Attention Training and Relaxation for GAD: Testing the Efficacy of Home-Delivery

描述(由申请人提供)：广泛性焦虑症(GAD)的特征是过度的、不可控制的担忧(Barlow等人，1986)，导致医疗过度利用、感觉健康不良、生活质量评分低以及工作中的损害，从而导致重大的经济和公共卫生影响(Ballenger等人，2001；Hoffman等人，2008；Wittchen，2002)。GAD的终生患病率很高(5.7%，Kessler等人，2005年；8.5%在初级保健环境中，Roy-Byrne&Wager，2004年)。虽然存在治疗广泛性焦虑症的有效的心理社会和药物治疗(综述见Nutt等人，2002年)，但这些人中的大多数并没有获得我们最有效的治疗(Collins等人，2004年)，并且相对于其他焦虑和情绪障碍，这种疾病寻求治疗的延误时间最长(即，从发病时起14年；Kessler等人，1998年)。寻求治疗的大量延误、无法获得循证治疗以及过度使用医疗服务，造成了长期的个人和经济代价。因此，对于开发有可能被广泛性广泛性AD患者广泛获得的有效和成本效益高的治疗方法，存在着巨大的未得到满足的需求。目前的提案直接回应了国家卫生和卫生组织在评估方便用户的干预措施和增加获得循证干预措施的非传统提供方法方面的优先事项。我们将评估为期12周的以电脑为基础的家庭治疗方案对广泛性AD的疗效。治疗将包括两种被证明在治疗广泛性AD方面有效的干预措施的组合。注意修正程序(AMP)是一个计算机化的程序，旨在促进注意力从威胁刺激中解脱出来(Amir等人，2009年)。应用放松(AR)是一种基于技能的行为干预，个体学习减少与焦虑和担忧相关的生理线索的方法(VST，1987；Siev&Chamless，2007)。遵循NIMH心理社会干预发展工作组(Hollon等人，2002年)的推荐指南，我们回顾了表明这两种疗法都是GAD循证治疗有效、经济和广泛运输的理想候选者。这项提案有可能对公共卫生产生重大影响，因为它评估了一种新的方法，通过使用创新技术为难以接触到的人群提供循证干预措施。

DESCRIPTION (provided by applicant): Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry (Barlow, et al., 1986) leading to medical over-utilization, poor perceived health, low ratings of quality of life, and impairment at work that result in a significant economic and public health impact (Ballenger et al., 2001; Hoffman et al., 2008; Wittchen, 2002). Lifetime prevalence of GAD is high (5.7%, Kessler et al., 2005; 8.5% in primary care setting, Roy-Byrne & Wager, 2004). Although efficacious psychosocial and pharmacological treatments for GAD exist (for a reviews see Nutt, et al., 2002), the majority of these individuals do not access our most effective treatments (Collins et al., 2004) and treatment-seeking delays are longest for this condition relative to other anxiety and mood disorders (i.e., 14 years from the time of onset; Kessler et al., 1998). The substantial delays in treatment seeking, failure to access evidence-based treatments and overutilization of medical services, result in prolonged personal and economic costs. Thus, there is a significant unmet need for the development of efficient and cost-effective treatments that have the potential to be widely accessible to individuals with GAD. The current proposal directly responds to the NIMH priorities for evaluating user-friendly interventions and non- traditional delivery methods to increase access to evidence-based interventions. We will evaluate the efficacy of a 12-week computer-delivered home-based treatment program for GAD. Treatment will comprise a combination of two interventions shown to be efficacious in the treatment of GAD. The Attention Modification Program (AMP) is a computerized program designed to facilitate attention disengagement from threatening stimuli (Amir et al., 2009). Applied Relaxation (AR) is a behavioral, skills-based intervention where individuals learn ways to reduce the physiological cues associated with anxiety and worry (Vst, 1987; Siev & Chambless, 2007). Following the recommended guidelines of the NIMH Workgroup on Psychosocial Intervention Development (Hollon et al., 2002), we review evidence suggesting that both treatments are ideal candidates for the efficient, economical, and widespread transportation of evidence-based treatments for GAD. This proposal has the potential for a significant public health impact by evaluating a new method for delivering evidence-based interventions for hard-to-reach populations through the use of innovative technologies.