Group Treatment for Depression in Heart Failure

描述(申请人提供)：这项研究的总体目标是开发一种有效的团体心理疗法来治疗充血性心力衰竭患者的严重抑郁。严重的抑郁症和心力衰竭都与严重的功能丧失和死亡率增加有关，这种并存的情况尤其令人虚弱。虽然治疗心力衰竭患者的抑郁有可能改善这一人群的功能和延长寿命，但目前还没有经验支持的治疗心力衰竭患者抑郁的方法。在几种有效的心理社会治疗中，团体认知行为疗法(CBT)已被提出为有效的，并已在心力衰竭患者中确立了可行性。团体CBT在伴有抑郁的CHF患者中可能特别有效，因为它有可能增加患者的社会支持。初步研究表明，有几种方法可以改进目前的团体CBT，以治疗充血性心力衰竭患者的严重抑郁，包括：(1)使用允许立即护理患者的“开放式”团体形式，(2)整合个别干预措施，以单独定制治疗目标并提高对治疗的依从性，以及(3)在团体CBT形式内以家庭为基础的干预措施，以动员患者的社会支持。建议的认知-行为综合治疗计划包括针对CHF患者抑郁的团体、个人和家庭治疗(GIFT-CHF)。目前的提案旨在开发GIFT-CHF计划。该提案包括三个阶段：开发、试验和修订阶段。在GIFT-CHF的开发阶段，这项研究的目标将是：(A)为患有心力衰竭的抑郁症患者开发综合团体治疗计划(GIFT-CHF)；(B)开发治疗师培训计划；以及(C)开发和测试能力和遵从性评定量表的可靠性和有效性。在GIFT-CHF计划的试点阶段，目标将是进行一项小型试点试验，调查GIFT-CHF计划与标准医疗保健/等待名单对照组相比的短期疗效，并确定效果大小。最后，在GIFT-CHF计划的修订阶段，研究的目标将是基于开发和试验阶段的结果，修订GIFT-CHF计划和治疗手册。这笔治疗开发赠款将为为患有充血性心力衰竭的抑郁症患者进行GIFT-CHF计划的大规模治疗结果研究奠定基础。

DESCRIPTION (provided by applicant): The overall aim of this research is to develop an efficacious group psychotherapy for the treatment of major depression among individuals with congestive heart failure. Both major depression and heart failure are associated with severe loss of functioning and increased mortality, and this co-morbid condition is particularly debilitating. While treating depression among heart failure patients has the potential to improve functioning and prolong life in this population, there are currently no empirically-supported treatments for depression among heart failure patients. Among the several well-validated psychosocial treatments, group cognitive-behavioral therapy (CBT) has been proposed as efficacious, and has established feasibility among heart failure patients. Group CBT may be particularly efficacious among CHF patients with depression due to the potential for increasing patient social support. Initial research suggests that there are several ways in which current group CBT could be improved to treat major depression among CHF patients, including: (1) the use of an "open" group format that allows for immediate patient care, (2) integration of individual interventions to individually tailor treatment goals and improve adherence to treatment, and (3) family-based interventions within the group CBT format to mobilize patient social support. The proposed integrated cognitive-behavioral therapy program includes group, individual, and family treatment (GIFT) for depression among individuals with CHF (GIFT-CHF). The current proposal is designed to develop the GIFT-CHF program. The proposal consists of three phases: a Development, Pilot, and Revision Phase. During the Development phase of the GIFT-CHF, the goal of the research will be to: (a) develop an integrative group therapy program for depressed patients with heart failure (GIFT-CHF); (b) develop a therapist training program; and (c) develop and test the reliability and validity of competence and adherence rating scales. During the Pilot phase of the GIFT-CHF program, the goal will be to conduct a small pilot trial investigating the short-term efficacy of the GIFT-CHF program in comparison to a Standard Medical Care/Wait-List control group, and determine effect size. Finally, during the Revision phase of the GIFT-CHF program, the goal of the research will be based on the results of the Development and Pilot phases, to revise the GIFT-CHF program and treatment manual. This treatment development grant will lay the groundwork for a large-scale treatment outcome study of the GIFT-CHF program for depressed individuals with congestive heart failure.