Expanding the Foundation for Population-Based Anxiety Management Interventions

描述（由申请人提供）：探索有效的传播机制，以增加科学知情的治疗的吸收是国家精神卫生研究所（NIMH）的服务和干预研究部门的高度优先事项。传播焦虑症的有效治疗方法尤为重要，因为焦虑症是最常见的精神疾病。虽然存在有效的、医学上支持的治疗方法，但绝大多数经历临床焦虑水平的人没有接受治疗。到目前为止，传播工作的重点是增加获得治疗的机会，但没有适当地解决需要采取具有成本效益的干预措施的问题，这些干预措施针对的是那些患有焦虑症但还不愿意接受治疗或还没有准备好采取必要的困难行动来解决其焦虑症的人。行为改变的跨理论模型（TTM）提供了一个理论基础的干预措施，可以解决访问和意愿，因为它的重点是准备和效用，在组织有效的，计算机化的干预。TTM的主要组织特征是变革的五个阶段，这五个阶段定义了个人在准备和采用变革方面的进展。TTM认为，通过五个阶段的变化，是由三个核心结构介导的：决策平衡（行为变化的利弊的相对重要性）;自我效能（一个人的信心，改变可以在一系列具有挑战性的情况下保持）;和参与10个过程的变化（涉及认知，行为和体验活动）的频率。由TTM指导的计算机化干预涉及对这些核心结构的交替评估和个性化反馈。然而，在基于TTM的针对焦虑管理的干预措施得以开发之前，需要进行前期的实证研究。拟议的研究将执行将TTM应用于焦虑管理所需的步骤。具体目标是：（1）制定有效和可靠的措施，改变阶段，决策平衡，自我效能，以及改变的经验和行为过程，因为它们与焦虑的管理有关;（2）为三个治疗组中参与者在每个变化阶段的核心TTM变量测量的预期分数建立数据驱动的指南（接受焦虑心理治疗的个体，仅接受药物治疗的个体，以及未接受任何治疗的个体）。该研究将招募360名具有临床焦虑水平的参与者完成在线调查。将使用测量开发的顺序过程。它将包括探索性和验证性分析，然后是一系列回归和组差异分析，以评估外部验证。这项工作将为研究计划的下一步铺平道路：开发和评估计算机定制的基于TTM的干预措施的有效性，旨在提高焦虑症治疗对所有有需要的人群的影响。

DESCRIPTION (provided by applicant): Exploration of effective dissemination mechanisms to increase uptake of scientifically-informed treatments is a high priority for the Division of Servics and Intervention Research of the National Institute of Mental Health (NIMH). Dissemination of effective treatments for anxiety disorders is particularly important because anxiety is the most prevalent form of mental illness. Although effective, empirically-supported treatments exist, the vast majority of individuals experiencing clinical levels of anxiety do not receive treatment. Dissemination efforts thus far have focused on increasing access, but have not appropriately addressed the need for cost-efficient interventions that target those individuals suffering from anxiety who are not yet willing to attend treatment or not yet ready to take difficult actions necessary to address their anxiety. The Transtheoretical Model of Behavior Change (TTM) provides a theoretical basis for interventions that could address both access and willingness owing to its emphasis on readiness and utility in organizing effective, computerized interventions. The key organizing feature of the TTM is the five stages of change, which define an individual's progress in preparing for and adopting changes. The TTM posits that movement through five stages of change, is mediated by three core constructs: Decisional Balance (relative importance of pros and cons of behavior change); Self-efficacy (one's confidence that change can be maintained across a range of challenging situations); and frequency of engagement in 10 Processes of Change (involving cognitive, behavioral, and experiential activities). Computerized interventions guided by the TTM involve alternating assessment of these core constructs and individually-tailored feedback. Before a TTM-based intervention targeting management of anxiety can be developed, however, precursor empirical work is required. The proposed research will carry out the steps needed to apply the TTM to the management of anxiety. The specific aims are to: (1) Develop valid and reliable measures of stage of change, decisional balance, self- efficacy, and the experiential and behavioral processes of change as they pertain to management of anxiety; (2) Build data-driven guidelines for expected scores on measures of core TTM variables for participants in each stage of change in three treatment groups (individuals receiving psychotherapy for anxiety, those receiving medication only, and those not in any treatment). The study will recruit 360 participants with clinical levels of anxiety to complete an online survey. A sequential process of measurement development will be used. It will consist of exploratory and confirmatory analyses, followed a series of regression and group difference analyses to evaluate external validation. This work will pave the way for the next step in an intended program of research: to develop and evaluate effectiveness of a computer-tailored, TTM-based intervention aimed at enhancing the reach of anxiety disorder treatments to the full population of individuals in need.