Assessing change in short-term therapy for depression using ESM

描述(由申请人提供)：结果研究表明，几种形式的心理治疗对抑郁症有效，但关于这些治疗如何、为什么以及何时有效的问题仍然存在。这项拟议的研究响应了对创新研究设计的呼吁，允许进行更密集、个性化的数据收集，以解决与治疗相关的变化的动态性质的复杂问题。在这项R21应用中，我们提出了一项概念验证研究，它使用了经验抽样方法(ESM)的创新应用，将单一主题研究的具体优势与大样本和多水平分析的统计优势相结合。ESM涉及对参与者日常环境中发生的行为的各个方面进行采样，从而提高生态有效性并减少回溯性偏见。34名患有原发性重度抑郁障碍的成年人将被随机分配到16周的治疗中，要么接受自我系统治疗(SST)，要么接受常规治疗(TAU)。SST是一种新的短期、有经验支持的抑郁症心理治疗方法，针对的是激励动机和目标追求方面的缺陷。参与者将在治疗前完成一系列的个体差异和诊断措施。治疗前和治疗后都将收集一周的强化ESM，在此期间，参与者将在每天的随机时间被发出信号，通过基于电话的交互式语音应答(IVR)系统回答有关几个领域(例如，情感、认知和目标追求)当前功能的问题。在整个16周的治疗中，参与者将在每周随机选择的两天完成类似的IVR评估。这项拟议的研究将检验三个主要假设。(1)与TAU组患者相比，SST组患者在参与推广目标和活动方面的增加更多，在治疗过程中与目标相关的日常积极情绪体验的增加也更多。(2)与TAU组患者相比，SST组患者在参与预防目标和活动方面表现出更大的减少，并且在治疗过程中与目标相关的日常负面影响体验的减少也更多。(3)在SST条件下，追求或实现提升目标失败的历史和长期调节定向(即对促进和预防目标的定向强度)的个体差异会调节SST对抑郁症状的改变和对提升目标投入的日常体验的影响。这项拟议的研究将对一个重要的公共卫生问题产生重大影响，并将扩大我们对抑郁症心理疗法如何奏效的了解。从这项研究中获得的数据将为更大规模的程序性研究抑郁症患者治疗引起的变化过程的性质提供可靠的经验和理论框架。 公共卫生相关性：在工业化国家，抑郁症是一个主要的公共卫生问题，也是导致发病率和残疾的主要原因。这项拟议的项目将通过评估成年人在日常生活中的功能，来研究临床抑郁症患者在短期心理治疗过程中的变化。该项目将导致更全面地了解治疗如何影响患者的日常功能，并与改善治疗结果直接相关。

DESCRIPTION (provided by applicant): Outcome studies have shown that several forms of psychotherapy are effective for depression, but questions about how, why, and when these treatments work remain. The proposed study answers the call for innovative research designs that allow for more intensive, individualized data collection that can address complex questions about the dynamic nature of treatment-related change. In this R21 application, we propose a proof-of-concept study using an innovative application of experience sampling methodology (ESM) that combines the idiographic advantages of single-subject research with the statistical advantages associated with larger samples and multilevel analyses. ESM involves sampling aspects of behavior occurring in the participant's everyday environment, thereby enhancing ecological validity and reducing retrospective bias. Thirty-four adults with primary major depressive disorder will be randomly assigned to 16 weeks of either self-system therapy (SST), a new short-term, empirically-supported psychotherapy for depression that targets deficits in incentive motivation and goal pursuit, or treatment-as-usual (TAU). Participants will complete a battery of individual difference and diagnostic measures at pretreatment. One week of intensive ESM will be collected at both pre- and post-treatment, during which participants will be signaled at random times during each day to answer questions about current functioning in several domains (e.g., affect, cognition, and goal pursuit) delivered via a phone-based interactive voice response (IVR) system. Throughout the 16 weeks of treatment, participants will complete similar IVR assessments on two randomly-selected days per week. The proposed study will test three main hypotheses. (1) Patients in SST will show greater increases in engagement with promotion goals and activities as well as greater increases in goal-related daily experiences of positive affect over the course of treatment compared to patients in TAU. (2) Patients in SST will show greater decreases in engagement with prevention goals and activities as well as greater decreases in goal- related daily experiences of negative affect over the course of treatment compared to patients in TAU. (3) Within the SST condition, a history of failure to pursue or achieve promotion goals and individual differences in chronic regulatory orientation (i.e., strength of orientation toward promotion and prevention goals) will moderate the effects of SST on changes in depressive symptoms and on daily experiences of promotion goal engagement. The proposed research will have a significant impact on an important public health problem and will expand our knowledge of how psychotherapy for depression works. The data to be obtained from this study will provide a sound empirical and theoretical framework for larger-scale programmatic research on the nature of treatment-induced change processes in patients with depression. PUBLIC HEALTH RELEVANCE: Depression is a major public health concern and a leading cause of morbidity and disability in industrialized nations. The proposed project will examine how adults with clinical depression change over the course of short-term psychotherapy by assessing how they are functioning in their daily lives. This project will lead to a more comprehensive understanding of how therapy affects patients' everyday functioning, and it has direct relevance for improving treatment outcomes.