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.

重要性：在美国，65岁以上的成年人占COVID-19相关死亡人数的80%以上， 老年人受这一流行病的影响比任何其他年龄组都大。因此，在本发明中， 他们在未来的岁月里可能会承受沉重的心理负担。老年人被贴上了标签 “易受”COVID-19影响，并强烈鼓励坚持“社交距离”。这一预防措施是 旨在缓解病毒传播，但增加了老年人社会孤立和孤独的风险， 这是两个已知的与晚年发病率和死亡率增加相关的因素。与流行病有关的限制 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， 存在，损害他们的生活质量，并可能增加他们的脆弱性，如果暴露于更糟糕的结果 新冠肺炎研究记录了大量与流行病相关的压力源，这些压力源在 老年人（例如，害怕感染，失去亲人，财务影响）和最终 心理影响。需要适应远程保健的循证心理干预措施， 这一流行病在老年退伍军人中造成的心理和身体上的损失。接受和承诺 治疗（ACT）减少情绪痛苦，改善福祉，促进和支持健康的行为 改变，并通过正念增加心理灵活性来治疗广泛的诊断， 接受和基于价值观的行为。更高的心理灵活性与流行病有关- 相关的应对和福祉。老年人ACT的随机研究很少，但很有希望， 对这一群体的研究采用了小组形式。在研究ACT的远程医疗服务时， 对于老年人来说是有限的，初步结果表明它是可行的，并且与亲自交付的ACT一样有效。 具体目标：拟议的研究将试点10个会议的远程保健大流行ACT组干预（即， 泛ACT组）与退伍军人年龄65岁及以上谁是经历流行病相关的情绪和 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。 干预将每周进行一次，每次90分钟，由{4}至5名退伍军人组成。可行性 研究程序的可接受性将通过入选率、远程医疗访问和 能力、成果计量的电子数据收集和数据收集的质量反馈 程序和措施。干预措施的可行性和可接受性将通过出席率来衡量; 损耗;家庭作业完成;参与者对干预的可行性、可接受性和适合性的评级; 定性反馈;和治疗保真度。结果测量的初步响应性将是 探讨了参与者将完成与流行病有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，自觉健康，{功能障碍}， 和有意义的参与{基线，治疗后和一个月随访。短暂的中点 第5周的评估将包括社会联系和功能的测量。 损伤将收集关于实施干预技能和具体 参与者在干预后注意到自己的情绪或行为变化。 结论：{本提案与RR&D RFA直接一致，以检查COVID-19特定康复 干预措施。远程保健泛ACT小组是一个精神和行为健康康复干预， 重点是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 在持续的COVID-19大流行期间。拟议的研究利用了研究人员的优势， 专业知识，以解决重大的研究和临床差距，收集新的知识，以满足迫切需要，并告知 开展全面的随机对照试验，以评估干预措施的有效性。