别重要但也特别具有挑战性的人群进行体育活动。

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.