2/2 Stepped, reward-exposure based therapy vs. PST in late life depression

2/2 阶梯式奖励暴露疗法与 PST 治疗晚年抑郁症的比较

• 批准号: 8613178
• 负责人: Patricia A. Arean
• 金额: $ 39.44万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-15 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8613178
• 关键词: Age; Alternative Therapies; Behavior Therapy; Behavioral; Biological; Biology; Caring; Characteristics; Clinical; Clinical Trials; Collaborations; Color; Communities; Depressed mood; Disease; Disease remission; Doctor of Medicine; Doctor of Philosophy; Educational process of instructing; Elderly; Emotional; Executive Dysfunction; Female; Gender; Generations; Geriatrics; Hamilton Rating Scale for Depression; Hour; Intervention; Major Depressive Disorder; Medical; Mental Depression; Mental Health; Modeling; Moods; Multicenter Studies; Neurobiology; Neurosciences; Nurses; Outcome; Participant; Patients; Persons; Pharmacotherapy; Physical activity; Policies; Population; Protocols documentation; Provider; Psychotherapy; Quality of life; Randomized; Recording of previous events; Recruitment Activity; Reporting; Research; Resources; Rewards; Sample Size; Science; Self Efficacy; Services; Severities; Site; Social Workers; Solutions; Structure; Techniques; Time; Training; World Health Organization; World Health Organization Disability Assessment Schedule; aging population; base; benzoylamido-4' -aminostilbene-2,2' -disulfonate; community setting; comparative efficacy; cost; data management; design; disability; effective therapy; evidence base; experience; geriatric depression; improved; novel; older patient; problem solving therapy; programs; public health relevance; response; skills; social; theories; therapy development; treatment adherence; treatment response

ABSTRACT Engage is a novel therapy for late life depression, a disorder that worsens the outcomes of most medical illnesses, promotes disability, increases expense, and complicates medical care by clouding the clinical picture and undermining treatment adherence. Late-life depression has a modest response to pharmacotherapy, and although problem-solving therapy (PST) was found efficacious, it is rarely utilized by community clinicians. Engage targets behavioral domains of late-life depression grounded on neurobiological constructs using behavioral strategies of known efficacy selected for their simplicity. "Reward exposure" is the principal treatment vehicle of Engage. The first 3 sessions consist of direct "reward exposure" but the therapists search for barriers in 3 behavioral domains, i.e. "negativity bias", "apathy", and "emotional dysregulation", and add strategies targeting these domains when needed. Engage uses a structured, stepped-care approach and makes personalization part of the treatment itself. The primary hypothesis of the study is that Engage is non-inferior to problem solving therapy (PST), a treatment with demonstrated efficacy in late life depression. Its secondary hypotheses postulate that Engage requires fewer training hours than PST, is non-inferior to PST in reducing disability and in inducing remission of depression. Exploratory analyses will focus on long-term efficacy of Engage (over 26 and 52 weeks) as well as mechanisms and predictors of its effects. The participants will be 300 (150 from each Center) older (e60 years) non-psychotic, non-demented persons with unipolar major depression who will be randomly assigned to 9 sessions of Engage or PST. We bring to this project two research groups with a history of a successful collaboration in 2 two-center R01 supported psychotherapy studies, complementary expertise in clinical biology, intervention development, clinical trials, and experience in directing multicenter studies. This proposal responds to two IOM reports, which predict that the workforce in geriatrics will be overwhelmed by the aging population, a problem that will reach cataclysmic proportions when the Affordable Care Programs come into being. Older adults seek services in community settings where the providers of initial care for depression are social workers and nurses without in-depth training in psychotherapies. Engage is designed for such clinicians and, therefore, may have broad scalability (used by many professionals) and reach by offering to many depressed seniors access to effective psychotherapy. The stepped approach to personalization used by Engage may make it applicable to other populations.

摘要 Engage是一种治疗老年抑郁症的新疗法，这种疾病会恶化大多数内科疾病的结果 疾病，促进残疾，增加费用，并使医疗护理复杂化，使临床情况变得模糊 并破坏了治疗的坚持。老年抑郁症对药物治疗的反应不大，而且 虽然问题解决疗法(PST)被发现是有效的，但很少被社区临床医生使用。 基于神经生物学结构的老年抑郁症的行为领域 已知功效的行为策略因其简单性而被选择。“悬赏曝光”是本金 交战的救治车辆。前3个疗程由直接的“奖励暴露”组成，但治疗师搜索 针对3个行为领域的障碍，即“消极偏见”、“冷漠”和“情绪失调”，并添加 在需要时针对这些领域的策略。Engage使用结构化、分步护理方法， 使个性化成为治疗本身的一部分。 这项研究的主要假设是，从事并不逊于问题解决疗法(PST)，即 治疗老年抑郁症疗效显著。它的第二个假设假设是 比PST需要更少的培训时间，在减少残疾和诱导缓解方面不逊于PST 抑郁症。探索性分析将侧重于Engage的长期疗效(超过26周和52周)以及 其影响的机制和预测因素。参赛者的年龄为300岁(每个中心150人)(60岁) 患有单相严重抑郁症的非精神病、非痴呆患者将被随机分配到9名 接洽或PST的会议。我们为这个项目带来了两个研究小组，他们都有成功的历史 在两个双中心R01支持的心理治疗研究中的合作，在临床上的互补专业知识 生物学、干预开发、临床试验和指导多中心研究的经验。 这项提议回应了国际移民组织的两份报告，这两份报告预测老年医学的劳动力将不堪重负 由于人口老龄化，当平价医疗计划实施时，这个问题将达到灾难性的程度 形成了。老年人在社区环境中寻求服务，在那里，初始护理的提供者 抑郁症是指没有接受过深入的心理治疗培训的社会工作者和护士。Engage专为 这样的临床医生，因此可能具有广泛的可扩展性(被许多专业人员使用)和通过提供 对于许多抑郁的老年人来说，他们可以获得有效的心理治疗。使用的个性化的逐步方法 通过接洽，可能会使其适用于其他人群。