Telehealth CBT to address social isolation in Veterans with chronic pain

孤独是一种主观的情绪状态，其特征是感觉到社会孤立， 社会心理压力与死亡率和慢性疼痛增加有关。的个人 慢性疼痛和报告孤独经历更大的疼痛相关的干扰活动，抑郁， 自杀意念重要的是，有可能有效的干预措施，可用于减少 孤独;然而，没有研究直接干预退伍军人的孤独感， 慢性疼痛认知行为治疗孤独症（CBT-L）通过寻址来干预孤独 消极的信念，使孤独永久化，增加负面影响，降低一个人参与的能力 社交活动。对于一个患有慢性疼痛的退伍军人来说，这是至关重要的，因为它可以解决负面影响， 一个人获得社会支持和获得社会支持的感觉是增强功能的关键方面。而 慢性疼痛的CBT（CBT-CP）包括促进社会功能的技能， 需要更好地解决孤独的问题，同时也解决功能障碍。 这项为期两年的研究采用了一种新颖的应用程序，即一种简短的、电话传递的、以证据为基础的 干预，CBT-L，通过修改社会相关的适应不良的思维模式， 增加参与愉快的社交活动，提高解决问题的能力。参与者将 通过在线广告在全国范围内招募。本提案的目标是调整CBT-L， 优化其对慢性疼痛退伍军人的影响，检查招募，保留和治疗提供 是否可行，以及CBT-L是否为参与者所接受，并评估 参与者随机接受CBT-L与CBT-CP，以告知后续更大的临床试验。 为了实现这些目标，我们将通过基于证据的迭代过程改编手册， 在报告孤独的慢性疼痛退伍军人中进行CBT-L（n=8）的单臂试验。炼化了 在单组试验后，我们将随机分配40名参与者， CBT-L或CBT-CP。我们将评估孤独感、社会交往的质量和数量以及疼痛结果 例如疼痛相关的干扰，以及在基线和治疗期后的疼痛恶化。我们将 还跟踪参与者流程、治疗师对手册的依从性、参与者家庭作业完成情况和参与者 对治疗的满意度。

Loneliness—a subjective emotional state characterized by the perception of social isolation—is a psychosocial stressor that is associated with increased mortality and chronic pain. Individuals who have chronic pain and report loneliness experience greater pain-related interference in activities, depression, and suicidal ideation. Importantly, there are potentially effective interventions that can be used to decrease loneliness; however, there are no studies that have directly intervened on loneness among Veterans with chronic pain. Cognitive-Behavioral Therapy for Loneliness (CBT-L) intervenes on loneliness by addressing negative beliefs that perpetuate loneliness, increase negative affect, and reduce one’s ability to engage in social activities. For a Veteran with chronic pain, this is critical as addressing negative affect, and having a sense that one has social support and engages social support are key aspects of increasing functioning. While CBT for Chronic Pain (CBT-CP) comprises skills to promote social functioning, more robust efforts may be needed to better address lonely while also addressing functional impairment. The proposed two-year study uses a novel application of a brief, phone-delivered, evidence-based intervention, CBT-L, to decrease loneliness by modifying socially-relevant maladaptive thinking patterns, increasing engagement in enjoyable and social activities, and improving problem solving skills. Participants will be recruited nationally using online advertising. The objectives of the current proposal are to adapt CBT-L to optimize its impact on Veterans with chronic pain, examine if the recruitment, retention, and treatment delivery is feasible and if CBT-L is acceptable to participants, and assess parameters of key outcomes among participants randomized to receive CBT-L versus CBT-CP to inform a subsequent larger clinical trial. To achieve these objectives, we will adapt a manual through an evidence-based, iterative process then conduct one-arm trial of CBT-L (n=8) in Veterans with chronic pain reporting loneliness. After refining the manual and procedures following the one-arm trial, we will randomize a total of 40 participants to receive either CBT-L or CBT-CP. We will assess loneliness, the quality and quantity of social interactions, and pain outcomes such as pain-related interference, and pain catastrophizing at baseline and after the treatment period. We will also track participant flow, therapist adherence to the manual, participant homework completion and participant satisfaction with the treatment.