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，为什么以及何时起作用的问题仍然存在。拟议的研究回应了对创新研究设计的呼吁，允许更密集、个性化的数据收集，可以解决有关治疗相关变化动态性质的复杂问题。在本R21申请中，我们提出了一项概念验证研究，该研究使用了经验抽样方法（ESM）的创新应用，该方法将单受试者研究的具体优势与大样本和多水平分析相关的统计优势相结合。ESM涉及对参与者日常环境中发生的行为进行抽样，从而提高生态效度并减少回顾性偏差。34名患有原发性重度抑郁症的成年人将被随机分配到16周的自我系统治疗（SST），一种针对激励动机和目标追求缺陷的新的短期经验支持的抑郁症心理治疗，或常规治疗（TAU）。参与者将在预处理时完成一系列个体差异和诊断措施。为期一周的强化ESM将在治疗前和治疗后收集，在此期间，参与者将在每天的随机时间收到信号，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周的治疗过程中，参与者将在每周随机选择的两天完成类似的IVR评估。拟议中的研究将检验三个主要假设。(1)与TAU组相比，SST组患者在治疗过程中对促进目标和活动的参与程度以及与目标相关的积极情绪日常体验的增加程度更高。(2)与TAU患者相比，SST患者在治疗过程中对预防目标和活动的参与程度以及与目标相关的日常负面情绪体验的减少程度更大。(3)在SST条件下，未能追求或实现晋升目标的历史和慢性调节取向的个体差异（即对晋升目标和预防目标的取向强度）将调节SST对抑郁症状变化和日常晋升目标投入体验的影响。这项拟议中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治疗如何起作用的认识。本研究获得的数据将为更大规模的程序化研究抑郁症患者治疗诱导改变过程的本质提供良好的经验和理论框架。

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.