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 参与是一种治疗晚年抑郁症的新疗法，这种疾病是大多数医疗手段的结果。 疾病，促进残疾，增加费用，并通过模糊临床图片使医疗护理复杂化 并破坏治疗依从性。晚年抑郁症对药物治疗的反应温和， 尽管问题解决疗法（PST）被发现是有效的，但它很少被社区临床医生使用。 Engage针对晚年抑郁症的行为领域，基于神经生物学结构， 选择具有已知功效的行为策略是因为它们简单。“悬赏曝光”是本金 治疗车的吸引力。前3个疗程包括直接的“奖励暴露”，但治疗师会寻找 对于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战略。Engage采用结构化的分步护理方法， 使个性化成为治疗本身的一部分。 该研究的主要假设是，参与不劣于问题解决疗法（PST）， 在晚年抑郁症中证明有效的治疗。它的次要假设假定， 所需的训练时数少于PST，在减少残疾和诱导缓解方面不劣于PST。 萧条探索性分析将侧重于Engage的长期疗效（超过26周和52周）以及 机制及其影响的预测因素。参与者将为300名（每个中心150名）以上（e60岁） 非精神病、非痴呆的单相抑郁症患者将被随机分配到9个 参与或PST会议。我们为这个项目带来了两个具有成功历史的研究小组。 在2个双中心R01支持的心理治疗研究中进行合作，在临床方面提供互补的专业知识 生物学、干预开发、临床试验和指导多中心研究的经验。 该提案回应了国际移民组织的两份报告，该报告预测老年医学领域的劳动力将不堪重负 随着人口老龄化，这个问题将达到灾难性的比例时，负担得起的医疗计划， 形成了。老年人在社区环境中寻求服务， 抑郁症患者是社会工作者和护士，没有接受过深入的心理治疗培训。Engage旨在 这样的临床医生，因此，可以具有广泛的可扩展性（由许多专业人员使用），并通过提供 使许多抑郁的老年人获得有效的心理治疗。使用的个性化分步方法 可以使其适用于其他人群。