iCare Stress Management e-Training for Dementia Family Caregivers

描述（由申请人提供）：阿尔茨海默病（AD）和相关痴呆症的后果不仅对痴呆症患者来说是毁灭性的，而且对家庭照顾者（估计有890万）来说也是毁灭性的，他们被认为是隐藏的患者，并且极易出现与痴呆症护理的压力和困难相关的抑郁症状和综合征。需要有效、低成本和可获得的干预措施来应对痴呆症护理，特别是压力管理。我们的快速通道第一/第二阶段项目的目标是：(1)通过一种新的心理治疗干预（iCare eTraining）提高痴呆症家庭照顾者的生活质量并减少照顾压力；(2)以低成本和可获得的方式（DVD和互联网）开发iCare压力管理电子培训，以便向数百万有需要的家庭推广。新的iCare纳入了：(a)整合了我们对不同种族的护理研究的内容；(b)根据认知行为疗法（CBT）调整我们的心理治疗课程，以适应视频和互联网模式；(c)创造性地使用DVD、在线视频和网络技术。结果是一种创新的心理治疗干预，以更有效和强大的功能来治疗痴呆症护理者的压力：引人入胜的方法（DVD和在线视频）；鼓励与专业人员和其他护理人员进行支持性互动的工具；加强沟通;收集和传播应对照护集体知识的方法；以及其他支持性工具。相关临床优势是：鼓励培训参与，使用户互动，促进更好的概念同化；这将提高照顾者处理高要求的照顾任务的技能（最终导致减轻压力和提高生活质量）。iCare课程的基础是由Gallagher-Thompson博士、Thompson博士及其同事在许多循证程序中开发的，最终形成了一个成功的“应对护理”系列课程（CWC），并在几项随机临床试验中进行了评估，例如，美国国立卫生研究院资助的多站点国家研究项目“提高阿尔茨海默氏症护理者健康资源”(REACH； Belle等人，2006年；Schulz等人，2003)，这表明CWC培训减轻了来自不同社区的护理人员的压力。iCare的心理治疗方面指的是“旨在鼓励对个人成长和行为纠正问题的洞察力的心理技术”（以电子培训为导向），而不是由治疗师治疗（由于成本原因，不适合广泛部署）。iCare的教学形式是DVD/在线视频培训和使用补充材料的结合，以培养技能和刺激实践。我们将与阿尔茨海默氏症协会、家庭照顾者联盟和其他组织合作，与专家咨询委员会（进行科学审查）和家庭照顾者（为消费者提供意见）一起开发和评估iCare（针对一般照顾者人群）。我们将通过一项随机临床试验（II期）来评估iCare在改善护理人员幸福感和减少压力方面的有效性。

DESCRIPTION (provided by applicant): The consequences of Alzheimer's Disease (AD) and related dementia are devastating not only for dementia patients, but also for family caregivers (estimated at 8.9 million), who are considered the hidden patients, and are at high risk for depressive symptoms and syndromes related to the stress and difficulties of dementia caregiving. Efficient, low-cost and accessible interventions are needed to cope with dementia caregiving, particularly stress management. The goals of our Fast Track Phase I/Phase II project are: (1) to enhance the quality of life and reduce the caregiving stress of dementia family caregivers with a new psychotherapy intervention (iCare eTraining); and (2) to develop the iCare stress management eTraining in low-cost and accessible methods (DVD and Internet) for deployment to millions of families who need it. The novel iCare incorporates: (a) integration of content from our caregiving studies with different ethnic groups; (b) adaptation of our psychotherapy curriculum, based on Cognitive Behavioral Therapy (CBT), for video and Internet modalities; and (c) creative use of DVD, online video, and web technology. The result is an innovative psychotherapy intervention to treat dementia caregiver stress with more effective and powerful features: engaging methods (DVD and online video); tools to encourage supportive interactions with professionals and other caregivers; enhanced communication; methods to gather and distribute collective knowledge on coping with caregiving; and other supportive tools. Related clinical advantages are: encourage training participation, enable user interaction, and promote better assimilation of concepts; which should enhance caregivers' skills to deal with demanding tasks of caregiving (ultimately leading to alleviate stress and improve quality of life). The basis for the iCare curriculum was developed in many evidence-based procedures by Dr. Gallagher-Thompson, Dr. Thompson, and associates, resulting in a successful "Coping with Caregiving " class series (CWC), evaluated in several randomized clinical trials, e.g. a component of NIH-funded multi-site national research project "Resources for Enhancing Alzheimer's Caregiver Health" (REACH; Belle et al., 2006; Schulz et al., 2003), which demonstrated that CWC trainings reduced stress for caregivers from diverse communities. The psychotherapy aspect of iCare refers to "psychological techniques designed to encourage insight into problems for personal growth and behavior modification" (oriented by eTraining), rather than treatment by therapist (not feasible for broad deployment due to costs). The pedagogical format of iCare is a combination of DVD/online video training and use of supplemental materials that build skills and stimulate practice. In collaboration with the Alzheimer's Association, Family Caregiver Alliance, and other organizations, we will develop and evaluate iCare (targeting general caregiver population), with an expert Advisory Board (for scientific review) and family caregivers (for consumer input). We will assess the iCare effectiveness in improving the well-being and decreasing the stress of caregivers with a randomized clinical trial (Phase II).