GROUP CBT FOR DEPRESSION AND AOD DISORDERS

描述(由申请人提供)： 我们建议进行一项阶段1研究，以适应和测试一种有效的团体CBT治疗抑郁症的方法，用于AOD治疗中报告持续抑郁症状的客户。修订后的疗法的目标是减少抑郁症状，改善AOD结果。最初的方案是16个疗程的CBT治疗抑郁症，已在多个随机对照试验中证明有效。虽然这个方案似乎特别适合于公共AOD治疗环境，但它并没有解决许多与AOD障碍患者的抑郁症治疗相关的问题。我们的研究试图通过缩小研究和实践之间的差距来推动CBT和AOD领域的发展。首先，通过调整治疗人群和环境，我们希望提高其疗效。第二，我们让关键的利益相关者参与整个研究过程。这将确保开发的治疗方法是可行的，并为患者和提供者所接受，同时保持现有治疗的理论基础，增加干预措施被采用和持续的可能性。我们建立在兰德和BHS之间的现有关系之上，BHS是洛杉矶县最大的公共资助的AOD治疗提供商。我们的具体目标是(1)调整现有的团体疗法(针对抑郁症的CBT)，创建一种用于患有持续性抑郁症状和AOD障碍的客户的机械化治疗，以及伴随的实施措施和工具，并从患者和提供者的角度获得对治疗的初步评估，以及(2)对修订后的治疗进行试点测试，其中我们(A)证明，当治疗实施时，抑郁症状和AOD的使用在临床上显著减少；(B)估计可能的效果大小；以及(C)调查改变的潜在机制，包括认知-行为和群体过程及其与抑郁症和AOD治疗结果的关系。采用随机设计，我们将招募84名有持续性抑郁症状的患者，这些患者处于两种情况之一：(1)常规护理(UC)和(2)UC加16次CBT治疗抑郁症。受试者将完成：(1)基线访谈，(2)治疗后访谈(在CBT治疗结束时)和(3)随访访谈(CBT治疗结束后3个月)。在试点结束时，我们将有一个手动干预，有足够的数据来估计干预效果的大小，以及一个很好地描述的涉及提供者和客户的过程。

DESCRIPTION (provided by applicant): We propose a Stage 1 study to adapt and test an efficacious group CBT treatment for depression for use with clients in AOD treatment who report persistent depressive symptoms. The goal of the revised therapy is to reduce depressive symptoms and improve AOD outcomes. The original protocol, a 16-session group CBT therapy for depression, has demonstrated efficacy in multiple RCTs. Although this protocol seems particularly suited to public AOD treatment settings, it does not address many issues relevant to the treatment of depression in clients with AOD disorders. Our study seeks to move the CBT and AOD fields forward by narrowing the gap between research and practice. First, by adapting the therapy to the population and setting, we hope to improve its efficacy. Second, we involve key stakeholders in the entire research process. This will ensure that the treatment developed will be feasible, as well as acceptable to patients and providers, while maintaining the theoretical foundations of the existing therapy, increasing the likelihood the intervention will be adopted and sustained. We build upon an existing relationship between RAND and BHS, the largest publicly funded AOD treatment provider in Los Angeles County. Our specific aims are (1) To adapt an existing group therapy (CBT for depression), creating a manualized treatment for use with clients with persistent depressive symptoms and AOD disorders, along with accompanying implementation measures and tools, and to obtain preliminary assessments of the treatment from patient and provider perspectives and (2) To conduct a pilot test of the revised treatment in which we (a) demonstrate that when the therapy is implemented with fidelity, clinically significant reductions in depressive symptoms and AOD use occur; (b) estimate the likely effect size; and (c) investigate the underlying mechanisms of change, including both cognitive-behavioral and group processes and their relationship to depression and AOD treatment outcomes. Using a randomized design, we will enroll 84 clients with persistent depressive symptoms in one of two conditions: (1) usual care (UC) and (2) UC plus 16 sessions of group CBT for depression. Subjects will complete: (1) a baseline interview, (2) a post-treatment interview (at the conclusion of the CBT treatment) and (3) a follow-up interview (3 months after CBT treatment ends). At the end of this pilot, we will have a manualized intervention, sufficient data to estimate the intervention effect size, and a well-described process for involving providers and clients.