Increasing Access to Depressive Relapse Prophylaxis with Web-Based MBCT

描述（由申请人提供）：互联网为精神疾病的新疗法的发展和传播提供了广阔的前景。必须彻底探索有效的基于互联网的干预措施的可能性，这种干预措施可以纳入传统治疗环境之外不同人群的需求和情况。一种现有的治疗方法，基于正念的认知行为疗法（MBCT），在普通成人样本中显著降低了复发性抑郁症的复发率，一种基于MBCT的互联网预防干预（“eMBCT”）正在概念开发中。提出了一项研究，探讨eMBCT预防抑郁症复发/复发的可行性、安全性、可接受性和初步疗效。项目分为三个阶段：1)基于理论和实证研究的干预概念化；2)制定和规范干预措施；3)开展一项公开试验，通过评估抑郁症状水平和复发风险的近端标志物来评估eMBCT的临床和可行性结果。第一阶段将确定内容领域，写下学习目标，列出具体的正念练习和抑郁意识练习，这些练习包含在9次MBCT会议中，这些会议将构成eMBCT的支柱。在第二阶段，成瘾和心理健康中心的研究人员、科罗拉多大学博尔德分校和科罗拉多凯撒永久医疗机构将与电子学习应用和定制网页设计领域的领导者Allen Interactions合作，开发一个功能齐全的eMBCT网站原型。这个过程将是迭代和增量的，包括网络交互和内容的生成，以及基于焦点小组和用户对患者和临床医生/利益相关者样本（N=84）的测试的材料的修订。这将为eMBCT的可用性、满意度、知识获取和可接受性提供重要数据。在第三阶段，将对抑郁症缓解患者进行概念验证开放试验（N=50）。该试验将通过比较现场MBCT组报告的损失率和作业依从性指数，收集有关患者参与eMBCT程度的数据。治疗前和治疗后抑郁评分的差异，以及在其他研究中被证明是复发的有力预测因素的两个变量，即沉思和正念程度，也将被检验。考虑到抑郁症患者未经治疗的复发和复发风险的负面、长期后果，以及社区中MBCT资源的稀缺性，eMBCT的发展有可能显著造福患者、他们的家庭和整个社会。

DESCRIPTION (provided by applicant): The Internet provides promising terrain for the development and delivery of novel treatments for mental illness. The possibility of effective Internet-based interventions, which can incorporate the needs and circumstances of diverse populations outside traditional treatment settings, must be thoroughly explored. An existing treatment, Mindfulness-based Cognitive-behavioral Therapy (MBCT), significantly reduces relapse rates in recurrent depression among general adult samples, and an internet-delivered preventive intervention based on MBCT ("eMBCT") is in conceptual development. A study investigating the feasibility, safety, acceptability, and preliminary efficacy of eMBCT in preventing depressive relapse/recurrence, is proposed. The project involves 3 phases: 1) conceptualizing the intervention based on theory and empirical research; 2) developing and standardizing the intervention, and 3) conducting an open trial to evaluate clinical and feasibility outcomes of eMBCT by assessing levels of depressive symptoms and proximal markers of relapse risk. Phase 1 will identify content domains, write learning objectives and list the specific mindfulness practices and depression awareness exercises contained in each of the 9 MBCT sessions that will form the backbone of eMBCT. In Phase 2, researchers at the Centre for Addiction and Mental Health, the University of Colorado at Boulder and Kaiser Permanente Colorado will work collaboratively with Allen Interactions, a leader in eLearning applications and custom web design, to develop a fully functional prototype of the eMBCT website. This process will be iterative and incremental, comprising the generation of web interactions and content and revisions of this material based on focus group and user testing with both patient and clinician/stakeholder samples (N=84). This will provide important data on eMBCT's usability, satisfaction, knowledge acquisition and acceptability. In Phase 3, a proof of concept open trial (N=50) with remitted depressed patients will be conducted. This trial will allow data gathering on the degree of patient engagement with eMBCT by comparing rates of attrition and homework compliance with indices reported for in-person MBCT groups. Pre and post treatment differences on depression scores and two variables shown to be strong predictors of relapse in other studies, namely rumination and degree of mindfulness, will also be examined. Given the negative, long-term, consequences of untreated relapse and recurrence risk in people recovering from depression, and the scarcity of MBCT resources in the community, the development of eMBCT has the potential to significantly benefit patients, their families, and society at large. PUBLIC HEALTH RELEVANCE: Relapse and recurrence following recovery from Major Depressive Disorder is a significant public health concern, with debilitating outcomes that carry enormous social costs in the United States of America. Mindfulness-Based Cognitive Therapy (MBCT) is one of the most promising recent developments in the effort to prevent relapse and recurrence of depression; however its dissemination within community mental health or primary care settings is considerably limited. eMBCT, a web-based version of MBCT will be developed and tested so that access to this preventive treatment can be extended to a broader audience of at risk individuals.