Feasibility Study of Compassion Meditation Intervention for Older Veterans in Primary Care with Anxiety or Mood Disorders

老年退伍军人表现出临床上显著的心理困扰，如焦虑， 抑郁症状这种高患病率包括在初级保健诊所就诊的患者。这些症状 不仅本身令人厌恶，而且还与心理社会残疾的风险有关， 医疗并发症，早期死亡率和增加的卫生保健费用。尽管这些担忧同样存在 在年轻的退伍军人中，老年退伍军人的情况尤其成问题，因为老年人 与心理健康服务利用率低有关。以前的研究集中在确定障碍， 老年退伍军人的精神卫生保健利用率一再指出， 以赤字为重点的治疗，这可以被一些退伍军人认为是“以赤字为重点”。因此 可能有助于制定有效的基于优势的干预措施。冥想（CM）训练是一种 在这方面，有希望的优势集中的候选人，在以前的研究，虽然与民用样品， 建议的CM培训促进积极的情绪和幸福感，同时减少焦虑，抑郁， 其他负面情绪。关于退伍军人样本的研究较少，但Lang和 同事们还建议对患有创伤后应激障碍的退伍军人有效。CM尚未在 治疗患有焦虑或抑郁症的老年退伍军人的背景。拟议项目将收集试验数据， 为未来手动CM组干预的随机对照试验（RCT）建立可行性， 恢复通过VA初级保健诊所确定为具有临床意义的老年退伍军人的功能 心理困扰这项非随机可行性研究是适应CM的关键第一步 并评估其作为用于该人群的有效力量集中治疗的潜力。 参与者将包括多达40名退伍军人，年龄> 55岁，通过初级保健心理健康 VA圣地亚哥医疗保健系统的综合计划，患有轻度至中度焦虑或抑郁 症状这些参与者中的20至30人将参加为期10周的CM培训组（8-10人 每个组的参与者）。这些小组将进行手动CM干预，虽然部分 可行性研究的目标是确定并调整干预措施，以满足这一特定人群的需求。 可行性研究的关键问题包括确定参与者的入组意愿、依从性和 完成干预，以及确定干预中的适当修改， 最大限度地接受和适合老年退伍军人。我们还将收集有关 干预改善健康、症状严重程度和/或积极心理因素的潜力。 在该领域，人们越来越感兴趣的是将结果测量扩展到主观行为报告之外， 因此，我们也将探索使用炎症生物标志物作为CM的非行为指标的可行性 干预反应。作为确定后续大规模RCT可行性的一部分， 参与者将参加一个10节的手动心理教育小组，重点是健康方面的主题。 衰老后一组将进行研究，以探讨采用这一方法作为 随访RCT中的对照条件。参加者还将在完成CM或 心理教育小组，以获得他们的主观印象和建议的内容 和群体的结构。鉴于对这一人群的这一研究路线的初步性质， 将主要是描述性的，而不是集中在假设检验。

Older Veterans show a high prevalence of clinically significant psychological distress such as anxiety and depressive symptoms. This high prevalence includes patients seen in Primary Care clinics. These symptoms are not only aversive in themselves, they are also associated with risk of psychosocial disability, increased medical comorbidity, early mortality, and increased health care costs. Although these concerns similarly exist among younger Veterans, the situation is particularly problematic among older Veterans as older age is associated with low utilization of mental health services. Prior research focused on identifying barriers to mental health care utilization among older Veterans have repeatedly pointed to the perceived stigma of symptom-focused treatments, which can be perceived by some Veterans as being “deficit-focused”. Therefore, it may be useful to develop effective strengths-based interventions. Compassion meditation (CM) training is a promising strengths-focused candidate in this regard, in that prior research, albeit with civilian samples, has suggested CM training promotes positive emotions and well-being, while reducing anxiety, depression, and other negative emotions. There has been less research with Veteran samples, but one study by Lang and colleagues also suggested effectiveness for Veterans with PTSD. CM has not been adapted or tested in the context of treating older Veterans with anxiety or depression. The proposed project will collect pilot data to establish feasibility for a future randomized controlled trial (RCT) of manualized CM group intervention to restore functioning in older Veterans identified through VA Primary Care clinics as having clinically significant psychological distress. This non-randomized feasibility study represents a critical initial step in adapting CM and evaluating its potential as an effective strengths-focused treatment for use with this population. Participants will include up to 40 Veterans age > 55 years identified through the Primary Care Mental Health Integrated program at the VA San Diego Healthcare System with mild-to-moderate anxiety or depressive symptoms. Twenty to 30 of these participants will be enrolled in a 10-week CM training group (with 8-10 participants in each group). The groups will be conducted with a manualized CM intervention, although part of the goal of the feasibility study is to identify and adapt the intervention to the needs of this specific population. Key questions for the feasibility study include determining participants' willingness to enroll, adherence and completion of the intervention, as well as to determine appropriate modifications in the intervention to make it maximally acceptable and appropriate to older Veterans. We will also be collecting pilot data regarding the potential of the intervention to improve well-being, symptom severity, and/or positive psychological factors. There is a growing interest in the field in expanding outcome measures beyond subjective behavioral reports, thus, we will also explore the feasibility of using inflammatory biomarkers as a non-behavioral indicator of CM intervention response. As part of establishing feasibility for a subsequent large-scale RCT, 10 additional participants will be enrolled in a 10-session manualized psychoeducational group focused on topics in healthy aging. The latter group will be conducted to examine the feasibility and appropriateness of employing this as a control condition in a follow-up RCT. Participants will also be interviewed after completion of the CM or psychoeducational groups in order to obtain their subjective impressions and recommendations for the content and structure of the groups. Given the preliminary nature of this line of research for this population, analyses will be primarily descriptive rather than focused on hypothesis testing.