Internet-based Self-Management Intervention for Prolonged Grief

描述(申请人提供)：长期悲伤障碍(PGD)是一种比正常悲伤更严重和持续的精神状况，发生在大约10%的丧亲之痛中。它的特点是对逝者的长期思念，痛苦，人际关系的脱离，以及一种无意义的感觉。PGD与相当大的功能损害、身心健康发病率、生产力丧失、自杀和低质量调整寿命年有关。目前，对PGD尚无循证的二级预防干预措施。这项研究的长期目标是解决对那些有发生PGD风险的人进行有效、成本效益高、资源效率高和易于耐受的二级预防干预的需求。主要目标是开发和试点一种基于互联网的PGD自我管理干预措施，采用经验派生的认知行为治疗(CBT)策略，促进稳定、积极的日常生活、自我照顾、适应损失、增强自我效能、重新参与愉快的活动，以及与重要他人的重新依恋。这项拟议的工作利用了现有的CBT技术和最近关于使用互联网提供CBT干预的研究，旨在为大型临床试验提供必要的开发和试点工作。关键的假设是，这种干预将减少PGD症状和相关的功能障碍。我们假设，由于互联网提供的匿名性和可访问性增加，干预的参与率将会很高，这减少了污名化，增加了治疗依从性，进而将增加治疗反应。我们将通过追求这些具体目标来实现这些目标：(1)搜索丢失和PGD文献，并与专家合作，制定一项基于经验和技能的、为期6周的治疗师辅助自我管理方案；(2)开发一种工具，评估可能阻碍PGD患者进行有效自我护理和重新参与他们的社交圈的不良认知和感知障碍(并在干预中实施该工具)；(3)开发和完善具有潜在数据获取和治疗监控能力的交互式、易于协商的互联网接口，以实施该方案；(4)根据专家、护理提供者和患者的反馈，验证和规范治疗方案和互联网接口；(5)进行试点试验，以确定干预的可行性、安全性、有效性、互联网治疗提供和监测技术的有用性，并根据完成方案的参与者的反馈，进一步细化干预。

DESCRIPTION (provided by applicant): Prolonged Grief Disorder (PGD) is a psychiatric condition more severe and unremitting than normative grief, occurring in about 10% of bereavement. It is marked by prolonged yearning for the deceased, bitterness, interpersonal disengagement, and a sense of meaninglessness. PGD is associated with considerable functional impairment, physical and mental health morbidity, lost productivity, suicide, and lowered quality adjusted life years. At present, there are no evidence-based, secondary prevention interventions for PGD. The long-term goal of this research is to address the need for an efficacious, cost-effective, resource-efficient, and readily tolerated secondary prevention intervention for those at risk for developing PGD. The primary objective is to develop and pilot-test an internet-based self-management intervention for PGD that employs empirically derived cognitive-behavioral therapy (CBT) strategies to promote stable, active routines, self-care, accommodation of loss, enhanced self-efficacy, reengagement in pleasurable activities, and reattachment with significant others. The proposed work capitalizes on established CBT techniques and recent research on using the internet to deliver CBT interventions, and is intended to provide the necessary development and pilot work for a large clinical trial. The key hypothesis is that this intervention will reduce PGD symptoms and associated functional impairments. We hypothesize that participation in the intervention will be high due to the increased anonymity and accessibility afforded by the internet, which reduces stigmatization, increases treatment compliance, and, in turn, will increase treatment response. We will accomplish the objectives by pursuing these specific aims: (1) Search the loss and PGD literature and collaborate with experts to develop an experiential and skills-based, 6- week, therapist-assisted self-management protocol; (2) Develop a tool to assess the maladaptive cognitions and perceived barriers that may prevent PGD patients engaging in effective self-care, and reengaging their social circle (and implement the tool in the intervention); (3) Develop and refine an interactive, easy-to-negotiate internet interface with underlying data capture and treatment monitoring capabilities to implement the protocol; (4) Validate and standardize the treatment protocol and internet interface based on feedback from experts, care providers, and patients; (5) Conduct a pilot trial to determine feasibility, safety, efficacy of the intervention, the usefulness of the internet treatment delivery and monitoring technology, and further refine the intervention based on feedback from participants who complete the protocol.