Narrative intervention to disseminate ACT for depression in primary care

描述（由申请人提供）：现有抑郁症治疗的公共卫生影响受到我们传播这些治疗的能力的限制。特别需要 寻找创新的方法，在初级保健环境中传播经验支持的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精神卫生保健，初级保健可以覆盖许多由于被认为是耻辱或其他障碍而可能无法获得精神病护理的人。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。叙事传播指的是“讲故事”--真实的人讲述他们的奋斗经历和成功的应对方式。叙事干预可以导致其他问题的行为改变，如高血压。叙事交流的一个优点是它可以很容易地（通过视频）传播，可以非常吸引人，并且可以接触到无法使用其他技术或遇到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是一种治疗抑郁症和相关问题的药物支持疗法。促进行为改变和缓解抑郁症的关键原则包括：1）努力保持个人价值观和日常行为之间的一致性; 2）更愿意体验消极的想法/感受，以服务于个人价值观; 3）将消极的想法/感受视为短暂的; 4）在日常生活中更充分地存在（或注意）。该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一起制作一个讲故事的视频干预（sTVi），真实的初级保健患者讨论他们自己（ACT一致）的成功应对策略。使用迭代过程，我们将创建4个30分钟的“剧集”，打算在一个月内观看;我们还将创建一个附带的工作簿。其次，我们将进行a）sTVi的小型开放试验（n = 10）和B）初步随机对照试验（n = 40），其中抑郁症初级保健患者接受抗抑郁药物治疗（TAU）+ sTVi vs. TAU +注意力控制视频。将在基线和第4周和第12周进行评估。我们将检查sTVi的可行性和可接受性（通过检查sTVi的吸收和完成，视频是否被认为是吸引人的，以及观众是否理解关键的ACT原则，并将其视为与他们的生活相关）和RCT研究设计。我们将检查治疗差异（在相关置信区间内）对结局的影响（例如，抑郁症）。我们将研究假设机制的变化，即，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作为抑郁症初级保健患者抗抑郁药物的辅助治疗的疗效，并检查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.