Internet-based Self-Management Intervention for Prolonged Grief

描述（由申请人提供）：长期悲伤障碍（PGD）是一种比正常悲伤更严重和持续的精神疾病，发生在约10%的丧亲之痛中。它的特点是对死者的长期渴望、痛苦、人际脱离和无意义感。PGD与相当大的功能损害、身体和精神健康发病率、生产力丧失、自杀和质量调整生命年降低有关。目前，尚无针对PGD的循证二级预防干预措施。这项研究的长期目标是为那些有PGD风险的人提供一种有效的、具有成本效益的、资源效率高的、容易耐受的二级预防干预措施。主要目标是开发和试点一种基于互联网的PGD自我管理干预，该干预采用经验衍生的认知行为疗法（CBT）策略来促进稳定、积极的日常生活、自我照顾、适应损失、增强自我效能、重新参与愉快的活动以及与重要他人的重新联系。建议的工作利用已建立的CBT技术和最近关于使用互联网提供CBT干预的研究，旨在为大型临床试验提供必要的开发和试点工作。关键的假设是，这种干预将减少PGD症状和相关的功能障碍。我们假设，由于互联网提供的匿名性和可访问性的增加，干预的参与度将很高，这减少了污名化，增加了治疗依从性，反过来，将增加治疗反应。我们将通过追求以下具体目标来实现目标：(1)搜索失落和PGD文献，并与专家合作制定一个以经验和技能为基础的、为期6周的、治疗师辅助的自我管理方案；(2)开发一种工具来评估可能阻碍PGD患者进行有效自我照顾和重新融入社交圈的不适应认知和感知障碍（并在干预中实施）；(3)开发和完善具有底层数据捕获和处理监测功能的交互式、易于协商的互联网接口，以实施协议；(4)根据专家、医护人员和患者的反馈，验证和规范治疗方案和互联网接口；(5)开展试点试验，确定干预措施的可行性、安全性、有效性、互联网治疗提供和监测技术的有用性，并根据完成方案的参与者的反馈进一步完善干预措施。

DESCRIPTION (provided by applicant): Prolonged Grief Disorder (PGD) is a psychiatric condition more severe and unremitting than normative grief, occurring in about 10% of bereavement. It is marked by prolonged yearning for the deceased, bitterness, interpersonal disengagement, and a sense of meaninglessness. PGD is associated with considerable functional impairment, physical and mental health morbidity, lost productivity, suicide, and lowered quality adjusted life years. At present, there are no evidence-based, secondary prevention interventions for PGD. The long-term goal of this research is to address the need for an efficacious, cost-effective, resource-efficient, and readily tolerated secondary prevention intervention for those at risk for developing PGD. The primary objective is to develop and pilot-test an internet-based self-management intervention for PGD that employs empirically derived cognitive-behavioral therapy (CBT) strategies to promote stable, active routines, self-care, accommodation of loss, enhanced self-efficacy, reengagement in pleasurable activities, and reattachment with significant others. The proposed work capitalizes on established CBT techniques and recent research on using the internet to deliver CBT interventions, and is intended to provide the necessary development and pilot work for a large clinical trial. The key hypothesis is that this intervention will reduce PGD symptoms and associated functional impairments. We hypothesize that participation in the intervention will be high due to the increased anonymity and accessibility afforded by the internet, which reduces stigmatization, increases treatment compliance, and, in turn, will increase treatment response. We will accomplish the objectives by pursuing these specific aims: (1) Search the loss and PGD literature and collaborate with experts to develop an experiential and skills-based, 6- week, therapist-assisted self-management protocol; (2) Develop a tool to assess the maladaptive cognitions and perceived barriers that may prevent PGD patients engaging in effective self-care, and reengaging their social circle (and implement the tool in the intervention); (3) Develop and refine an interactive, easy-to-negotiate internet interface with underlying data capture and treatment monitoring capabilities to implement the protocol; (4) Validate and standardize the treatment protocol and internet interface based on feedback from experts, care providers, and patients; (5) Conduct a pilot trial to determine feasibility, safety, efficacy of the intervention, the usefulness of the internet treatment delivery and monitoring technology, and further refine the intervention based on feedback from participants who complete the protocol.