Group Treatment for Depression in Heart Failure

描述（由申请人提供）：本研究的总体目标是开发一种有效的团体心理治疗方法来治疗充血性心力衰竭患者的重度抑郁症。重度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，这种合并症尤其使人衰弱。虽然治疗心力衰竭患者的抑郁症有可能改善这一人群的功能和延长寿命，但目前尚无经验支持的心力衰竭患者抑郁症治疗方法。在几种有效的心理治疗方法中，群体认知行为治疗（CBT）被认为是有效的，并且在心力衰竭患者中已经建立了可行性。团体CBT可能对伴有抑郁症的CHF患者特别有效，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群体CBT治疗慢性心力衰竭患者的重度抑郁症，包括：(1)使用“开放”的群体形式，允许患者立即护理；(2)整合个人干预措施，以个性化定制治疗目标并提高治疗依从性；(3)在群体CBT形式中以家庭为基础的干预措施，以调动患者的社会支持。提出的综合认知行为治疗方案包括团体、个人和家庭治疗（GIFT-CHF）治疗慢性心力衰竭患者的抑郁症。当前提案的目的是发展GIFT-CHF计划。该提案包括三个阶段：开发阶段、试点阶段和修订阶段。在GIFT-CHF的开发阶段，研究的目标将是：(a)为患有心力衰竭的抑郁症患者开发一个综合团体治疗方案（GIFT-CHF）；(b)制定治疗师培训计划；(c)编制并检验胜任力和依从性量表的信度和效度。在GIFT-CHF计划的试点阶段，目标是进行一个小型的试点试验，调查GIFT-CHF计划与标准医疗护理/等候名单对照组相比的短期效果，并确定效果大小。最后，在GIFT-CHF计划的修订阶段，研究的目标将基于发展和试点阶段的结果，修订GIFT-CHF计划和治疗手册。这项治疗发展赠款将为GIFT-CHF项目对患有充血性心力衰竭的抑郁症患者进行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.