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

描述(由申请人提供)：此申请正在提交给NIMH DAHBR健康和行为研究分支机构共病计划。这是一项试验性研究，旨在从文化上适应拉美裔人对共病惊恐障碍(PD)和哮喘的行为治疗，并检验其与积极的安慰剂治疗的疗效。这项R34建议是R21研究的后续，该研究开发了恐慌性哮喘的治疗方法，并显示了在减少恐慌和哮喘症状方面的有希望的结果。帕金森病和哮喘的症状有很大程度的相似性。混淆恐慌和哮喘症状可能会导致这两种疾病自我管理的严重错误。帕金森病和哮喘患者需要量身定做的干预措施，因为对一种情况可能是治疗的东西可能会加剧另一种情况。干预措施教会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。该疗法还包括对哮喘患者安全的帕金森病认知行为疗法，并将其与哮喘教育和心率变异性生物反馈疗法结合起来。该研究计划将涉及两个目标：1)恐慌-哮喘治疗的文化适应；2)随机、安慰剂对照的先导研究。参与者将主要从纽约布朗克斯的两家大型市中心医院招募。帕金森病的诊断将基于DSM-IV的结构化临床访谈。哮喘的诊断将基于国家指南。该项目的第一年将专门用于约5个重点小组，其中有拉丁裔(主要是波多黎各人)参与者、试验性治疗和参与者反馈。该方案将根据第一阶段系统观察到的关键文化问题进行调整。在第二至第三年，40名患有帕金森病和哮喘的患者将被随机分成两个治疗组：恐慌-哮喘治疗组和积极的安慰剂治疗组，其中包括音乐治疗和以静止呼吸频率进行起搏呼吸。每次治疗将包括每周8次疗程。面试者将对治疗情况视而不见，将在治疗前、治疗中期、治疗后和3个月随访时进行评估。主要的假设是，从试验前到试验后以及在3个月的随访中，恐慌-哮喘治疗组的参与者在帕金森病严重程度量表和沙丁胺醇使用(即抢救哮喘药物)上的降幅将比安慰剂组的受试者更大。检查沙丁胺醇的使用很重要，因为它可能是恐慌和哮喘症状之间混淆的指标。由于副作用较少，减少沙丁胺醇的使用可能会导致恐慌症状的改善。这项研究的目标与NIMH的使命高度相关，即开发有效的、与文化相关的行为疗法来治疗同时发生的精神和身体障碍。这项R34研究将产生可行性数据(例如，初始效果大小、招募和保留率、治疗可信度等)。通过R01拨款，设计一项未来的全面随机、安慰剂对照试验。 公共卫生相关性：为患有惊恐障碍和哮喘的拉丁裔人开发一种行为治疗方法，具有降低这两种疾病的巨大公共卫生成本的巨大潜力。惊恐障碍在哮喘患者中的比例过高，而哮喘对波多黎各人的影响不成比例。恐慌-哮喘治疗将进行调整，以纳入与拉丁裔相关的特定文化问题。

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.