A mobile Enabling Technology to promote adherence to behavioral therapy

描述(由申请人提供)：本申请涉及广泛的挑战领域(06)使能技术，06-DA-105：通过ICT/移动技术改善健康。这项研究的最终目标是从根本上改变行为干预的交付方式。我们提出了一种创新的移动使能技术-iHeal-它可以识别威胁患者康复的压力源，然后在最需要的时刻提供基于证据的干预。我们的目标是在受试者中确定iHeal检测到的生理和情感变化在受试者中预测创伤后应激或药物线索的程度。研究小组在技术开发和评估共发疾病的行为干预方面拥有相当多的专业知识。我们将研究从SAMHSA资助的现有调查中提取的25名受试者，该调查利用密集的病例管理来监测归来的退伍军人的创伤后应激障碍和药物滥用的进展。我们提议的调查将与SMAHSA研究共享干预措施，该研究基于对创伤后应激障碍和药物滥用的动机访谈和认知行为治疗方法的混合。具体目标：1)评估iHeal将生理和情感现象描述为与创伤后应激障碍和环境药物线索相关的急性应激反应的准确性；以及2)评估基于动机访谈的干预措施对与创伤后应激障碍和环境药物线索相关的急性应激反应的影响。这一初步提议极具创新性。拟议中的iHeal设备将采用尖端无线技术，将可穿戴传感器连接到个人移动计算平台(如iPhone)。这种联系将使iHeal能够检测同时发生的生物和行为过程，而移动平台中的嵌入式计算使iHeal能够在适当的时候提供基于证据的同理心干预。IHeal可以学习以对用户最有效的方式进行干预，包括模仿简短干预的脚本化文本对话；使用来自亲人的激励图像或信息；播放一首有意义的歌曲；或者在最需要的时刻联系顾问。归根结底，一种能够预测压力源并在可能过渡到高风险活动时进行干预的可穿戴无线设备在各种社会、行为和生物医学研究企业中具有巨大的潜力。重要的是，iHeal立即具有商业应用，将鼓励行为科学、生物医学、计算机科学、电信和电气工程企业的就业增长。IHeal是一款创新设备，它使用可穿戴传感器来检测脉搏、皮肤电导和加速度；传感器阵列无线连接到iPhone，iPhone上有一个应用程序，可以识别用户生理的变化。与创伤后应激障碍加重或药物使用线索相一致的变化会在iPhone和用户之间产生一种移情对话，用户输入关于社会/行为/环境背景的实时数据。IPhone(追踪时间和GPS数据)使用预测性软件来预测即将到来的压力源，并帮助用户避开它们。这项建议的公共卫生意义是：1)iHeal将实时检测共同发生的生物和行为过程；2)它将识别未被发现的行为状态；3)它将预测感兴趣的行为；4)它将在适当的时机向用户提供同理心干预。由于iHeal基于现有技术的结合，并立即具有商业应用，它将鼓励行为科学、生物医学、计算机科学、电信和电气工程企业的就业增长。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (06) Enabling Technologies, 06-DA-105: Improving health through ICT/mobile technologies. The ultimate goal of this research is to fundamentally change the ways in which behavioral interventions are delivered. We propose an innovative mobile Enabling Technology-iHeal-that recognizes stressors that threaten a patient's recovery and then delivers evidence-based interventions exactly at the moment of greatest need. Our objective is to determine, within subjects, the extent to which physiologic and affective changes detected by iHeal are predictive, within subjects, of posttraumatic stress or drug cues. The study team has considerable expertise in technology development and in assessment of behavioral interventions in co-occurring disorders. We will study 25 subjects drawn from an existing SAMHSA-funded investigation that utilizes intense case management to monitor progression of PTSD and substance abuse in returning combat veterans. Our proposed investigation will share interventions with the SMAHSA study that are based upon a blending of Motivational Interviewing and Cognitive Behavioral Therapy approaches for PTSD and substance abuse. Specific aims: 1) To evaluate the accuracy with which iHeal characterizes physiological and affective phenomena as acute stress reactions related to PTSD and environmental drug cues; and 2) To evaluate the effect of Motivational Interviewing-based interventions on acute stress reactions related to PTSD and environmental drug cues. This initial proposal is extremely innovative. The proposed iHeal device will employ cutting-edge wireless technology to link wearable sensors to personal mobile computing platforms (e.g., iPhone). This linkage will allow iHeal to detect co-occurring biological and behavioral processes, while embedded computing in the mobile platform permits iHeal to deliver evidence-based empathetic interventions at the opportune moment. iHeal can learn to intervene in ways that are most effective for the user, including scripted text-based dialogues modeled after brief interventions; use of motivating images or messages from loved ones; playing a meaningful song; or contacting a counselor at the moment of greatest need. Ultimately, a wearable wireless device that anticipates stressors and intervenes at a likely transition to risky activities has enormous potential in a variety of social, behavioral, and biomedical research enterprises. Importantly, iHeal has immediate commercial applications that will encourage job growth in behavioral science, biomedical, computer science, telecommunication, and electrical engineering enterprises. iHeal is an innovative device that uses wearable sensors to detect pulse, skin conductance, and acceleration; the sensor array links wirelessly to an iPhone which has an app that identifies changes in the user's physiology. Changes consistent with acute stress from PTSD exacerbations or drug use cues generate an empathetic conversation between the iPhone and the user, who enters real-time data on social/behavioral/environmental contexts. The iPhone (which tracks time and GPS data) uses predictive software to anticipate upcoming stressors and helps the user avoid them. The public health significance of this proposal is 1) iHeal will detect co-occurring biological and behavioral processes in real time; 2) it will discern undiscovered behavioral states; 3) it will predict a behavior of interest; and 4) it will deliver empathetic interventions to the user at the opportune moment for intervention. Because it is based on the union of existing technology and has immediate commercial applications, iHeal will encourage job growth in behavioral science, biomedical, computer science, telecommunication, and electrical engineering enterprises.