Reducing Anxiety and Improving Functioning in Older Veterans

 产品说明： 拟议的CDA-2将提供克莉丝汀古尔德博士，在VA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VA老年学高级研究员，与研究培训，以促进她的职业生涯，旨在减缓老年退伍军人焦虑和抑郁症的功能衰退。她的导师团队包括Ruth O 'Hara博士、Sherry A.博德鲁，玛丽戈德斯坦，和朱莉韦瑟雷尔。顾问包括海伦娜·克雷默博士、杰奎琳·旺（特里）·胡博士和埃里克·库恩博士。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comorphism和功能，以及4）赠款和科学写作。在CDA-2研究计划中，古尔德博士旨在测试对焦虑进行简短的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。焦虑是普遍的，代价高昂的，并导致行为回避，残疾和生活质量差。拟议的CDA-2预计将有利于老年退伍军人（= 60岁），减少焦虑和回避，从而增加他们对活动的参与，改善整体功能。该项目与老年人对心理治疗的偏好相一致，而不是治疗焦虑的药物治疗。拟议项目的第一个目的是调整渐进式肌肉放松（PMR），一种有效的治疗晚年焦虑的方法，在家里使用DVD视频进行管理。自我指导的PMR将增加老年退伍军人获得这种简短的治疗。该计划，呼吸（呼吸，放松和教育焦虑治疗在家庭环境中），是由古尔德博士与她的导师的投入，包括年龄适当的小插曲引起焦虑的情况（例如，与健康有关的担忧、财务问题、参加医疗访问）。两项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名老年退伍军人对视频模块的定性反馈。在研究1b中，呼吸的可行性将在10名患有焦虑症的老年退伍军人中进行试点，具体而言，广泛性焦虑症（GAD），惊恐障碍（PD），广场恐怖症，社交焦虑症（SAD）和焦虑症NOS。将使用修改后的活动卡分类评估功能。CDA-2的第二个目标是评估退伍军人的偏好，访问和可用于提供简短的心理社会治疗的技术平台的看法。研究2将通过电话、基于网络的移动的应用程序、远程医疗和基于DVD的干预平台的访谈和问卷调查获得反馈，在75名老年退伍军人中实现这一目标。CDA-2的第三个目的是确定呼吸是否比主动控制（心理教育）对焦虑和功能有更大的影响。研究3将在60名患有焦虑症（GAD、PD、广场恐怖症、SAD和未指明的焦虑症）的老年退伍军人中进行基于DVD的BREATHE与心理教育的随机对照试验，以解决这一目标。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学和临床上显著减少。与随机接受心理教育的受试者相比，随机接受呼吸条件的受试者的功能（活动卡分类）预计会有所改善。研究3中的假设将采用混合效应模型进行处理。这CDA-2是朝着古尔德博士的长期目标迈出的重要一步，该目标是成为退伍军人管理局的领导者，研究旨在通过治疗心理健康症状来改善老年退伍军人的功能。该CDA-2也符合古尔德博士的目标，即通过不同的技术平台开发这些干预措施，作为她未来独立VA研究生涯中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.