Reducing Anxiety and Improving Functioning in Older Veterans

减少老年退伍军人的焦虑并改善其功能

• 批准号: 8867010
• 负责人: Christine E. Gould
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8867010
• 关键词: Address; Affect; Aftercare; Age; Agoraphobia; Anxiety; Anxiety Disorders; Award; Behavioral; Breathing; Cellular Phone; Clinical; Clinical Trials; Communities; Comorbidity; DSM-IV; Education; Educational process of instructing; Elderly; Evidence based treatment; Feasibility Studies; Feedback; Fostering; Future; Generalized Anxiety Disorder; Geriatrics; Goals; Grant; Health; Healthcare; Home environment; Internet; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Knowledge; Life; Manuals; Measures; Medical; Mental Depression; Mental Health; Mentors; Methods; Modality; Modeling; Muscle relaxation phase; Online Systems; Outcome Measure; Panic; Panic Disorder; Participant; Patients; Perception; Pharmacotherapy; Process; Provider; Psychologist; Psychotherapy; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recruitment Activity; Rehabilitation therapy; Relaxation; Research; Research Infrastructure; Research Training; SF-12; Social Anxiety Disorder; Social Phobia; Sorting - Cell Movement; Specific qualifier value; Stress; Structure; Surveys; Symptoms; Tablets; Technology; Telephone; Testing; Training; Treatment outcome; Universities; Veterans; Visit; Work; Writing; active control; anxiety symptoms; anxiety treatment; anxious; base; brief intervention; career; clinically significant; cost; design; disability; eHealth; experience; functional decline; health care service utilization; health related quality of life; improved; improved functioning; information gathering; late-life anxiety; mobile application; older patient; outreach; preference; prevent; primary outcome; programs; psychoeducation; psychosocial; public health relevance; secondary outcome; social; telehealth

 DESCRIPTION: The proposed CDA-2 will provide Dr. Christine Gould, a Clinical Psychologist at the VA Palo Alto Geriatric Research Education and Clinical Center (GRECC) and recently graduated VA Advanced Fellow in Geriatrics, with research training to foster her career aimed at slowing functional decline in older Veterans with anxiety and depression. Her mentor team includes Drs. Ruth O'Hara, Sherry A. Beaudreau, Mary Goldstein, and Julie Wetherell. Consultants include Drs. Helena Kraemer, Joung Won (Terri) Huh, and Eric Kuhn. In this CDA-2 award, Dr. Gould will obtain training in 1) clinical trials and longitudinal methods, 2) technology and eHealth, 3) medical comorbidity and functioning, and 4) grant and scientific writing. In the CDA-2 research plan, Dr. Gould aims test whether a brief psychosocial intervention for anxiety improves functioning in older Veterans with anxiety disorders. Anxiety is pervasive, costly, and leads to behavioral avoidance, disability, and poor quality of life. The proposed CDA-2 is expected to benefit older Veterans (= 60 years) by reducing anxiety and avoidance and thereby increasing their engagement in activities and improving overall functioning. This project is aligned with older adults' preference of psychotherapy to pharmacotherapy for treating anxiety. The first aim of the proposed project is to adapt progressive muscle relaxation (PMR), an efficacious treatment for late-life anxiety, for administration at home using DVD videos. Self-directed PMR will increase older Veterans' access to this brief treatment. The program, BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment), was developed by Dr. Gould with her mentors' input and includes age-appropriate vignettes of anxiety-evoking situations (e.g., health related worries, financial concerns, attending medical visits). Two studie will address the first aim. In study 1a, qualitative feedback from 20 older Veterans on the video modules will be obtained via semi- structured interviews. In study 1b, the feasibility of BREATHE will be piloted in 10 older Veterans with anxiety disorders, specifically, Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Agoraphobia, Social Anxiety Disorder (SAD), and Anxiety Disorder NOS. Functioning will be assessed using the modified Activity Card Sort. The second aim of the CDA-2 is to assess Veterans' preferences, access to, and perceptions of technology platform that can be used to deliver brief psychosocial treatments. Study 2 will address this aim in 75 older Veterans by obtaining feedback via interview and questionnaires about telephone, web-based, mobile app, telehealth, and DVD-based platforms for interventions. The third aim of the CDA-2 is to determine whether BREATHE has a greater impact on anxiety and functioning compared with an active control (psychoeducation). Study 3 will address this aim with a randomized control trial of DVD-based BREATHE compared with psychoeducation in 60 older Veterans with anxiety disorders (GAD, PD, Agoraphobia, SAD, and unspecified anxiety disorder). It is hypothesized that BREATHE will result in a statistically and clinically significant reduction of anxiety symptoms as measured with the Geriatric Anxiety Scale compared with psychoeducation. Improvements in functioning (Activity Card Sort) are expected for participants randomized to the BREATHE condition compared with those randomized to psychoeducation. Hypotheses in study 3 will be addressed with mixed effects models. This CDA-2 is an essential step towards Dr. Gould's long term goal of becoming a VA leader in research on interventions aimed toward improving older Veteran's functioning via the treatment of mental health symptoms. This CDA-2 also aligns with Dr. Gould's aim of developing these interventions for dissemination via different technology platforms as part of the implementation and outreach process in her future independent VA research career.

 描述： 拟议的CDA-2将为VA Palo Alto老年研究教育和临床中心（GRECC）的临床心理学家Christine Gould博士（GRECC）提供研究，并最近毕业于VA老年人员研究员，并培养了旨在促进她的职业生涯，旨在减慢老年退伍军人的焦虑和抑郁症的功能下降。她的心理团队包括Drs。露丝·奥哈拉（Ruth O'Hara），雪利酒A. Beaudreau，玛丽·戈德斯坦（Mary Goldstein）和朱莉·韦瑟（Julie Wetherell）。顾问包括Drs。 Helena Kraemer，Joung Won（Terri）Huh和Eric Kuhn。在该CDA-2奖中，古尔德博士将在1）临床试验和纵向方法中获得培训，2）技术和eHealth，3）医学合并症和功能，以及4）授予和科学写作。在CDA-2研究计划中，Gould博士旨在测试对动画的简短社会心理干预是否可以改善焦虑症的老年退伍军人的功能。焦虑无处不在，昂贵，并导致避免行为，残疾和生活质量差。拟议的CDA-2有望通过减少动画和回避，从而增加其参与活动并改善整体功能，从而使老年退伍军人（= 60年）受益。该项目与老年人对心理治疗的偏爱而对治疗焦虑的药物治疗保持一致。拟议项目的第一个目的是适应渐进式肌肉放松（PMR），这是一种有效的晚期焦虑症治疗方法，用于使用DVD视频在家中进行管理。自我指导的PMR将增加老年退伍军人对此短暂待遇的访问。该计划是由古尔德（Gould）博士通过导师的意见开发的，该计划（呼吸，放松和对家庭环境中的焦虑症治疗教育）开发了，其中包括适合年龄的焦虑症状情况（例如，与健康相关的奇迹，财务关注，财务问题，参加医疗访问）的焦虑症。两个工作室将解决第一个目标。在研究1a中，将通过半结构化访谈获得来自视频模块上20名老兵的定性反馈。在研究1B中，呼吸的可行性将在10名患有焦虑症的老年退伍军人中进行试验，特别是普遍的焦虑症（GAD），恐慌症（PD），代理恐惧症，社交焦虑症（SAD）和焦虑症NOS。将使用修改的活动卡排序评估功能。 CDA-2的第二个目的是评估退伍军人对技术平台的偏好，访问和感知，可用于提供简短的社会心理治疗。研究2将通过访谈，基于Web，移动应用，远程医疗和基于DVD的平台以进行干预措施，通过访谈和问卷获得反馈，以解决75名老兵的目标。 CDA-2的第三个目的是确定与主动对照（心理教育）相比，呼吸对焦虑和功能有更大的影响。与60名患有焦虑症的老年退伍军人（GAD，PD，Agoraphobia，Sad和未指定的焦虑症）相比，研究3将通过基于DVD的呼吸的随机控制试验来解决这一目标。假设呼吸将导致与心理教育相比，用老年焦虑量表测量的焦虑症状在统计学和临床​​上显着减轻。与随机的心理教育相比，随机分配到呼吸状况的参与者的功能（活动卡排序）的改善（活动卡排序）的改善。研究3中的假设将通过混合效应模型来解决。这种CDA-2是朝着古尔德博士的长期目标迈出的重要一步，即成为旨在通过治疗心理健康症状来改善老年退伍军人功能的干预措施的研究领导者。该CDA-2还与古尔德博士的目标相吻合，目的是通过不同的技术平台开发这些干预措施来传播这些干预措施，这是她未来独立VA研究生涯中实施和推广过程的一部分。