Internet-based Self-Management Intervention for Prolonged Grief

描述（由申请人提供）：持续性悲伤障碍（PGD）是一种比正常悲伤更严重和持续的精神疾病，发生在约10%的丧亲之痛中。它的特点是对死者的长期思念、痛苦、人际关系的脱离和无意义感。PGD与相当大的功能障碍、身体和精神健康发病率、生产力损失、自杀和质量调整生命年降低相关。目前，还没有基于证据的PGD二级预防干预措施。这项研究的长期目标是解决需要一个有效的，具有成本效益的，资源效率高，并容易耐受的二级预防干预的风险发展PGD。主要目标是开发和试点测试基于互联网的自我管理干预PGD，采用经验得出的认知行为治疗（CBT）策略，以促进稳定，积极的日常生活，自我照顾，住宿的损失，提高自我效能，重新参与愉快的活动，并与重要的其他人重新连接。拟议的工作利用了已建立的CBT技术和最近关于使用互联网提供CBT干预措施的研究，旨在为大型临床试验提供必要的开发和试点工作。关键假设是这种干预将减少PGD症状和相关的功能障碍。我们假设，参与干预将是高的，由于增加匿名性和互联网提供的可访问性，这减少了污名化，增加治疗依从性，并反过来，将增加治疗反应。本研究将透过以下的具体目标来达成目的：（1）搜寻失能与PGD的相关文献，并与专家合作，发展出一套经验与技巧为基础的、为期六周的、治疗师协助的自我管理方案;（2）开发一种工具来评估可能阻止PGD患者进行有效自我护理的适应不良认知和感知障碍，重新融入他们的社交圈（3）开发和完善交互式、易于协商的互联网接口，具有基本的数据采集和治疗监测能力，以执行协议;（4）根据专家、护理提供者和患者的反馈，对治疗方案和互联网接口进行规范和标准化;（5）进行试点试验，以确定干预的可行性、安全性、有效性，因特网治疗提供和监测技术的有用性，并根据完成方案的参与者的反馈进一步完善干预措施。

DESCRIPTION (provided by applicant): Prolonged Grief Disorder (PGD) is a psychiatric condition more severe and unremitting than normative grief, occurring in about 10% of bereavement. It is marked by prolonged yearning for the deceased, bitterness, interpersonal disengagement, and a sense of meaninglessness. PGD is associated with considerable functional impairment, physical and mental health morbidity, lost productivity, suicide, and lowered quality adjusted life years. At present, there are no evidence-based, secondary prevention interventions for PGD. The long-term goal of this research is to address the need for an efficacious, cost-effective, resource-efficient, and readily tolerated secondary prevention intervention for those at risk for developing PGD. The primary objective is to develop and pilot-test an internet-based self-management intervention for PGD that employs empirically derived cognitive-behavioral therapy (CBT) strategies to promote stable, active routines, self-care, accommodation of loss, enhanced self-efficacy, reengagement in pleasurable activities, and reattachment with significant others. The proposed work capitalizes on established CBT techniques and recent research on using the internet to deliver CBT interventions, and is intended to provide the necessary development and pilot work for a large clinical trial. The key hypothesis is that this intervention will reduce PGD symptoms and associated functional impairments. We hypothesize that participation in the intervention will be high due to the increased anonymity and accessibility afforded by the internet, which reduces stigmatization, increases treatment compliance, and, in turn, will increase treatment response. We will accomplish the objectives by pursuing these specific aims: (1) Search the loss and PGD literature and collaborate with experts to develop an experiential and skills-based, 6- week, therapist-assisted self-management protocol; (2) Develop a tool to assess the maladaptive cognitions and perceived barriers that may prevent PGD patients engaging in effective self-care, and reengaging their social circle (and implement the tool in the intervention); (3) Develop and refine an interactive, easy-to-negotiate internet interface with underlying data capture and treatment monitoring capabilities to implement the protocol; (4) Validate and standardize the treatment protocol and internet interface based on feedback from experts, care providers, and patients; (5) Conduct a pilot trial to determine feasibility, safety, efficacy of the intervention, the usefulness of the internet treatment delivery and monitoring technology, and further refine the intervention based on feedback from participants who complete the protocol.