Does Adding a Tailored Cognitive Behavioral Therapy (CBT) Mobile Skills App Mediate Higher Rates of Depression Recovery, Adjustment, and Quality of Life in OEF/OIF Veterans Compared to Standard CBT?

认知行为疗法(CBT)是治疗抑郁症的领先的循证心理疗法，它 影响18.5%的持久自由行动(OEF)、伊拉克自由行动(OIF)和新行动 黎明(OND)退伍军人(以下简称OEF/OIF)。然而，OEF/OIF退伍军人的平均比例只有30% 从治疗初期到治疗后期的平均抑郁评分降低。这是真的，尽管 针对VA CBT-D的严格培训和认证程序。提高抑郁症的恢复率和 减刑对于提高OEF/OIF退伍军人改善工作和家庭适应以及整体的能力至关重要 生活质量。 广泛获取CBT的所有关键要素，包括技能练习(家庭作业)，与 改善和更快地从抑郁中恢复。OEF/OIF退伍军人和抑郁症患者 许多障碍(例如，时间、混乱的生活方式和低能量)使他们无法完成技能练习 任务。在缺乏有针对性的战略/干预措施来解决阻碍CBT技能的障碍的情况下 在实践中，OEF/OIF退伍军人将仍然无法充分享受CBT的好处/效果。具有特定的定制 解决这一治疗缺口的干预措施，OEF/OIF退伍军人将提高从 抑郁，家庭和工作适应能力减弱，生活质量不佳。 利用这一代退伍军人的技术智慧，改善获得CBT技能的机会 实践是解决这一治疗差距的合乎逻辑的策略。智能手机应用程序被认为是一种有用的 广泛使用的提高心理治疗效果的工具。然而，有一种稀缺的 移动应用在治疗退伍军人抑郁症中应用的实证研究 整体的心理治疗。一款全面定制的智能手机应用程序的有前景的试点结果 针对OEF/OIF退伍军人的CBT技能实践(“CBT MobileWork-V”)，使我们提出了一个更大规模的 随机临床试验(RCT)，以衡量CBT MobileWork-V(CBT MobileWork-V)增强CBT的疗效 实验ARM)，用于改善CBT理解和技能获得以及抑郁症状 OEF/OIF退伍军人抑郁症与标准CBT-D的比较具体来说，在27个月的时间里，我们 建议随机选择268名符合条件的有抑郁症状的OEF/OIF退伍军人，接受CBT增强 通过全面的CBT技能培训智能手机应用程序CBT MobileWork-V或标准CBT-D 传统的技能练习方法(即纸和铅笔)。这项研究的具体目的是： 主要目标1)评估CBT-D是否增加了CBT MobileWork-V(以下称为CBT- D+)与传统的CBT-D相比，促进了对CBT的更好理解和技能获得。 主要目的2a)比较CBT-D+治疗12周后抑郁症状的短期疗效。 标准CBT-D 主要目标2b)检查治疗后6个月对抑郁症状的长期影响 CBT-D+干预与传统CBT-D干预比较

Cognitive Behavioral Therapy (CBT) is the leading evidence-based psychotherapy for depression, which affects 18.5% of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans (hereafter referred to as OEF/OIF). Yet, OEF/OIF Veterans had only a 30% average reduction in mean depression scores from the initial to later phase of treatment. This was true despite the rigorous training and certification procedures for VA CBT-D. Improving the rate of depression recovery and remission is vital to enhance OEF/OIF Veteran’s ability to improve work and home adjustment and overall quality of life. Broad access to all key ingredients of CBT, including skills practice (homework), is associated with improved and faster recovery from depression. OEF/OIF Veterans and patients with depression have reported many barriers (i.e., time, chaotic lifestyles, and low energy) to following through with their skills practice assignments. In the absence of targeted strategies/interventions to address the barriers that prevent CBT skills practice, OEF/OIF Veterans will remain unable to reap the full benefits/effects of CBT. With specific tailored interventions to address this gap in treatment, OEF/OIF Veterans will improve rates of recovery from depression, diminished home and work adjustment, and poor quality of life. Leveraging the technological savvy of this generation of Veterans to improve access to CBT skills practice is a logical tactic to address this gap in treatment. Smartphone apps have been identified as a useful widely-used tool to improve the effectiveness of psychological treatments. There is, however, a paucity of empirical studies on the use of mobile apps in the treatment of depressed OEF/OIF Veterans and in psychological treatment overall. The promising pilot results of a comprehensive tailored smartphone app for CBT skills practice for OEF/OIF Veterans (“CBT MobileWork-V”), leads us to propose a larger-scale randomized clinical trial (RCT) to measure the efficacy of CBT enhanced with CBTMobileWork-V (the experimental arm) for improving CBT understanding and skill acquisition and depressive symptoms, in OEF/OIF Veterans with depression compared to standard CBT-D. Specifically, over a 27-month period we propose to randomize 268 eligible OEF/OIF Veterans with depressive symptoms, to either CBT augmented with the comprehensive CBT skill training smartphone app CBT MobileWork-V or standard CBT-D with traditional skills practice methods (i.e., paper and pencil). The Specific Aims of this study are: Primary Aim 1) To assess whether CBT-D augmented with CBT MobileWork-V (hereafter referred to as CBT- D+) promotes greater CBT understanding and skill acquisition compared to traditional CBT-D. Primary Aim 2a) To examine the short-term effect in depressive symptoms after 12 weeks of CBT-D+ versus standard CBT-D. Primary Aim 2b) To examine the long-term effect in depressive symptoms at 6 months post treatment of the CBT-D+ intervention versus traditional CBT-D.