Increasing Access to Depressive Relapse Prophylaxis with Web-Based MBCT

描述(申请人提供)：互联网为开发和提供治疗精神疾病的新疗法提供了前景广阔的领域。必须彻底探讨以互联网为基础的有效干预措施的可能性，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，基于MBCT的互联网传递的预防性干预(“eMBCT”)正在概念开发中。一项关于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的研究被提出。该项目包括3个阶段：1)在理论和实证研究的基础上对干预措施进行概念化；2)开发和标准化干预措施；3)进行一项开放试验，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，并列出9个MBCT课程中包含的具体正念练习和抑郁意识练习，这些练习将构成eMBCT的主干。在第二阶段，成瘾和心理健康中心、科罗拉多大学博尔德分校和科罗拉多州凯撒永久大学的研究人员将与在线学习应用程序和定制网页设计领域的领导者Allen Interaction合作，开发一个功能齐全的eMBCT网站原型。这一过程将是迭代和递增的，包括根据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，生成网络互动和内容，并对本材料进行修订。这将提供有关eMBCT的可用性、满意度、知识获取和可接受性的重要数据。在第三阶段，将对缓解的抑郁症患者进行概念验证开放试验(N=50)。这项试验将通过比较消耗率和家庭作业依从性与报告的面对面MBCT组的指数来收集关于患者参与eMBCT的程度的数据。治疗前后抑郁评分的差异以及在其他研究中被证明是复发的强烈预测因素的两个变量，即沉思和专注程度，也将被检查。考虑到抑郁症康复者未经治疗的复发和复发风险的长期负面后果，以及社区中MBCT资源的稀缺，eMBCT的发展有可能显著造福于患者、他们的家庭和整个社会。 公共卫生相关性：严重抑郁障碍康复后的复发和复发是一个重大的公共卫生问题，在美利坚合众国，造成衰弱的后果会带来巨大的社会成本。基于正念的认知疗法(MBCT)是近年来在预防抑郁症复发和复发方面最有希望的发展之一；然而，它在社区心理健康或初级保健环境中的传播相当有限。将开发和测试基于网络的MBCT版本eMBCT，以便将获得这种预防性治疗的机会扩大到更广泛的高危人群。

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.