2/2 Stepped, reward-exposure based therapy vs. PST in late life depression

2/2 阶梯式奖励暴露疗法与 PST 治疗晚年抑郁症的比较

• 批准号: 9251911
• 负责人: Patricia A. Arean
• 金额: $ 28.35万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-11 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9251911
• 关键词: Age; Alternative Therapies; Behavior Therapy; Behavioral; Biological; Biology; Caring; Characteristics; Clinical; Clinical Trials; Collaborations; Color; Communities; Competence; Depressed mood; Disease; Disease remission; Doctor of Medicine; Doctor of Philosophy; Elderly; Executive Dysfunction; Female; Gender; Generations; Geriatrics; Hamilton Rating Scale for Depression; Hour; Intervention; Major Depressive Disorder; Medical; Mental Depression; Mental Health; Moods; Multicenter Studies; Neurobiology; Neurosciences; Nurses; Outcome; Participant; Patients; Persons; Pharmacotherapy; Physical activity; Policies; Population; Protocols documentation; Provider; Psychotherapy; Quality of life; Randomized; Recording of previous events; Recruitment Activity; Reporting; Research; Resources; Rewards; Sample Size; Science; Self Efficacy; Services; Severities; Site; Social Workers; Structure; Techniques; Time; Training; World Health Organization; World Health Organization Disability Assessment Schedule; aging population; base; chronic depression; community setting; comparative efficacy; cost; data management; design; disability; effective therapy; emotion dysregulation; evidence base; experience; geriatric depression; improved; non-demented; novel therapeutics; older patient; predictive modeling; problem solving therapy; programs; public health relevance; response; skills; social; theories; therapy development; treatment adherence; treatment response

DESCRIPTION (provided by applicant): Engage is a novel therapy for late life depression, a disorder that worsens the outcomes of most medical illnesses, promotes disability, increases expense, and complicates medical care by clouding the clinical picture and undermining treatment adherence. Late-life depression has a modest response to pharmacotherapy, and although problem-solving therapy (PST) was found efficacious, it is rarely utilized by community clinicians. Engage targets behavioral domains of late-life depression grounded on neurobiological constructs using behavioral strategies of known efficacy selected for their simplicity. "Reward exposure" is the principal treatment vehicle of Engage. The first 3 sessions consist of direct "reward exposure" but the therapists search for barriers in 3 behavioral domains, i.e. "negativity bias", "apathy", and "emotional dysregulation", and add strategies targeting these domains when needed. Engage uses a structured, stepped-care approach and makes personalization part of the treatment itself. The primary hypothesis of the study is that Engage is non-inferior to problem solving therapy (PST), a treatment with demonstrated efficacy in late life depression. Its secondary hypotheses postulate that Engage requires fewer training hours than PST, is non-inferior to PST in reducing disability and in inducing remission of depression. Exploratory analyses will focus on long-term efficacy of Engage (over 26 and 52 weeks) as well as mechanisms and predictors of its effects. The participants will be 300 (150 from each Center) older (>60 years) non-psychotic, non-demented persons with unipolar major depression who will be randomly assigned to 9 sessions of Engage or PST. We bring to this project two research groups with a history of a successful collaboration in 2 two-center R01 supported psychotherapy studies, complementary expertise in clinical biology, intervention development, clinical trials, and experience in directing multicenter studies. This application responds to two IOM reports, which predict that the workforce in geriatrics will be overwhelmed by the aging population, a problem that will reach cataclysmic proportions when the Affordable Care Programs come into being. Older adults seek services in community settings where the providers of initial care for depression are social workers and nurses without in-depth training in psychotherapies. Engage is designed for such clinicians and, therefore, may have broad scalability (used by many professionals) and reach by offering to many depressed seniors access to effective psychotherapy. The stepped approach to personalization used by Engage may make it applicable to other populations.

描述（由申请人提供）：Engage是一种治疗晚期抑郁症的新型疗法，这种疾病会影响大多数医疗疾病的结果，促进残疾，增加费用，并通过模糊临床图像和破坏治疗依从性来使医疗护理复杂化。晚年抑郁症对药物治疗的反应不大，尽管发现问题解决疗法（PST）有效，但社区临床医生很少使用它。Engage针对晚年抑郁症的行为领域，基于神经生物学结构，使用因其简单性而选择的已知功效的行为策略。“奖励曝光”是Engage的主要治疗手段。前三个疗程由直接的“奖励暴露”组成，但治疗师在3个行为领域寻找障碍，即“消极偏见”，“冷漠”和“情绪失调”，并在需要时添加针对这些领域的策略。Engage使用结构化的分步护理方法，并将个性化作为治疗本身的一部分。该研究的主要假设是，参与不劣于问题解决疗法（PST），这是一种在晚年抑郁症中表现出疗效的治疗方法。它的次要假设假定，从事需要更少的培训时间比PST，是不劣于PST在减少残疾和诱导抑郁缓解。探索性分析将侧重于Engage的长期疗效（超过26周和52周）以及其作用的机制和预测因素。参与者将是300名（每个中心150名）老年（>60岁）非精神病、非痴呆的单相重度抑郁症患者，他们将被随机分配到9个Engage或PST疗程。我们为这个项目带来了两个研究小组，他们在2个双中心R01支持的心理治疗研究中有成功合作的历史，在临床生物学，干预开发，临床试验方面的互补专业知识，以及指导多中心研究的经验。该应用程序响应了两份IOM报告，该报告预测老年医学的劳动力将被人口老龄化所淹没，当平价医疗计划形成时，这一问题将达到灾难性的程度。老年人在社区环境中寻求服务，那里的抑郁症初步护理提供者是社会工作者和护士，没有深入的培训， 心理治疗Engage是为这些临床医生设计的，因此可能具有广泛的可扩展性（许多专业人士使用），并通过为许多抑郁的老年人提供有效的心理治疗来达到。Engage使用的个性化的阶梯式方法可能适用于其他人群。