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

项目总结 血液透析(HD)是一种繁重的过程，疾病负担大，自我护理要求高。AS 这样，超过30%的HD患者抑郁症状加重--研究表明 合并抑郁症与不良的肾脏疾病结局、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 集中的，不经常使用的，通常包括由训练有素的临床医生通过 多次面对面交流。仍然存在一个关键的科学差距，即易于传播和 有效的策略，以改善美国和世界各地HD患者的情绪健康状况。 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，让用户完全沉浸在 虚拟逼真的环境，为我们提供循证的积极心理干预和检验 是否改善合并抑郁症的血液透析患者的情绪幸福感。例如，在 专注于正念/冥想的模块，我们将使用头盔显示器来完全沉浸和运输 HD患者被带到一条平静的小溪旁的空地上，在那里他们将进行12分钟的有指导的冥想。 因此，我们建议进行一项双臂随机对照试验，HD患者(N=84)将被 随机分配接受基于JovialityTM VR的积极心理干预或主动心理干预 控制条件(即，教育电视节目)。我们假设主席的演讲 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，但不明显 错过高清课程的比率和更低的住院率-所有这些都是更具成本效益和更远的- 到达平台，将极大地扩大传播。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，而 同时允许他们离开诊所的限制，几乎旅行到遥远的地区 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.