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Deployment-Focused Development of Depression Treatment for Victimized Youth

以部署为重点的受害青少年抑郁症治疗发展

基本信息

批准号：
7849690
负责人：
STEPHEN R SHIRK
金额：
$ 19.3万
依托单位：
UNIVERSITY OF DENVER (COLORADO SEMINARY)
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-05-09 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7849690
关键词：
Address Adherence Adolescent Affect Aftercare Ambulatory Care Facilities Attention Behavior Therapy Behavioral Child Clinic Clinical Clinical Trials Cognition Cognitive Cognitive Therapy Collaborations Communities Community Mental Health Centers Consultations Depressed mood Depressive disorder Deterioration Development Diagnosis Domestic Violence Emotional Ensure Evaluation Failure Future Gender Goals Individual Intervention Maintenance Major Depressive Disorder Manuals Measures Mental Depression Mental Health Modeling Modification Outcome Parents Pathway interactions Pattern Pharmacotherapy Phase Population Process Protocols documentation Randomized Randomized Controlled Trials Recording of previous events Reporting Research Research Personnel Resistance Sampling Schools Sexual abuse Short-Term Memory Structure Substance abuse problem Symptoms Teenagers Testing Thinking Training Trauma Treatment Efficacy Treatment Protocols Writing Youth base cognitive function community setting depressive symptoms design early childbearing efficacy trial executive function follow-up maltreatment mindfulness psychologic psychosocial public health priorities randomized trial response satisfaction skill acquisition suicidal risk therapy development treatment adherence treatment as usual treatment duration treatment effect treatment response trial comparing

项目摘要

DESCRIPTION (provided by applicant): This primary goal of this revised R34 application is to develop and conduct an initial evaluation of a modified cognitive-behavioral treatment (m-CBT) for depressed adolescents with histories of interpersonal trauma. A substantial number of adolescents retain their diagnoses or remain symptomatic following psychosocial or pharmacotherapy for depression. Notably, depressed adolescents with histories of trauma have been found to be less responsive to cognitive-behavioral therapy (CBT) for depression than non-exposed adolescents. Interpersonal trauma has been identified as a prominent developmental pathway to major depressive disorder and is prevalent among referrals to community clinics; thus, addressing the needs of this "treatment resistant" group is a high public health priority. In order to address the needs of this "treatment resistant" group, we propose to modify a cognitive-behavioral protocol that has been shown to be efficacious in prior clinical trials. Treatment modifications are based on the hypothesis that standard CBT does not address two factors central to depression in trauma-exposed youth: 1.) deficits in executive function; and 2.) trauma-related cognitions. First, deficits in executive functioning (e.g., attention, interference control, set shifting) found among traumatized youth are hypothesized to interfere with skill acquisition in CBT. To this end, the usual CBT modules will be modified to include empirically-supported interventions targeting executive function (e.g., attention control training, mindfulness-based cognitive interventions). Second, trauma-exposed individuals have been shown to endorse specific trauma-related maladaptive cognitions that are not typically targeted by CBT. To this end, the treatment will target both depressive automatic thoughts and trauma-related cognitions. Because a history of interpersonal trauma is prevalent among depressed adolescents in community clinics, this project uses a deployment-focused model of treatment development in order to create a "clinic-ready" intervention. To this end, the treatment will be developed and tested in a community mental health center with community clinicians and referred adolescents. The study involves two phases; the first involves pilot testing of the treatment manual with 8 referred adolescents. Acceptability, satisfaction, treatment adherence, and pre- post change in depressive symptoms will be examined. Following manual refinement, a randomized controlled trial under clinically-representative conditions will be conducted with a referred sample of 60 adolescents with a primary depression diagnosis and a history of interpersonal trauma. Adolescents will be randomized to the new intervention (m-CBT) or to an eclectic treatment-as-usual condition. Changes in depressive symptoms, global functioning, and cognitive processes (executive functions and trauma-related cognitions) will be evaluated between pre and post-treatment, and at 3-month follow-up. Linear mixed models with repeated measures will be used to evaluate the effects of treatment. Major depression affects approximately 1 in 6 adolescents during the teen years and results in increased risk for suicide, substance abuse, early childbearing, and school failure. Child interpersonal trauma is a well- documented pathway to major depression. Because youth exposed to interpersonal trauma are less likely to respond favorably to existing depression treatments, this project will develop and evaluate a new treatment for depressed adolescents with interpersonal trauma histories.

描述（由申请人提供）：本修订版R34申请的主要目标是开发并对有人际创伤史的抑郁青少年的改良认知行为治疗（m-CBT）进行初步评估。相当多的青少年保留他们的诊断或保持症状后，心理或药物治疗抑郁症。值得注意的是，有创伤史的抑郁青少年对抑郁症的认知行为治疗（CBT）的反应比未暴露的青少年要低。人际创伤已被确定为一个突出的发展途径，以严重抑郁症，是普遍的转介到社区诊所，因此，解决这个“治疗抵抗”组的需要是一个高度的公共卫生优先事项。为了解决这个“治疗抵抗”组的需求，我们建议修改认知行为协议，已被证明是有效的，在以前的临床试验。治疗的修改是基于这样的假设，即标准的CBT并没有解决创伤暴露青年抑郁症的两个核心因素：1。执行功能缺陷; 2.）创伤相关的认知首先，执行功能的缺陷（例如，注意力，干扰控制，设置转移）中发现的创伤青年被假设为干扰技能的获得在CBT。为此，通常的CBT模块将被修改，以包括针对执行功能（例如，注意力控制训练，基于正念的认知干预）。第二，创伤暴露的个体已经被证明支持特定的创伤相关的适应不良认知，而这些认知通常不是CBT的目标。为此，治疗将针对抑郁的自动思维和创伤相关的认知。由于人际创伤史在社区诊所的抑郁青少年中很普遍，因此该项目采用了以部署为重点的治疗开发模型，以创建“临床准备”干预。为此，将在社区精神卫生中心与社区临床医生和转诊的青少年一起开发和测试这种治疗方法。该研究包括两个阶段;第一阶段是对8名被转诊的青少年进行治疗手册的试点测试。研究对象包括接受度、满意度、治疗依从性及治疗前后抑郁症状的变化.在手工提炼后，将在具有临床代表性的条件下进行随机对照试验，其中包括60名患有原发性抑郁症诊断和人际创伤史的青少年。青少年将被随机分配到新的干预措施（m-CBT）或折衷的治疗照常条件。将在治疗前和治疗后以及3个月随访时评价抑郁症状、整体功能和认知过程（执行功能和创伤相关认知）的变化。将使用重复测量的线性混合模型评价治疗效果。重度抑郁症在青少年时期影响大约六分之一的青少年，并导致自杀，药物滥用，早育和学业失败的风险增加。儿童的人际创伤是导致严重抑郁症的一个有据可查的途径。由于暴露于人际创伤的青少年不太可能对现有的抑郁症治疗产生积极的反应，因此该项目将为有人际创伤史的抑郁青少年开发和评估一种新的治疗方法。