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

描述（由申请人提供）：广泛性焦虑症（GAD）的特征在于过度的、无法控制的担忧（Barlow等人，1986），导致医疗过度使用、感知健康差、生活质量评分低以及工作损伤，从而导致显著的经济和公共健康影响（Ballenger等人，2001;霍夫曼等人，2008; Wittchen，2002）。GAD的终生患病率很高（5.7%，Kessler等人，2005年; 8.5%在初级保健设置，罗伊-伯恩和Wager，2004年）。尽管存在对GAD有效的心理社会和药理学治疗（综述参见Nutt等人，2002年），这些人中的大多数都无法获得我们最有效的治疗（柯林斯等人，2004）并且相对于其他焦虑和情绪障碍，这种病症的寻求治疗的延迟是最长的（即，发病后14年; Kessler等人，1998年）。寻求治疗的严重拖延、无法获得循证治疗以及过度使用医疗服务，导致长期的个人和经济成本。因此，对于开发有效且具有成本效益的治疗方法存在显著未满足的需求，这些治疗方法有可能被广泛用于患有GAD的个体。目前的提案直接响应了NIMH的优先事项，即评估方便用户的干预措施和非传统的提供方法，以增加获得循证干预措施的机会。我们将评估为期12周的计算机提供的GAD家庭治疗方案的疗效。治疗将包括在治疗GAD中显示有效的两种干预措施的组合。注意力修正程序（AMP）是一种计算机化程序，旨在促进注意力从威胁性刺激中脱离（Amir等人，2009年）。应用放松（AR）是一种行为，基于技能的干预，个人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（Hollon et al.，2002），我们审查的证据表明，这两种治疗方法是理想的候选人的有效，经济，广泛运输的循证治疗广泛性焦虑症。该提案通过评估一种新方法，通过使用创新技术为难以接触到的人群提供循证干预措施，有可能产生重大的公共卫生影响。

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.