Reducing Anxiety and Improving Functioning in Older Veterans

 说明： 拟议的CDA-2将为退伍军人事务部帕洛阿尔托老年研究教育和临床中心(GRECC)的临床心理学家、最近毕业的退伍军人事务部老年医学高级研究员克里斯汀·古尔德博士提供研究培训，以促进她的职业生涯，旨在减缓患有焦虑和抑郁的老年退伍军人的功能衰退。她的导师团队包括Ruth O‘Hara博士、Sherry A.Beaudreau、Mary Goldstein和Julie Wetherell。顾问包括海伦娜·克莱默博士、Joung Won(Terri)Huh博士和Eric Kuhn博士。在CDA-2奖项中，古尔德博士将获得以下方面的培训：1)临床试验和纵向方法，2)技术和电子健康，3)医学共病和功能，以及4)拨款和科学写作。在CDA-2研究计划中，古尔德博士的目标是测试针对焦虑的短暂心理社会干预是否能改善患有焦虑症的老年退伍军人的功能。焦虑无处不在，代价高昂，并导致行为回避、残疾和生活质量低下。拟议的CDA-2预计将通过减少焦虑和回避，从而增加他们对活动的参与和改善整体功能，使老年退伍军人(=60岁)受益。这个项目与老年人在治疗焦虑方面更倾向于心理治疗而不是药物治疗相一致。拟议项目的第一个目标是通过DVD视频将渐进式肌肉放松(PMR)-一种治疗老年焦虑的有效方法-应用于家庭管理。自我导向的PMR将增加老年退伍军人获得这一短暂治疗的机会。这项名为“呼吸(呼吸、放松和家庭环境中的焦虑治疗教育)”的项目由古尔德博士和她的导师共同开发，其中包括与年龄相适应的焦虑引发情况的小插曲(例如，与健康相关的担忧、经济问题、就诊)。两个研究将解决第一个目标。在研究1a中，将通过半结构化访谈获得20名年长退伍军人对视频模块的定性反馈。在研究1b中，将在10名患有焦虑症的老年退伍军人中试验呼吸的可行性，特别是患有广泛性焦虑障碍(GAD)、惊恐障碍(PD)、广场恐惧症、社交焦虑障碍(SAD)和焦虑障碍NOS。将使用修改后的活动卡分类对功能进行评估。CDA-2的第二个目标是评估退伍军人的偏好、获得技术平台的机会和对可用于提供简短心理社会治疗的技术平台的看法。研究2将在75名老年退伍军人中解决这一目标，方法是通过采访和问卷调查获得关于电话、基于网络、移动应用程序、远程医疗和基于DVD的干预平台的反馈。CDA-2的第三个目标是确定与主动控制(心理教育)相比，呼吸是否对焦虑和功能有更大的影响。研究3将通过对60名患有焦虑症(GAD、PD、广场恐怖症、SAD和不明焦虑症)的老年退伍军人进行基于DVD的呼吸与心理教育的随机对照试验来解决这一目标。据推测，与心理教育相比，呼吸将导致老年焦虑量表测量的焦虑症状在统计和临床上的显著减少。与随机接受心理教育的参与者相比，与随机接受心理教育的参与者相比，随机接受呼吸状况的参与者预计功能会有所改善。研究3中的假设将通过混合效应模型来解决。这种CDA-2是朝着古尔德博士的长期目标迈出的重要一步，他的目标是成为退伍军人管理局干预研究的领先者，旨在通过治疗精神健康症状来改善老年退伍军人的功能。这一CDA-2也符合古尔德博士的目标，即开发这些干预措施，通过不同的技术平台传播，作为她未来独立的退伍军人管理局研究生涯实施和推广过程的一部分。

 DESCRIPTION: The proposed CDA-2 will provide Dr. Christine Gould, a Clinical Psychologist at the VA Palo Alto Geriatric Research Education and Clinical Center (GRECC) and recently graduated VA Advanced Fellow in Geriatrics, with research training to foster her career aimed at slowing functional decline in older Veterans with anxiety and depression. Her mentor team includes Drs. Ruth O'Hara, Sherry A. Beaudreau, Mary Goldstein, and Julie Wetherell. Consultants include Drs. Helena Kraemer, Joung Won (Terri) Huh, and Eric Kuhn. In this CDA-2 award, Dr. Gould will obtain training in 1) clinical trials and longitudinal methods, 2) technology and eHealth, 3) medical comorbidity and functioning, and 4) grant and scientific writing. In the CDA-2 research plan, Dr. Gould aims test whether a brief psychosocial intervention for anxiety improves functioning in older Veterans with anxiety disorders. Anxiety is pervasive, costly, and leads to behavioral avoidance, disability, and poor quality of life. The proposed CDA-2 is expected to benefit older Veterans (= 60 years) by reducing anxiety and avoidance and thereby increasing their engagement in activities and improving overall functioning. This project is aligned with older adults' preference of psychotherapy to pharmacotherapy for treating anxiety. The first aim of the proposed project is to adapt progressive muscle relaxation (PMR), an efficacious treatment for late-life anxiety, for administration at home using DVD videos. Self-directed PMR will increase older Veterans' access to this brief treatment. The program, BREATHE (Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment), was developed by Dr. Gould with her mentors' input and includes age-appropriate vignettes of anxiety-evoking situations (e.g., health related worries, financial concerns, attending medical visits). Two studie will address the first aim. In study 1a, qualitative feedback from 20 older Veterans on the video modules will be obtained via semi- structured interviews. In study 1b, the feasibility of BREATHE will be piloted in 10 older Veterans with anxiety disorders, specifically, Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Agoraphobia, Social Anxiety Disorder (SAD), and Anxiety Disorder NOS. Functioning will be assessed using the modified Activity Card Sort. The second aim of the CDA-2 is to assess Veterans' preferences, access to, and perceptions of technology platform that can be used to deliver brief psychosocial treatments. Study 2 will address this aim in 75 older Veterans by obtaining feedback via interview and questionnaires about telephone, web-based, mobile app, telehealth, and DVD-based platforms for interventions. The third aim of the CDA-2 is to determine whether BREATHE has a greater impact on anxiety and functioning compared with an active control (psychoeducation). Study 3 will address this aim with a randomized control trial of DVD-based BREATHE compared with psychoeducation in 60 older Veterans with anxiety disorders (GAD, PD, Agoraphobia, SAD, and unspecified anxiety disorder). It is hypothesized that BREATHE will result in a statistically and clinically significant reduction of anxiety symptoms as measured with the Geriatric Anxiety Scale compared with psychoeducation. Improvements in functioning (Activity Card Sort) are expected for participants randomized to the BREATHE condition compared with those randomized to psychoeducation. Hypotheses in study 3 will be addressed with mixed effects models. This CDA-2 is an essential step towards Dr. Gould's long term goal of becoming a VA leader in research on interventions aimed toward improving older Veteran's functioning via the treatment of mental health symptoms. This CDA-2 also aligns with Dr. Gould's aim of developing these interventions for dissemination via different technology platforms as part of the implementation and outreach process in her future independent VA research career.