Telehealth CBT to address social isolation in Veterans with chronic pain

孤独是一种主观的情绪状态，其特征是对社会孤立的感知 与死亡率和慢性疼痛增加相关的心理社会压力。拥有 慢性疼痛和报告孤独在活动中经历更多与疼痛相关的干扰，抑郁，和 自杀念头。重要的是，有一些潜在有效的干预措施可以用来减少 孤独感；然而，还没有研究直接干预退伍军人的孤独感。 慢性疼痛。孤独认知行为疗法(CBT-L)通过寻址干预孤独 持续孤独、增加负面情绪、降低参与能力的负面信念 社会活动。对于患有慢性疼痛的退伍军人来说，这对于解决负面影响和拥有 一个人拥有社会支持和参与社会支持的感觉是增强功能的关键方面。而当 CBT治疗慢性疼痛(CBT-CP)包括促进社会功能的技能，更有力的努力可能是 需要更好地解决孤独问题，同时还要解决功能障碍问题。 这项拟议的为期两年的研究使用了一种新的应用，即简短的、电话递送的、基于证据的 干预，CBT-L，通过改变与社会相关的适应不良思维模式来减少孤独， 更多地参与愉快的社会活动，提高解决问题的能力。参与者将 使用在线广告在全国范围内招聘。当前提案的目标是使CBT-L适应 优化其对患有慢性疼痛的退伍军人的影响，检查招募、保留和治疗交付 是否可行，以及CBT-L是否为参与者所接受，并评估关键结果的参数 参与者随机接受CBT-L与CBT-CP，以告知随后的更大规模的临床试验。 为了实现这些目标，我们将通过基于证据的迭代过程来调整手册 对报告孤独的慢性疼痛退伍军人进行单臂CBT-L试验(n=8)。在提炼完 手册和程序在单臂试验之后，我们将随机选择总共40名参与者，让他们接受 CBT-L或CBT-CP。我们将评估孤独，社会互动的质量和数量，以及痛苦的结果 例如与疼痛有关的干预，以及在基线和治疗期间之后的疼痛灾难。我们会 还要跟踪参与者的流程、治疗师对手册的遵守情况、参与者的作业完成情况和参与者 对治疗的满意度。

Loneliness—a subjective emotional state characterized by the perception of social isolation—is a psychosocial stressor that is associated with increased mortality and chronic pain. Individuals who have chronic pain and report loneliness experience greater pain-related interference in activities, depression, and suicidal ideation. Importantly, there are potentially effective interventions that can be used to decrease loneliness; however, there are no studies that have directly intervened on loneness among Veterans with chronic pain. Cognitive-Behavioral Therapy for Loneliness (CBT-L) intervenes on loneliness by addressing negative beliefs that perpetuate loneliness, increase negative affect, and reduce one’s ability to engage in social activities. For a Veteran with chronic pain, this is critical as addressing negative affect, and having a sense that one has social support and engages social support are key aspects of increasing functioning. While CBT for Chronic Pain (CBT-CP) comprises skills to promote social functioning, more robust efforts may be needed to better address lonely while also addressing functional impairment. The proposed two-year study uses a novel application of a brief, phone-delivered, evidence-based intervention, CBT-L, to decrease loneliness by modifying socially-relevant maladaptive thinking patterns, increasing engagement in enjoyable and social activities, and improving problem solving skills. Participants will be recruited nationally using online advertising. The objectives of the current proposal are to adapt CBT-L to optimize its impact on Veterans with chronic pain, examine if the recruitment, retention, and treatment delivery is feasible and if CBT-L is acceptable to participants, and assess parameters of key outcomes among participants randomized to receive CBT-L versus CBT-CP to inform a subsequent larger clinical trial. To achieve these objectives, we will adapt a manual through an evidence-based, iterative process then conduct one-arm trial of CBT-L (n=8) in Veterans with chronic pain reporting loneliness. After refining the manual and procedures following the one-arm trial, we will randomize a total of 40 participants to receive either CBT-L or CBT-CP. We will assess loneliness, the quality and quantity of social interactions, and pain outcomes such as pain-related interference, and pain catastrophizing at baseline and after the treatment period. We will also track participant flow, therapist adherence to the manual, participant homework completion and participant satisfaction with the treatment.