Feasibility Study of Compassion Meditation Intervention for Older Veterans in Primary Care with Anxiety or Mood Disorders

对初级保健中患有焦虑或情绪障碍的老年退伍军人进行同情冥想干预的可行性研究

• 批准号: 10383129
• 负责人: Barton W. Palmer
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10383129
• 关键词: Adherence; Adolescent; Age; Aging; Anxiety; Anxiety Disorders; Award; Awareness; Behavioral; Biological Markers; Clinic; Clinical; Cognitive; Compassion; Data; Development; Effectiveness; Elderly; Emotions; Enrollment; Feasibility Studies; Focus Groups; Fostering; Future; Goals; Group Structure; Health; Health Care Costs; Healthcare Systems; High Prevalence; Home; Inflammation; Inflammatory; Inflammatory Response; Intervention; Intervention Studies; Interview; Length; Link; Medical; Meditation; Mental Depression; Mental Health; Mental Health Services; Meta-Analysis; Minority; Modification; Mood Disorders; Moods; Morbidity - disease rate; Nature; Outcome; Outcome Measure; Participant; Patients; Personal Satisfaction; Physiological; Population; Population Analysis; Post-Traumatic Stress Disorders; Primary Health Care; Psychiatry; Psychological Factors; Psychology; Randomized Controlled Trials; Recommendation; Recovery; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk; Sampling; Severities; Stigmatization; Stress; Symptoms; Testing; Training; Veterans; anxiety symptoms; base; cardiovascular risk factor; care seeking; clinically significant; comorbidity; depressive symptoms; design; disability; effective therapy; emotional distress; experience; follow-up; functional restoration; group intervention; health care service utilization; healthy aging; impression; improved; interest; mortality; novel; optimism; physical conditioning; positive emotional state; preference; programs; protective effect; psychiatric symptom; psychoeducational; psychologic; psychological distress; psychosocial; resilience; response; self esteem; social; social stigma; treatment group; university student; willingness; young adult

Older Veterans show a high prevalence of clinically significant psychological distress such as anxiety and depressive symptoms. This high prevalence includes patients seen in Primary Care clinics. These symptoms are not only aversive in themselves, they are also associated with risk of psychosocial disability, increased medical comorbidity, early mortality, and increased health care costs. Although these concerns similarly exist among younger Veterans, the situation is particularly problematic among older Veterans as older age is associated with low utilization of mental health services. Prior research focused on identifying barriers to mental health care utilization among older Veterans have repeatedly pointed to the perceived stigma of symptom-focused treatments, which can be perceived by some Veterans as being “deficit-focused”. Therefore, it may be useful to develop effective strengths-based interventions. Compassion meditation (CM) training is a promising strengths-focused candidate in this regard, in that prior research, albeit with civilian samples, has suggested CM training promotes positive emotions and well-being, while reducing anxiety, depression, and other negative emotions. There has been less research with Veteran samples, but one study by Lang and colleagues also suggested effectiveness for Veterans with PTSD. CM has not been adapted or tested in the context of treating older Veterans with anxiety or depression. The proposed project will collect pilot data to establish feasibility for a future randomized controlled trial (RCT) of manualized CM group intervention to restore functioning in older Veterans identified through VA Primary Care clinics as having clinically significant psychological distress. This non-randomized feasibility study represents a critical initial step in adapting CM and evaluating its potential as an effective strengths-focused treatment for use with this population. Participants will include up to 40 Veterans age > 55 years identified through the Primary Care Mental Health Integrated program at the VA San Diego Healthcare System with mild-to-moderate anxiety or depressive symptoms. Twenty to 30 of these participants will be enrolled in a 10-week CM training group (with 8-10 participants in each group). The groups will be conducted with a manualized CM intervention, although part of the goal of the feasibility study is to identify and adapt the intervention to the needs of this specific population. Key questions for the feasibility study include determining participants' willingness to enroll, adherence and completion of the intervention, as well as to determine appropriate modifications in the intervention to make it maximally acceptable and appropriate to older Veterans. We will also be collecting pilot data regarding the potential of the intervention to improve well-being, symptom severity, and/or positive psychological factors. There is a growing interest in the field in expanding outcome measures beyond subjective behavioral reports, thus, we will also explore the feasibility of using inflammatory biomarkers as a non-behavioral indicator of CM intervention response. As part of establishing feasibility for a subsequent large-scale RCT, 10 additional participants will be enrolled in a 10-session manualized psychoeducational group focused on topics in healthy aging. The latter group will be conducted to examine the feasibility and appropriateness of employing this as a control condition in a follow-up RCT. Participants will also be interviewed after completion of the CM or psychoeducational groups in order to obtain their subjective impressions and recommendations for the content and structure of the groups. Given the preliminary nature of this line of research for this population, analyses will be primarily descriptive rather than focused on hypothesis testing.

老年退伍军人表现出高度的临床显著心理困扰，如焦虑和 抑郁症状。这一高患病率包括在初级保健诊所看到的患者。这些症状 他们不仅本身令人厌恶，还与心理社会残疾的风险有关，增加 医疗合并症、早期死亡率和增加的医疗保健费用。尽管这些担忧同样存在 在年轻的退伍军人中，这种情况在老年退伍军人中尤其成问题，因为年龄较大 与心理健康服务利用率低有关。之前的研究侧重于识别障碍， 老年退伍军人对精神卫生保健的利用一再指出 以症状为重点的治疗，这可能被一些退伍军人视为“以缺陷为重点”。因此，它 可能有助于制定有效的以优势为基础的干预措施。同情冥想(CM)训练是一种 在这方面，有希望的专注于优势的候选人，在之前的研究中，尽管是平民样本，但已经 建议CM培训促进积极情绪和幸福感，同时减少焦虑、抑郁和 其他负面情绪。对老牌样本的研究较少，但朗和 同事们还建议对患有创伤后应激障碍的退伍军人有效。CM尚未在 治疗患有焦虑或抑郁的老年退伍军人的背景。拟议的项目将收集试点数据以 建立未来人工CM组干预的随机对照试验(RCT)的可行性 通过退伍军人初级保健诊所确定具有临床意义的老年退伍军人恢复功能 心理上的痛苦。这项非随机化的可行性研究是适应CM的关键的第一步 并评估其作为一种有效的、以优势为重点的治疗方法的潜力，供这一人群使用。 参与者将包括通过初级保健精神健康确定的最多40名年龄和55岁的退伍军人 退伍军人事务部圣地亚哥医疗系统的综合计划，患有轻度至中度焦虑或抑郁 症状。这些参与者中有20到30人将参加为期10周的CM培训小组(8-10人 每组参与者)。这些小组将通过手动CM干预进行，尽管部分 可行性研究的目标是确定干预措施并使之适应这一特定人群的需要。 可行性研究的关键问题包括确定参与者的注册意愿、遵守情况和 完成干预，以及确定干预中的适当修改以使其 最大限度地可接受并适合年长的退伍军人。我们还将收集关于 干预措施改善幸福感、症状严重程度和/或积极心理因素的潜力。 该领域越来越有兴趣将结果测量扩展到主观行为报告之外， 因此，我们还将探讨使用炎性生物标志物作为CM的非行为指标的可行性 干预反应。作为确定后续大规模区域风险评估可行性的一部分，另外10 参与者将参加一个为期10节的手动心理教育小组，重点是健康主题 衰老。后一组工作将会进行，以研究采用这项措施作为 在后续的随机对照试验中控制情况。参与者也将在完成CM或 心理教育小组，以获得他们对内容的主观印象和建议 和群体的结构。考虑到针对这一人群的这一研究的初步性质，分析 将主要是描述性的，而不是专注于假设检验。