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健康和行为研究分支共同Morphology计划。这是一项试点研究，旨在文化适应拉丁美洲人的行为治疗共病恐慌症（PD）和哮喘，并检查其疗效与积极的安慰剂治疗。这项R34提案是R21研究的后续，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。PD和哮喘之间有很大程度的症状相似性。恐慌和哮喘症状之间的混淆会导致严重的错误，在自我管理这两种疾病。患有PD和哮喘的患者需要量身定制的干预措施，因为对一种疾病可能具有治疗作用的药物可能会加重另一种疾病。干预教导参与者区分恐慌和哮喘症状，以及如何对每种症状应用自我管理策略。该治疗还包括对哮喘患者安全的PD认知行为治疗元素，并将其与哮喘教育和心率变异性生物反馈治疗相结合。 该研究计划将涉及两个目标：1）恐慌性哮喘治疗的文化适应和2）随机，安慰剂对照的试点研究。参与者将主要从纽约布朗克斯的两个主要的市中心医院招募。PD的诊断将基于DSM-IV的结构化临床访谈。哮喘的诊断将基于国家指南。该项目的第一年将致力于拉丁美洲（主要是波多黎各）参与者，试点治疗和参与者反馈的大约5个焦点小组。方案将根据第1阶段系统观察到的关键文化问题进行调整。在第2-3年期间，40名患有PD和哮喘的受试者将被随机分配到两个治疗组：恐慌-哮喘治疗和涉及音乐治疗和静息呼吸率下的起搏呼吸的活性安慰剂条件。每次治疗将包括8周的疗程。将由一名对治疗状况不知情的访谈者在治疗前、治疗中、治疗后和3个月随访时进行评估。主要假设是惊恐-哮喘治疗组的受试者在PD严重程度量表和沙丁胺醇使用方面的降幅大于安慰剂组受试者（即，急救哮喘药物）从试验前到试验后和3个月随访。沙丁胺醇的使用是重要的检查，因为它可能是恐慌和哮喘症状之间的混淆指标。减少沙丁胺醇的使用可能会导致恐慌症状的改善，因为副作用较少。 本研究的目标是高度相关的使命NIMH开发有效的，文化相关的行为治疗共同发生的精神和身体障碍。本R34研究将生成可行性数据（例如，初始效应大小、招募和保留率、治疗可信度等）通过R 01基金设计一个未来的全规模随机、安慰剂对照试验。 公共卫生相关性：为患有恐慌症和哮喘的拉丁美洲人开发行为治疗具有很大的潜力，可以减少这两种疾病的巨大公共卫生成本。惊恐障碍在哮喘患者中的比例过高，而哮喘不成比例地影响波多黎各人。恐慌哮喘治疗将适应纳入具体的，与拉丁美洲人相关的文化问题。

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.