Deployment-Focused Development of Depression Treatment for Victimized Youth

以部署为重点的受害青少年抑郁症治疗发展

• 批准号: 7931455
• 负责人: STEPHEN R SHIRK
• 金额: $ 15.33万
• 依托单位: UNIVERSITY OF DENVER (COLORADO SEMINARY)
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7931455
• 关键词: Address; Adherence; Adolescent; Affect; Aftercare; Ambulatory Care Facilities; Attention; Behavior Therapy; Behavioral; Child; Clinic; Clinical; Clinical Trials; Cognition; Cognitive; Collaborations; Communities; Community Mental Health Centers; Consultations; Depressive disorder; Deterioration; Development; Diagnosis; Domestic Violence; Emotional; Ensure; Evaluation; Failure; Future; Gender; Goals; Individual; Intervention; Maintenance; Major Depressive Disorder; Manuals; Measures; Mental Health; Modeling; Modification; Outcome; Parents; Pathway interactions; Pattern; Pharmacotherapy; Phase; Population; Process; Protocols documentation; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Personnel; Resistance; Sampling; Schools; Sexual abuse; Short-Term Memory; Structure; Substance abuse problem; Symptoms; Teenagers; Testing; Thinking; Training; Trauma; Treatment Efficacy; Treatment Protocols; Writing; Youth; base; cognitive behavior therapy; cognitive function; community setting; depressed; depression; depressive symptoms; design; early childbearing; efficacy trial; executive function; follow-up; maltreatment; mindfulness; psychologic; psychosocial; public health priorities; response; satisfaction; skill acquisition; suicidal risk; therapy development; treatment adherence; treatment as usual; treatment duration; treatment effect; treatment response; trial comparing

DESCRIPTION (provided by applicant): This primary goal of this revised R34 application is to develop and conduct an initial evaluation of a modified cognitive-behavioral treatment (m-CBT) for depressed adolescents with histories of interpersonal trauma. A substantial number of adolescents retain their diagnoses or remain symptomatic following psychosocial or pharmacotherapy for depression. Notably, depressed adolescents with histories of trauma have been found to be less responsive to cognitive-behavioral therapy (CBT) for depression than non-exposed adolescents. Interpersonal trauma has been identified as a prominent developmental pathway to major depressive disorder and is prevalent among referrals to community clinics; thus, addressing the needs of this "treatment resistant" group is a high public health priority. In order to address the needs of this "treatment resistant" group, we propose to modify a cognitive-behavioral protocol that has been shown to be efficacious in prior clinical trials. Treatment modifications are based on the hypothesis that standard CBT does not address two factors central to depression in trauma-exposed youth: 1.) deficits in executive function; and 2.) trauma-related cognitions. First, deficits in executive functioning (e.g., attention, interference control, set shifting) found among traumatized youth are hypothesized to interfere with skill acquisition in CBT. To this end, the usual CBT modules will be modified to include empirically-supported interventions targeting executive function (e.g., attention control training, mindfulness-based cognitive interventions). Second, trauma-exposed individuals have been shown to endorse specific trauma-related maladaptive cognitions that are not typically targeted by CBT. To this end, the treatment will target both depressive automatic thoughts and trauma-related cognitions. Because a history of interpersonal trauma is prevalent among depressed adolescents in community clinics, this project uses a deployment-focused model of treatment development in order to create a "clinic-ready" intervention. To this end, the treatment will be developed and tested in a community mental health center with community clinicians and referred adolescents. The study involves two phases; the first involves pilot testing of the treatment manual with 8 referred adolescents. Acceptability, satisfaction, treatment adherence, and pre- post change in depressive symptoms will be examined. Following manual refinement, a randomized controlled trial under clinically-representative conditions will be conducted with a referred sample of 60 adolescents with a primary depression diagnosis and a history of interpersonal trauma. Adolescents will be randomized to the new intervention (m-CBT) or to an eclectic treatment-as-usual condition. Changes in depressive symptoms, global functioning, and cognitive processes (executive functions and trauma-related cognitions) will be evaluated between pre and post-treatment, and at 3-month follow-up. Linear mixed models with repeated measures will be used to evaluate the effects of treatment. Major depression affects approximately 1 in 6 adolescents during the teen years and results in increased risk for suicide, substance abuse, early childbearing, and school failure. Child interpersonal trauma is a well- documented pathway to major depression. Because youth exposed to interpersonal trauma are less likely to respond favorably to existing depression treatments, this project will develop and evaluate a new treatment for depressed adolescents with interpersonal trauma histories.

描述(由申请人提供)：这个修订的R34申请的主要目标是开发和进行对有人际创伤病史的抑郁青少年的改良认知行为治疗(m-CBT)的初步评估。在心理社会或药物治疗抑郁症后，相当多的青少年保留他们的诊断或保持症状。值得注意的是，有创伤史的抑郁青少年被发现比未接触创伤的青少年对抑郁的认知行为疗法(CBT)反应较差。人际关系创伤已被确定为导致严重抑郁障碍的一条重要发展途径，并在转诊至社区诊所的患者中普遍存在；因此，解决这一“治疗抵抗”群体的需求是公共卫生的高度优先事项。为了解决这一“治疗抵抗”群体的需求，我们建议修改一种认知-行为方案，该方案已在先前的临床试验中被证明是有效的。治疗修改是基于这样一个假设，即标准的CBT没有解决创伤暴露青年中导致抑郁的两个核心因素：1)执行功能缺陷；和2.与创伤相关的认知。首先，在遭受创伤的年轻人中发现的执行功能缺陷(如注意力、干扰控制、定势转移)被假设为干扰了CBT中的技能获得。为此，通常的CBT模块将被修改，以包括针对执行功能的经验性干预(例如，注意力控制训练、基于正念的认知干预)。其次，暴露在创伤中的个人已被证明支持与创伤相关的特定适应不良认知，而这些认知通常不是CBT的目标。为此，治疗将针对抑郁的自动思维和与创伤相关的认知。由于社区诊所中的抑郁青少年普遍存在人际关系创伤史，因此该项目使用以部署为重点的治疗发展模式，以创建一种“诊所就绪”的干预措施。为此，将在社区心理健康中心与社区临床医生和转诊青少年一起开发和测试这种治疗方法。这项研究包括两个阶段；第一个阶段是对8名被转介的青少年进行治疗手册的试点测试。将检查可接受性、满意度、治疗依从性和抑郁症状改变前的情况。在人工改进之后，将在具有临床代表性的条件下进行随机对照试验，参考样本为60名被诊断为抑郁症并有人际关系创伤史的青少年。青少年将被随机分为新的干预措施(m-CBT)或折衷治疗(如往常)。抑郁症状、全球功能和认知过程(执行功能和与创伤相关的认知)的变化将在治疗前后和3个月的随访中进行评估。将使用重复测量的线性混合模型来评估治疗效果。在青少年时期，大约每6个青少年中就有一个患有严重抑郁症，并导致自杀、药物滥用、早产和学业失败的风险增加。儿童人际关系创伤是导致严重抑郁症的一个众所周知的途径。由于受到人际关系创伤的青少年不太可能对现有的抑郁症治疗产生积极反应，该项目将开发和评估一种针对有人际创伤病史的抑郁青少年的新疗法。