Attention Training and Relaxation for GAD: Testing the Efficacy of Home-Delivery

描述（由申请人提供）：广泛性焦虑障碍（GAD）的特征是过度的、无法控制的担忧（Barlow, et al., 1986），导致医疗过度利用、感知健康状况不佳、生活质量评分低和工作障碍，从而对经济和公共卫生产生重大影响（Ballenger et al., 2001; Hoffman et al., 2008; Wittchen, 2002）。广泛性焦虑症的终生患病率很高（5.7%,Kessler et al., 2005； 8.5%在初级保健机构，Roy-Byrne & Wager, 2004）。尽管有针对广泛性焦虑症的有效心理社会和药物治疗方法（综述见Nutt等人，2002年），但大多数患者无法获得最有效的治疗方法（Collins等人，2004年），而且与其他焦虑和情绪障碍相比，广泛性焦虑症寻求治疗的延迟时间最长（即从发病时间起14年；Kessler等人，1998年）。寻求治疗方面的严重延误、无法获得循证治疗以及医疗服务的过度使用，导致了长期的个人和经济成本。因此，开发有效和具有成本效益的治疗方法的需求尚未得到满足，这些治疗方法有可能使广泛性焦虑症患者广泛获得。目前的提案直接回应了NIMH评估用户友好干预措施和非传统交付方法的优先事项，以增加获得循证干预措施的机会。我们将评估一个为期12周的电脑家庭治疗方案对广泛性焦虑症的疗效。治疗将包括两种干预措施的组合，这两种干预措施在治疗广泛性焦虑症方面是有效的。注意修正程序（AMP）是一个计算机程序，旨在促进注意力从威胁刺激中脱离（Amir等人，2009）。应用放松（AR）是一种行为的、基于技能的干预，在这种干预中，个体学习如何减少与焦虑和担忧相关的生理线索（Vst, 1987; Siev & Chambless, 2007）。根据NIMH心理社会干预发展工作组的推荐指南（Hollon等人，2002），我们回顾了证据，表明这两种治疗方法都是有效、经济和广泛传播广泛性焦虑症循证治疗的理想选择。这一建议有可能产生重大的公共卫生影响，因为它评估了一种通过使用创新技术向难以接触到的人群提供循证干预措施的新方法。

DESCRIPTION (provided by applicant): Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry (Barlow, et al., 1986) leading to medical over-utilization, poor perceived health, low ratings of quality of life, and impairment at work that result in a significant economic and public health impact (Ballenger et al., 2001; Hoffman et al., 2008; Wittchen, 2002). Lifetime prevalence of GAD is high (5.7%, Kessler et al., 2005; 8.5% in primary care setting, Roy-Byrne & Wager, 2004). Although efficacious psychosocial and pharmacological treatments for GAD exist (for a reviews see Nutt, et al., 2002), the majority of these individuals do not access our most effective treatments (Collins et al., 2004) and treatment-seeking delays are longest for this condition relative to other anxiety and mood disorders (i.e., 14 years from the time of onset; Kessler et al., 1998). The substantial delays in treatment seeking, failure to access evidence-based treatments and overutilization of medical services, result in prolonged personal and economic costs. Thus, there is a significant unmet need for the development of efficient and cost-effective treatments that have the potential to be widely accessible to individuals with GAD. The current proposal directly responds to the NIMH priorities for evaluating user-friendly interventions and non- traditional delivery methods to increase access to evidence-based interventions. We will evaluate the efficacy of a 12-week computer-delivered home-based treatment program for GAD. Treatment will comprise a combination of two interventions shown to be efficacious in the treatment of GAD. The Attention Modification Program (AMP) is a computerized program designed to facilitate attention disengagement from threatening stimuli (Amir et al., 2009). Applied Relaxation (AR) is a behavioral, skills-based intervention where individuals learn ways to reduce the physiological cues associated with anxiety and worry (Vst, 1987; Siev & Chambless, 2007). Following the recommended guidelines of the NIMH Workgroup on Psychosocial Intervention Development (Hollon et al., 2002), we review evidence suggesting that both treatments are ideal candidates for the efficient, economical, and widespread transportation of evidence-based treatments for GAD. This proposal has the potential for a significant public health impact by evaluating a new method for delivering evidence-based interventions for hard-to-reach populations through the use of innovative technologies.