Developing an Integrative, Recovery-Based, Post-Acute COVID-19 Syndrome (PACS) Psychotherapeutic Intervention

项目摘要 目前，美国有3460万人，273232名退伍军人在退伍军人事务部接受测试或治疗 设施承包新冠肺炎。而急性后新冠肺炎综合征的确切患病率 退伍军人未知，使用全球新冠肺炎大样本估计精神科/神经科PAC 患者(N=236,379)表明，美国约有11,390,400人，退伍军人中有90,311人 退伍军人管理局护理，随着时间的推移，费率可能会上升。此外，大规模研究表明，高达35%的个人 新冠肺炎后8个月出现功能障碍，感染后精神疾病患病率高 包括焦虑症、抑郁症和创伤后应激障碍。使用我们的纵向数据 西奈山伊坎医学院学术分支机构(n≈1200)和当地詹姆斯·J·彼得斯 弗吉尼亚的临床PACS计划，加上我们在基于康复的心理治疗方面的专业知识，我们是独一无二的 准备为患有PACS的退伍军人开发一种创新的治疗方法。 我们的干预旨在改善对PACS症状的心理适应，促进复原力，并促进 应对，所有这些都会影响功能状态和生活质量。PACS-应对和康复(PACS-CR) 我们旨在开发的干预措施侧重于心理调整和应对，并加强了医疗、 对这一人群进行康复和神经治疗。我们的方法是基于 个人恢复包括五个主要过程：1)联系；2)希望和乐观 未来；3)身份认同；4)生活意义；5)赋权。我们将针对CHINE过程使用 已建立的心理治疗技术，如技能培训、基于接受和基于身份 原则。 基于对现有基于康复和新冠肺炎困境小组干预措施的适应，我们的团队 已经开发并试行，我们提出了一个由12个90分钟组成的核心治疗框架 会议(1次/周×12周)，每周额外举行一次关于可选专题的会议。我们是 提议进行一项治疗开发国立卫生研究院阶段1A研究，以发展急性后新冠肺炎综合征 心理治疗干预，“PACS应对和康复”(PACS-CR)通过迭代开发 在收集试点数据的同时，评估其可接受性和可行性。 我们的治疗开发尖塔将专注于1)确定PACS退伍军人的治疗需求，2) 使用试点定性数据并在利益相关者反馈的帮助下开发治疗方法，3)改进 由我们团队的三名迭代飞行员进行干预，亲自和远程健康版本进行测试。前置和后置 将利用措施来跟踪功能改善和这次恢复的重点程度 干预使退伍军人能够进行有意义的生活改变。

Project Abstract At present, 34.6 million people in the United States, and 273,232 Veterans tested or treated in Veteran Affairs facilities contracted COVID-19. While the exact prevalence of Post-Acute COVID-19 Syndrome (PACS) among Veterans is unknown, estimates of psychiatric/neurological PACS using a large global sample of COVID-19 patients (N=236,379) suggest a prevalence of approximately 11,390,400 Americans, and 90,311 Veterans in VA care, with rates likely to increase over time. Moreover, large scale studies suggest up to 35% of individuals experience functional impairment 8 months after COVID-19, and high prevalence of post-infection mental illness including anxiety disorders, depression, and post-traumatic stress disorder. Using longitudinal data from our academic affiliate, Icahn School of Medicine at Mount Sinai’s COVID registry (n≈1200), and local James J. Peters VA’s Clinical PACS program, coupled with our expertise in recovery-based psychotherapy, we are uniquely poised to develop an innovative treatment for Veterans struggling with PACS. Our intervention aims to improve psychological adjustment to PACS symptoms, promote resiliency, and facilitate coping, all of which can impact functional status and quality of life. The PACS-Coping and Recovery (PACS-CR) intervention we aim to develop focuses on psychological adjustment and coping, and augments medical, rehabilitative and neurological treatment for this population. Our approach is based on the CHIME model of personal recovery which includes five overarching processes: 1) Connectedness; 2) Hope and optimism about the future; 3) Identity; 4) Meaning in life; and 5) Empowerment. We will target the CHIME processes using established psychotherapeutic techniques such as skills training, acceptance-based and identity-based principles. Based on adaptations from existing recovery-based and COVID-19 distress group interventions that our team has developed and piloted, we are proposing a treatment framework that consists of a core of twelve 90-minutes sessions (1x/week x 12 weeks) with additional weekly sessions on specialized topics that are optional. We are proposing a treatment development NIH Stage 1A study to develop a Post-Acute COVID-19 Syndrome psychotherapeutic intervention, “PACS Coping and Recovery” (PACS-CR) through an iterative development process while collecting pilot data to assess its acceptability and feasibility. Our treatment development SPiRE will focus on 1) determining the treatment needs of Veterans with PACS, 2) developing the treatment using pilot qualitative data and aided by stakeholder feedback, 3) refining the intervention by three iterative pilots of our groups, testing both in person and telehealth versions. Pre and post measures will be utilized to track functional improvement and the degree to which this recovery-focused intervention has enabled the veterans to engage in meaningful life changes.