Narrative intervention to disseminate ACT for depression in primary care

在初级保健中传播针对抑郁症的 ACT 的叙事干预

基本信息

批准号：
9220647
负责人：
BRANDON A GAUDIANO
金额：
$ 17.67万
依托单位：
BUTLER HOSPITAL (PROVIDENCE, RI)
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-03-01 至 2019-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9220647
关键词：
Antidepressive Agents Antihypertensive Agents Censuses Clinic Clinical Code Cognitive Therapy Communication Community Health Computers Confidence Intervals Data Depressed mood Development Disabled Persons Ensure Event Feedback Feeling Focus Groups Goals Health behavior change Healthcare Hispanics Hour Household Hypertension Individual Internet Intervention Interview Learning Life Low income Major Depressive Disorder Mental Depression Mental Health National Institute of Mental Health Outcome Patient Care Patients Pharmaceutical Preparations Primary Health Care Process Production Provider Psyche structure Psychiatric therapeutic procedure Psychotherapy Public Health Randomized Controlled Trials Recruitment Activity Research Research Design Research Support Sampling Services Severities Strategic Planning Technology Testing Thinking Training Work attentional control base behavior change blood pressure reduction brief intervention coping experience improved innovation member mindfulness primary care setting psychosocial public health relevance response routine care social cognitive theory social stigma therapy development treatment as usual uptake

项目摘要

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.

描述（由申请人提供）：现有治疗对抑郁症的公共卫生影响受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来传播初级保健环境中经验支持的心理治疗的关键原则。接受精神卫生保健的美国居民中，有一半以上的居民在初级保健中获得了医疗保健，并且由于感知到的污名或其他障碍而无法获得精神病医生的许多人。叙事交流是传播心理疗法关键原理的另一种方法，从而催化行为改变。叙事交流是指“讲故事” - 真实的人讲述他们的斗争和成功的应对方式的故事。叙事干预措施可能会导致其他问题（例如高血压）的行为改变。叙事交流的优势是（通过视频）可以很容易地分发，很可能很吸引人，并且可能会吸引那些无法获得其他技术或遇到传统心理治疗障碍的人。我们建议可以通过视频讲故事的干预来传播一种认知行为疗法（接受和承诺疗法或行为）的关键原则。 ACT是一种经验支持抑郁症和相关问题的经验疗法。催化行为变化和减轻抑郁症的关键原则包括：1）努力在个人价值观和日常行动之间保持一致性； 2）更愿意在为个人价值观服务时体验负面的想法/感受； 3）将负面思想/感觉视为短暂的； 4）在日常生活中更充分地存在（或正念）。该治疗开发项目有两个主要目标。首先，与一家视频制作公司一起，我们将制作讲故事的视频干预（STVI），而真正的初级保健患者讨论了自己的（一致）成功应对策略。使用迭代过程，我们将创建4个30分钟的“情节”，旨在在一个月的过程中观看；我们还将创建一个随附的工作簿。其次，我们将进行a）STVI和b）试验随机对照试验（n = 40）的小型开放试验（n = 10），初级保健抑郁症患者像往常一样接受抗抑郁药治疗（TAU） + STVI + STVI + TAU +注意控制视频。评估将在基线和4和12周进行。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，视频是否被视为引人入胜，以及观众是否了解关键ACT原则并将其视为与他们的生活有关）和RCT研究设计。我们将在结果（例如抑郁症）上检查治疗差异（相关置信区间）。我们将研究假设机制的变化，即行动一致的应对策略。这项研究系列的下一步是在大规模的随机对照试验中测试STVI作为抑郁症的初级保健患者抗抑郁药的辅助性的功效，并检查行动一致的应对策略作为作用机制。