Narrative intervention to disseminate ACT for depression in primary care

描述(由申请人提供)：现有的抑郁症治疗方法对公共健康的影响受到我们传播这些治疗方法的能力的限制。有一种特别的需要 寻找创新的方法，在初级保健环境中传播经验性心理治疗的关键原则。超过一半接受精神卫生保健的美国居民在初级保健中接受，初级保健可以接触到许多可能由于感觉到耻辱或其他障碍而无法获得精神保健的人。叙事交流是传播促进行为改变的心理治疗关键原则的另一种方式。叙事性交流指的是“讲故事”--真实的人讲述他们的挣扎和成功的应对方式。叙事干预可以导致其他问题的行为改变，比如高血压。叙事交流的一个优势是，它可以很容易地传播(通过视频)，可以非常吸引人，可能会接触到无法获得其他技术或经历传统心理治疗障碍的人。我们建议，一种认知行为疗法(接受和承诺疗法，或ACT)的关键原则可以通过视频讲故事干预来传播。ACT是一种经验性的治疗抑郁症和相关问题的疗法。促进行为改变和缓解抑郁的关键原则包括：1)努力保持个人价值观和日常行动之间的一致性；2)更愿意在为个人价值观服务的过程中体验消极的想法/感觉；3)将消极的想法/感觉视为短暂的；以及4)在日常生活中更加充分地呈现(或专注)。这个治疗开发项目有两个主要目标。首先，我们将与一家视频制作公司合作，制作一部讲述故事的视频干预(STVI)，让真正的初级保健患者讨论他们自己(与ACT一致的)成功的应对策略。使用迭代过程，我们将创建4个30分钟的“剧集”，打算在一个月的过程中观看；我们还将创建一个附带的工作簿。第二，我们将进行a)STVI的小型开放试验(n=10)和b)试点随机对照试验(n=40)，包括抑郁症初级保健患者照常接受抗抑郁药物治疗(TAU)STVI与TAU注意力控制视频。评估将在基线、4周和12周进行。我们将审查STVI的可行性和可接受性(通过检查STVI的吸收和完成情况，视频是否被认为吸引人，以及观众是否理解ACT的关键原则并将其视为与他们的生活相关)以及RCT研究设计。我们将检查治疗结果的差异(在相关的可信区间内)(例如，抑郁)。我们将考察假设机制的变化，即与ACT一致的应对策略。这一系列研究的下一步是在一项大规模随机对照试验中，测试STVI作为抗抑郁药物辅助治疗在抑郁症初级保健患者中的有效性，并检查与ACT一致的应对策略作为作用机制。

DESCRIPTION (provided by applicant): The public health impact of existing treatments for depression is limited by our ability to disseminate those treatments. There is a particular need to find innovative ways to disseminate key principles of empirically supported psychotherapy in primary care settings. Over half of U.S. residents who receive mental health care receive it in primary care, and primary care can reach many who might not access psychiatric care due to perceived stigma or other barriers. Narrative communication is an alternative way to disseminate key principles of psychotherapy that catalyze behavior change. Narrative communication refers to "storytelling" -real people telling stories about their struggles and successful ways of coping. Narrative interventions can result in behavior change for other problems, such as hypertension. An advantage of narrative communication is that it can be easily distributed (by video), can be very engaging, and may reach people who do not have access to other technologies or who experience barriers to traditional psychotherapy. We propose that key principles of a type of cognitive-behavioral therapy (Acceptance and Commitment Therapy, or ACT) can be disseminated through a video storytelling intervention. ACT is an empirically-supported therapy for depression and related problems. Key principles for catalyzing behavior change and alleviating depression include: 1) striving for consistency between personal values and daily actions; 2) being more willing to experience negative thoughts/ feelings in the service of personal values; 3) viewing negative thoughts/feelings as transient; and 4) being more fully present (or mindful) in everyday life. There are two primary aims of this treatment development project. First, together with a video production firm, we will produce a storytelling video intervention (sTVi), with real primary care patients discussing their own (ACT-consistent) successful coping strategies. Using an iterative process, we will create 4 30-minute "episodes" intended to be viewed over the course of a month; we will also create an accompanying workbook. Second, we will conduct a) a small open trial (n = 10) of sTVi and b) pilot randomized controlled trial (n = 40) with depressed primary care patients receiving antidepressant medication treatment as usual (TAU) + sTVi vs. TAU + attention control videos. Assessments will occur at baseline and 4 and 12 weeks. We will examine feasibility and acceptability of sTVi (by examining uptake and completion of sTVi, whether the videos are considered engaging, and whether viewers understand key ACT principles and see them as relevant to their lives) and of the RCT research design. We will examine treatment differences (within relevant confidence intervals) on outcomes (e.g., depression). We will examine change in hypothesized mechanisms, i.e., ACT-consistent coping strategies. The next step in this line of research is to test, in a large- scale randomized controlled trial, the efficacy of sTVi as an adjunct to antidepressant medication in depressed primary care patients, and to examine ACT-consistent coping strategies as mechanisms of action.