Expanding the Foundation for Population-Based Anxiety Management Interventions

描述(由申请人提供)：探索有效的传播机制以增加对科学知情治疗的接受是国家精神卫生研究所(NIMH)服务和干预研究部的高度优先事项。传播治疗焦虑症的有效方法特别重要，因为焦虑是最普遍的精神疾病形式。尽管存在有效的、有经验支持的治疗方法，但绝大多数经历临床焦虑水平的人没有得到治疗。到目前为止，宣传工作的重点是增加机会，但没有适当地解决需要成本效益高的干预措施，以那些尚不愿意接受治疗或尚未准备采取必要的困难行动来解决其焦虑问题的焦虑症患者为对象。跨理论行为改变模式(TTM)为既能获得又能解决意愿的干预措施提供了理论基础，因为它强调在组织有效的计算机化干预措施方面的准备和效用。TTM的关键组织特征是变化的五个阶段，这五个阶段定义了个人在准备和采用变化方面的进展。TTM假设，变化的五个阶段是由三个核心结构调节的：决策平衡(行为变化的利弊的相对重要性)；自我效能感(一个人对变化可以在一系列具有挑战性的情况下保持的信心)；以及参与10个变化过程的频率(涉及认知、行为和经验活动)。由TTM指导的计算机化干预包括对这些核心结构的交替评估和个性化的反馈。然而，在开发以TTM为基础的以焦虑管理为目标的干预之前，需要进行先期的实证工作。这项拟议的研究将执行将TTM应用于焦虑管理所需的步骤。具体目标是：(1)制定与焦虑管理相关的变化阶段、决策平衡、自我效能以及变化的经验和行为过程的有效和可靠的测量方法；(2)为三个治疗组(接受焦虑心理治疗的个人、只接受药物治疗的人和没有接受任何治疗的人)每个变化阶段参与者的核心TTM变量测量的预期分数建立数据驱动的指导方针。这项研究将招募360名临床焦虑程度的参与者来完成一项在线调查。将使用测量开发的顺序过程。它将包括探索性和验证性分析，随后进行一系列回归分析和组差异分析，以评估外部有效性。这项工作将为下一步的预期研究计划铺平道路：开发和评估计算机定制的、基于TTM的干预措施的有效性，旨在将焦虑症治疗扩大到所有有需要的人。

DESCRIPTION (provided by applicant): Exploration of effective dissemination mechanisms to increase uptake of scientifically-informed treatments is a high priority for the Division of Servics and Intervention Research of the National Institute of Mental Health (NIMH). Dissemination of effective treatments for anxiety disorders is particularly important because anxiety is the most prevalent form of mental illness. Although effective, empirically-supported treatments exist, the vast majority of individuals experiencing clinical levels of anxiety do not receive treatment. Dissemination efforts thus far have focused on increasing access, but have not appropriately addressed the need for cost-efficient interventions that target those individuals suffering from anxiety who are not yet willing to attend treatment or not yet ready to take difficult actions necessary to address their anxiety. The Transtheoretical Model of Behavior Change (TTM) provides a theoretical basis for interventions that could address both access and willingness owing to its emphasis on readiness and utility in organizing effective, computerized interventions. The key organizing feature of the TTM is the five stages of change, which define an individual's progress in preparing for and adopting changes. The TTM posits that movement through five stages of change, is mediated by three core constructs: Decisional Balance (relative importance of pros and cons of behavior change); Self-efficacy (one's confidence that change can be maintained across a range of challenging situations); and frequency of engagement in 10 Processes of Change (involving cognitive, behavioral, and experiential activities). Computerized interventions guided by the TTM involve alternating assessment of these core constructs and individually-tailored feedback. Before a TTM-based intervention targeting management of anxiety can be developed, however, precursor empirical work is required. The proposed research will carry out the steps needed to apply the TTM to the management of anxiety. The specific aims are to: (1) Develop valid and reliable measures of stage of change, decisional balance, self- efficacy, and the experiential and behavioral processes of change as they pertain to management of anxiety; (2) Build data-driven guidelines for expected scores on measures of core TTM variables for participants in each stage of change in three treatment groups (individuals receiving psychotherapy for anxiety, those receiving medication only, and those not in any treatment). The study will recruit 360 participants with clinical levels of anxiety to complete an online survey. A sequential process of measurement development will be used. It will consist of exploratory and confirmatory analyses, followed a series of regression and group difference analyses to evaluate external validation. This work will pave the way for the next step in an intended program of research: to develop and evaluate effectiveness of a computer-tailored, TTM-based intervention aimed at enhancing the reach of anxiety disorder treatments to the full population of individuals in need.