Pandemic Acceptance and Commitment Therapy (Pan-ACT): Feasibility and Acceptability of Telehealth Delivery with Older Veterans

流行病接受和承诺疗法（Pan-ACT）：老年退伍军人远程医疗服务的可行性和可接受性

• 批准号: 10655582
• 负责人: LORI L. DAVIS
• 金额: --
• 依托单位: TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10655582
• 关键词: Accounting; Address; Adult; Aftercare; Aging; Anxiety; Attention; Behavior; Behavioral; COVID-19; COVID-19 mortality; COVID-19 pandemic; Climacteric; Clinical; Cognitive Therapy; Coping Skills; Data; Data Collection; Development; Diagnosis; Distress; Effectiveness; Effectiveness of Interventions; Elderly; Emotional; Enrollment; Feedback; Fright; Health; Impairment; Infection; Influenza vaccination; Intervention; Knowledge; Label; Life; Loneliness; Measures; Medical; Mental Depression; Mental Health; Method Acceptability; Methods; Modality; Modeling; Morbidity - disease rate; Nutritional; Outcome; Outcome Measure; Participant; Personal Satisfaction; Persons; Pilot Projects; Population; Prevention Measures; Procedures; Protocols documentation; Psychological Impact; Quality of life; Quasi-experiment; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Research; Research Personnel; Risk; Risk Factors; SARS-CoV-2 exposure; Sampling; Schedule; Science; Self Efficacy; Social Distance; Social isolation; Suicide; United States; Veterans; Virus; Well in self; acceptability and feasibility; age group; arm; behavior change; behavioral health; chronic pain; cohort; coping; design; effective therapy; electronic data; emotional distress; evidence base; experience; flexibility; follow-up; functional disability; group intervention; human old age (65+); improved; improved outcome; infancy; insight; invention; loved ones; male; medical appointment; military veteran; mindfulness; mortality; negative affect; pandemic disease; pandemic impact; pilot trial; post-pandemic; psychiatric comorbidity; psychologic; psychosocial; research study; skills; social; stay-at-home order; stressor; suicide rate; telehealth; timeline; treatment effect; willingness

Significance: Accounting for over 80% of COVID-19 related deaths in the United States, adults ages 65 and older have been disproportionately impacted by this pandemic more than any other age group. As a result, they may bear a heavy psychological burden in the months and years to come. Older adults have been labeled “vulnerable” to COVID-19 and strongly encouraged to adhere to “social distancing.” This prevention measure is meant to mitigate the spread of the virus but has increased older adults’ risk of social isolation and loneliness, which are two known correlates of increased morbidity and mortality in late life. Pandemic-related restrictions have decreased older adults’ life-space mobility and negatively affected their physical and nutritional well- being, impairing their quality of life and potentially increasing their vulnerability to poorer outcomes if exposed to COVID-19. Research has documented a plethora of pandemic-related stressors that are common among older adults (e.g., fear of infection, loss of loved ones, financial repercussions) and the culminating psychological impact. Telehealth-adapted evidence-based psychological interventions are needed to address the psychosocial and physical toll of the pandemic among older Veterans. Acceptance and Commitment Therapy (ACT) decreases emotional suffering, improves well-being, promotes and supports healthy behavior changes, and treats a wide range of diagnoses by increasing psychological flexibility through mindfulness, acceptance, and values-based behaviors. Higher psychological flexibility has been associated with pandemic- related coping and well-being. Randomized studies of ACT with older adults are few but promising, and most research studies with this population have used a group format. While research on telehealth delivery of ACT for older adults is limited, preliminary results indicate it is feasible and as effective as ACT delivered in person. Specific Aim: The proposed study will pilot a 10-session telehealth Pandemic ACT group intervention (i.e., Pan-ACT group) with Veterans ages 65 and older who are experiencing pandemic-related emotional and physical distress. Methods and Procedures: Twenty-five older Veterans will be enrolled in this single-arm feasibility pilot trial. The intervention will be delivered weekly in 90-minute sessions of groups of {four} to five Veterans. {Feasibility and acceptability of study procedures will be measured by referred-to-enrolled rate, telehealth access and capability, electronic data collection of outcome measures, and qualitative feedback on data collection procedures and measures. Feasibility and acceptability of the intervention will be measured by attendance; attrition; homework completion; participant ratings of the intervention’s feasibility, acceptability, and fit; qualitative feedback; and treatment fidelity.} Preliminary responsiveness of outcomes measures will be explored. Participants will complete measures of pandemic-related emotional and physical distress, psychological flexibility, depression, anxiety, social connectedness, perceived health, {functional impairment}, and meaningful engagement {at baseline, posttreatment, and one-month follow-up. A brief midpoint assessment at week 5 of the group will consist of measures of social connectedness and functional impairment. Qualitative data will be gathered on perceived efficacy to implement intervention skills and specific emotional or behavioral changes participants have noticed in themselves as a result of the intervention.} Conclusion: {This proposal directly aligns with the RR&D RFA to examine COVID-19-specific rehabilitation interventions. The telehealth Pan-ACT Group is a mental and behavioral health rehabilitation intervention that focuses on helping older Veterans develop or recover coping skills that were lost or are no longer effective during the ongoing COVID-19 pandemic.} The proposed study leverages the investigators’ strengths and expertise to address a major research and clinical gap, gather new knowledge for an urgent need, and inform the development of a full-scale randomized controlled trial to evaluate the intervention’s effectiveness.

意义：占美国新冠肺炎相关死亡的80%以上，65岁及以上的成年人 与任何其他年龄段相比，老年人受到这场大流行的影响更大。结果, 在未来的几个月和几年里，他们可能会承受沉重的心理负担。老年人已经被贴上了标签 易受新冠肺炎攻击，强烈鼓励坚持“社交疏远”。这项预防措施是 旨在缓解病毒的传播，但增加了老年人社交孤立和孤独的风险， 这是晚年发病率和死亡率增加的两个已知相关性。与大流行相关的限制 已经降低了老年人的生活空间流动性，并对他们的身体和营养状况产生了负面影响 如果暴露在环境中，会损害他们的生活质量，并可能增加他们对较差结果的易感性 敬新冠肺炎。研究已经记录了过多的与大流行相关的压力源，这些压力源在 老年人(例如，对感染的恐惧、失去亲人、经济影响)以及 心理影响。远程健康适应的循证心理干预需要解决 这场大流行在老年退伍军人中造成的心理社会和身体损失。接受和承诺 治疗(ACT)减少情绪痛苦，改善幸福感，促进和支持健康行为 通过正念增加心理灵活性，改变和治疗广泛的诊断， 接受，以及基于价值观的行为。较高的心理灵活性与大流行有关- 相关的应对方式和幸福感。对老年人进行的ACT随机研究很少，但很有希望，而且大多数 对这一群体的研究采用了小组形式。同时对ACT的远程医疗服务进行研究 对于老年人来说是有限的，初步结果表明它是可行的，与亲自提供的ACT一样有效。 具体目的：拟议的研究将试行为期10届的远程卫生大流行ACT小组干预(即， 泛ACT组)与65岁及以上的退伍军人一起，他们正在经历与大流行有关的情感和 身体上的痛苦。 方法和程序：25名老年退伍军人将参加这项单臂可行性试点试验。 干预将以每周90分钟的时间进行，由{4}到5名退伍军人组成的小组进行。{可行性 研究程序的可接受性将通过转诊至注册率、远程医疗准入和 能力、成果衡量的电子数据收集和数据收集的定性反馈 程序和措施。干预的可行性和可接受性将通过出席率来衡量； 流失率；作业完成；参与者对干预的可行性、可接受性和适合性的评分； 质量反馈；和治疗保真度。}结果措施的初步响应性将是 探索过了。参与者将完成与大流行相关的情绪和身体痛苦的测量， 心理灵活性、抑郁、焦虑、社会联系、感知健康、功能障碍、 和有意义的参与(在基线、治疗后和一个月的随访中)。一个简短的中间点 小组第五周的评估将包括社会联系和功能的测量 减损。将收集有关感知疗效的定性数据，以实施干预技能和具体 作为干预的结果，参与者注意到自己的情绪或行为变化。} 结论：{该建议直接与RR&D RFA保持一致，以检查新冠肺炎特有的康复 干预措施。远程健康泛ACT小组是一种心理和行为健康康复干预措施， 重点帮助老年退伍军人发展或恢复失去或不再有效的应对技能 在正在进行的新冠肺炎大流行期间。}拟议的研究利用了调查人员的优势和 解决重大研究和临床差距的专业知识，收集新知识以满足迫切需求，并提供信息 开展一项全面的随机对照试验，以评估干预的有效性。