Adaptation of a Behavioral Treatment for Latinos with Panic Disorder and Asthma

描述（由申请人提供）：本申请正在提交给NIMH DAHBR健康和行为研究分部共同发病率计划。这是一项试点研究，旨在适应拉丁美洲人对共病性惊恐障碍（PD）和哮喘的行为治疗，并检查其与积极安慰剂治疗的疗效。这项R34提案是R21研究的后续研究，该研究开发了恐慌-哮喘治疗，并显示出减少恐慌和哮喘症状的有希望的结果。帕金森病与哮喘有很大程度的症状相似。混淆恐慌和哮喘症状可导致严重错误的自我管理这两种疾病。患有帕金森病和哮喘的患者需要量身定制的干预措施，因为可能对一种疾病有治疗作用的措施可能会加剧另一种疾病。干预教导参与者区分恐慌和哮喘症状，以及如何针对每种症状应用自我管理策略。治疗还包括对哮喘患者安全的PD认知行为疗法，并将其与哮喘教育和心率变异性生物反馈疗法相结合。该研究计划包括两个目标：1)惊恐哮喘治疗的文化适应性；2)随机、安慰剂对照的先导研究。参与者将主要从纽约州布朗克斯市内的两家主要医院招募。PD的诊断将基于DSM-IV的结构化临床访谈。哮喘的诊断将以国家指南为基础。该项目的第一年将专门针对拉丁裔（主要是波多黎各人）参与者的大约5个焦点小组、试点治疗和参与者反馈。该议定书将根据第一阶段系统观察到的关键文化问题进行调整。在第2-3年，40名患有帕金森病和哮喘的参与者将被随机分为两个治疗组：惊恐哮喘治疗组和积极安慰剂组，包括音乐治疗和静息呼吸速率下的有节奏呼吸。每次治疗将包括8周的疗程。在治疗前、治疗中、治疗后和3个月随访期间，由一名对治疗情况不知情的访谈者进行评估。主要假设是，从测试前到测试后以及3个月的随访中，惊恐-哮喘治疗组的参与者在PD严重程度量表和沙丁胺醇（即抢救哮喘药物）的使用上比安慰剂组的参与者有更大的下降。检查沙丁胺醇的使用情况很重要，因为它可能是恐慌和哮喘症状混淆的一个指标。由于副作用较少，减少沙丁胺醇的使用可能会改善恐慌症状。这项研究的目标与NIMH的使命高度相关，即开发有效的、与文化相关的精神和身体疾病的行为治疗方法。这项R34研究将产生可行性数据（例如，初始效应大小、招募和保留率、治疗可信度等），以通过R01拨款设计未来的全规模随机、安慰剂对照试验。

DESCRIPTION (provided by applicant): This application is being submitted to the NIMH DAHBR Health and Behavior Research Branch Co- Morbidity Program. This is a pilot study designed to culturally adapt for Latinos a behavioral treatment for comorbid panic disorder (PD) and asthma, and examine its efficacy versus an active placebo treatment. This R34 proposal is a follow-up to an R21 study, which developed the Panic-Asthma Treatment and showed promising results for reducing panic and asthma symptoms. There is a large degree of symptom similarity between PD and asthma. Confusion between panic and asthma symptoms can result in serious errors in self- management of both disorders. Patients with PD and asthma need a tailored intervention because what may be therapeutic for one condition can potentially exacerbate the other condition. The intervention teaches participants to differentiate between panic and asthma symptoms, and how to apply self-management strategies for each. The treatment also includes elements of cognitive behavioral therapy for PD that are safe for patients with asthma, and combines it with asthma education and heart rate variability biofeedback therapy. The research plan will involve two aims: 1) Cultural adaptation of the Panic-Asthma Treatment and 2) a randomized, placebo-controlled pilot study. Participants will be primarily recruited from two major, inner-city hospitals in the Bronx, NY. Diagnosis of PD will be based on the Structured Clinical Interview for DSM-IV. Diagnosis of asthma will be based on national guidelines. The first year of the project will be devoted to approximately 5 focus groups with Latino (primarily Puerto Rican) participants, pilot treatment and participant feedback. The protocol will be adapted based on key cultural issues that are systematically observed during Phase 1. During Years 2-3, 40 participants with PD and asthma will be randomized into two treatment arms: Panic-Asthma Treatment and an active placebo condition involving music therapy and paced breathing at resting respiration rates. Each treatment will involve 8 weekly sessions. An interviewer, who will be blind to treatment condition, will conduct assessments at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up. The primary hypotheses are that participants in the Panic-Asthma treatment group will have greater decreases than subjects in the placebo condition on the PD severity scale and albuterol use (i.e., rescue asthma medication) from pre-test to post-test and across 3-month follow-up. Albuterol use is important to examine because it may be an indicator of confusion between panic and asthma symptoms. Reductions in albuterol use may lead to improvements in panic symptoms due to fewer side effects. The goals of this study are highly relevant to the mission of NIMH to develop efficacious, culturally relevant behavioral treatments of co-occurring mental and physical disorders. This R34 study will generate feasibility data (e.g., initial effect sizes, recruitment and retention rates, treatment credibility, etc.) to design a future full- scale randomized, placebo-controlled trial via an R01 grant. PUBLIC HEALTH RELEVANCE: The development of a behavioral treatment for Latinos with comorbid panic disorder and asthma has great potential to reduce the immense public health costs of both disorders. Panic disorder is over-represented in patients with asthma, and asthma disproportionately affects Puerto Rican individuals. The Panic-Asthma treatment will be adapted to incorporate the specific, cultural issues relevant to Latinos.