Cognitive Behavioral Therapy in Primary Care: Treating the Medically Ill

面临慢性疾病的患者患抑郁症和焦虑症的风险增加。这个 抑郁症和焦虑症与不良患者预后之间的联系是明确的，而且 太戏剧化了。不幸的是，尽管这种流行和影响，很少有内科疾病患者得到 心理健康治疗，仍然缺乏与使用 初级保健环境中的非药物精神健康治疗，如CBT。为舞台布景 对于退伍军人事务部未来的CBT项目，需要进行额外的研究来记录现实世界 这种治疗方法的有效性。 召集起来的研究小组试图检查退伍军人事务部小学CBT的有效性 使用现有退伍军人管理局提供者作为研究临床医生的护理环境。我们假设身体上有疾病 接受初级保健精神卫生临床医生CBT的退伍军人将表现出更大的 抑郁/焦虑症状和躯体疾病结果的改善与 常规护理(UC)对照组，在治疗后和8个月和12个月的随访中。次要目标 将评估患者的治疗依从性和治疗师的CBT能力。探索性目标将 检查干预的成本效益，评估利益相关者的看法，以及更长时间- 学期干预应用“后研究”。 目前为期4年的调查将集中在CBT对复杂和 使用随机有效性研究设计的慢性疾病退伍军人。身体不适的退伍军人， 定义为患有慢性心脏病或肺病，并伴有抑郁症状的患者 和/或焦虑将被招募。CBT的提供将通过VISN 16精神卫生提供 在两家医院(休斯顿和俄克拉何马城)的初级保健倡议中。符合条件的患者将是 随机分为CBT干预组或UC组。CBT提供者将包括护士、社会 目前正在提供心理健康护理的工作人员、咨询师和心理学家 退伍军人事务部在初级保健中的精神健康倡议。CBT治疗将包括 为我们之前的HSR&DIIR研究(Kunik)开发的机械化疗法，以及随后的 使用从我们的SC MIRECC资助的试验(CULY)获得的数据进行了修改。CBT治疗将 包括为期6周的每周会议，使用模块化方法通过In- 面对面和电话会议。四次每周一次的后续电话宣传会议将是 用于维护和巩固更改。总共，CBT将涉及16周的护理。病人 将向分配给UC的人员提供教育材料、例行评估，并将 鼓励他们通过现有的退伍军人管理局寻求额外的护理。

Patients facing chronic medical conditions are at increased risk for depression and anxiety. The associations between depression and anxiety and poor patient outcomes are clear and dramatic. Unfortunately, despite this prevalence and impact, few medically ill patients receive mental health treatment and there continues to be a dearth of information related to the use of non-medication mental health treatments such as CBT in primary care settings. To set the stage for future CBT programs within VA, additional research is needed to document the real-world effectiveness of this treatment approach. The assembled research team seeks to examine the effectiveness of CBT within VA primary care settings using existing VA providers as study clinicians. We hypothesize that medically ill veterans receiving CBT from primary care mental health clinicians will show greater improvement in depressive / anxious symptoms and physical disease outcomes relative to a usual care (UC) control arm at post-treatment and 8- and 12-month follow-up. Secondary aims will assess patient treatment adherence and therapist CBT competence. Exploratory aims will examine the cost effectiveness of the intervention, assess stakeholder perceptions, and longer- term intervention application "post-study". The present 4-year investigation will focus on the effectiveness of CBT for complex and chronically ill veterans using a randomized effectiveness study design. Medically ill veterans, defined as patients with chronic heart or lung disease, with comorbid symptoms of depression and/or anxiety will be recruited. Provision of CBT will occur through the VISN 16 mental health in primary care initiative at 2 hospitals (Houston and Oklahoma City). Eligible patients will be randomized to either the CBT intervention or to UC. CBT providers will include nurses, social workers, counselors and psychologists who are currently providing mental health care as part of the VA's Mental Health in Primary Care Initiative. The CBT treatment will consist of a manualized therapy developed for our prior HSR&D IIR study (Kunik) and subsequently modified using data obtained from our SC MIRECC funded trial (Cully). CBT treatment will involve weekly sessions over a period of 6 weeks using a modular approach to care via in- person and telephone sessions. Four bi-weekly follow-up telephone booster sessions will be used to maintain and solidify changes. In total, CBT will involve 16 weeks of care. Patients assigned to UC will be provided with educational materials, routine assessments, and will be encouraged to seek additional care through their existing VA providers.