Virtual Reality: A New Technological Modality to Deliver Psychotherapyto Hemodialysis Patients with Comorbid Depression

项目摘要 血液透析（HD）是一种繁重的程序，具有广泛的疾病负担和艰巨的自我护理要求。作为 因此，超过30%的HD患者经历了抑郁症状的加重，研究表明， 共病抑郁症与不良肾脏疾病结局、更大的住院风险以及 存活率下降。目前治疗HD患者抑郁症状的干预措施是资源 密集的，不经常管理的，往往涉及由训练有素的临床医生通过提供心理治疗， 多次面对面交流对于容易传播和传播的信息， 改善美国和世界各地HD患者情绪健康状况的有效策略。 我们在这个小型R01研究中的目标是设计一个虚拟现实（VR）平台，使用户完全沉浸在一个 虚拟逼真的环境，以提供我们基于证据的积极心理干预，并测试 它是否能改善患有抑郁症的HD患者的情绪健康。例如，在 模块专注于正念/冥想，我们将使用头戴式显示器完全沉浸和传输 HD患者来到一个平静的小溪旁的空地，在那里他们将进行12分钟的指导冥想。 因此，我们建议进行一项2组随机对照试验，其中HD患者（N = 84）将 随机分配接受我们基于JovialityTM VR的积极心理干预或积极的 控制条件（即，教育电视节目）。我们假设在椅旁分娩 使用VR环境对HD患者进行心理治疗将被证明是可行的，并将导致 抑郁症状、生活质量和饮食依从性显著改善， 错过HD疗程的比率和较低的住院率，同时作为一个更具成本效益和更远， 这将极大地扩大传播平台。从完成拟议的 研究将产生第一个VR软件应用程序，为HD患者提供心理治疗， 同时允许他们离开诊所的范围，并虚拟地前往遥远的地区， 世界

PROJECT SUMMARY Hemodialysis (HD) is a taxing procedure with extensive illness burden and arduous self-care demands. As such, more than 30% of HD patients experience elevated symptoms of depression—and, research shows that comorbid depression is associated with adverse kidney disease outcomes, greater risk of hospitalization, and decreased survival rates. Current interventions to treat depressive symptoms in HD patients are resource intensive, infrequently administered, and often involve delivery of psychotherapy by highly-trained clinicians via multiple face-to-face communications. There remains a critical scientific gap for easily disseminatable and efficient strategies to improve emotional well-being profiles of HD patients in the U.S. and around the world. Our objective in this small R01 study is to design a virtual reality (VR) platform that fully immerses users into a fictitious lifelike environment, to deliver our evidence-based positive psychological intervention and to test whether it improves the emotional well-being of HD patients with comorbid depression. For instance, during the module focused on mindfulness/meditation, we will use a head-mounted display to fully immerse and transport HD patients to an open field beside a calming stream where they will engage in a 12-minute guided meditation. As such, we propose to conduct a 2-arm randomized controlled trial in which HD patients (N=84) will be randomly assigned to receive either our JovialityTM VR-based positive psychological intervention or an active control condition (i.e., educational television programming). We hypothesize that chairside delivery of psychotherapeutic treatment in HD patients using a VR environment will prove feasible and will result in significant improvements in depressive symptoms, quality of life, and dietary adherence, with lower evident rates for missed HD sessions and lower hospitalizations—all while serving as a more cost-effective and far- reaching platform that will greatly expand dissemination. Knowledge gained from completion of the proposed research will result in the first VR software application to deliver psychotherapy to HD patients, while simultaneously allowing them to leave the confines of the clinic and virtually travel to distant regions of the world.