Does Adding a Tailored Cognitive Behavioral Therapy (CBT) Mobile Skills App Mediate Higher Rates of Depression Recovery, Adjustment, and Quality of Life in OEF/OIF Veterans Compared to Standard CBT?

与标准 CBT 相比，添加定制认知行为治疗 (CBT) 移动技能应用程序是否可以提高 OEF/OIF 退伍军人的抑郁恢复率、调整率和生活质量？

• 批准号: 10175075
• 负责人: Judith Ann Callan
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10175075
• 关键词: Acute; Address; Affect; Aftercare; Anger; Anxiety; Certification; Cognitive Therapy; Depressed mood; Disease; Disease remission; Effectiveness; Freedom; Generations; Health Status; Healthcare; Home; Hospitals; Improve Access; Individual; Information Technology; Intervention; Life Style; Long-Term Effects; Measures; Mediating; Mental Depression; Mental disorders; Methods; Paper; Participant; Patients; Personal Satisfaction; Phase; Post-Traumatic Stress Disorders; Procedures; Psychotherapy; Quality of life; Randomized; Randomized Clinical Trials; Recovery; Reporting; Service delivery model; Site; System; Time; Training; Veterans; Work; cognitive benefits; comorbidity; depressive symptoms; evidence base; experimental arm; improved; innovation; mobile application; operation; population health; prevent; psychologic; skill acquisition; skills; skills training; smartphone Application; tool; treatment comparison

Cognitive Behavioral Therapy (CBT) is the leading evidence-based psychotherapy for depression, which affects 18.5% of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans (hereafter referred to as OEF/OIF). Yet, OEF/OIF Veterans had only a 30% average reduction in mean depression scores from the initial to later phase of treatment. This was true despite the rigorous training and certification procedures for VA CBT-D. Improving the rate of depression recovery and remission is vital to enhance OEF/OIF Veteran’s ability to improve work and home adjustment and overall quality of life. Broad access to all key ingredients of CBT, including skills practice (homework), is associated with improved and faster recovery from depression. OEF/OIF Veterans and patients with depression have reported many barriers (i.e., time, chaotic lifestyles, and low energy) to following through with their skills practice assignments. In the absence of targeted strategies/interventions to address the barriers that prevent CBT skills practice, OEF/OIF Veterans will remain unable to reap the full benefits/effects of CBT. With specific tailored interventions to address this gap in treatment, OEF/OIF Veterans will improve rates of recovery from depression, diminished home and work adjustment, and poor quality of life. Leveraging the technological savvy of this generation of Veterans to improve access to CBT skills practice is a logical tactic to address this gap in treatment. Smartphone apps have been identified as a useful widely-used tool to improve the effectiveness of psychological treatments. There is, however, a paucity of empirical studies on the use of mobile apps in the treatment of depressed OEF/OIF Veterans and in psychological treatment overall. The promising pilot results of a comprehensive tailored smartphone app for CBT skills practice for OEF/OIF Veterans (“CBT MobileWork-V”), leads us to propose a larger-scale randomized clinical trial (RCT) to measure the efficacy of CBT enhanced with CBTMobileWork-V (the experimental arm) for improving CBT understanding and skill acquisition and depressive symptoms, in OEF/OIF Veterans with depression compared to standard CBT-D. Specifically, over a 27-month period we propose to randomize 268 eligible OEF/OIF Veterans with depressive symptoms, to either CBT augmented with the comprehensive CBT skill training smartphone app CBT MobileWork-V or standard CBT-D with traditional skills practice methods (i.e., paper and pencil). The Specific Aims of this study are: Primary Aim 1) To assess whether CBT-D augmented with CBT MobileWork-V (hereafter referred to as CBT- D+) promotes greater CBT understanding and skill acquisition compared to traditional CBT-D. Primary Aim 2a) To examine the short-term effect in depressive symptoms after 12 weeks of CBT-D+ versus standard CBT-D. Primary Aim 2b) To examine the long-term effect in depressive symptoms at 6 months post treatment of the CBT-D+ intervention versus traditional CBT-D.

认知行为疗法（CBT）是抑郁症的主要循证心理治疗，这是 影响18.5％的持久自由行动（OEF），伊拉克行动自由（OIF）和新行动 黎明（OND）退伍军人（以下称为OEF/OIF）。但是，OEF/OIF退伍军人平均只有30％ 平均抑郁症得分从初始治疗的初始阶段降低。这是真正的目的地 VA CBT-D的严格培训和认证程序。提高抑郁症恢复速度和 缓解对于增强OEF/OIF退伍军人改善工作和家庭调整的能力至关重要 生活质量。 广泛访问CBT的所有关键因素，包括技能练习（作业），与 改善和更快地从抑郁症中恢复。 OEF/OIF退伍军人和抑郁症患者已报告 许多障碍（即时间，混乱的生活方式和低精力）遵循他们的技能练习 作业。在没有针对性的策略/干预措施的情况下，以应对防止CBT技能的障碍 练习，OEF/OIF退伍军人将无法获得CBT的全部好处/影响。带有特定的量身定制 解决这一差距的干预措施，OEF/OIF退伍军人将提高从 抑郁症，家庭调整减少，生活质量差。 利用这一代退伍军人的技术精明来提高获得CBT技能的机会 实践是解决这一差距的逻辑策略。智能手机应用已被确定为有用的 广泛使用的工具，以提高心理治疗的有效性。但是，很少 关于使用移动应用在治疗沮丧的OEF/OIF退伍军人以及IN的实证研究 心理治疗总体。综合量身定制的智能手机应用程序的有希望的飞行员结果 OEF/OIF退伍军人（“ CBT Mobilework-V”）的CBT技能练习，导致我们提出一个更大的规模 随机临床试验（RCT）测量使用CBTMobileWork-V提高CBT的效率（ 实验组）在 与标准CBT-D相比，具有抑郁症的OEF/OIF退伍军人。具体来说，在27个月内我们 提议随机268条具有抑郁症状的合格OEF/OIF退伍军人，以增强CBT 凭借全面的CBT技能培训智能手机应用CBT Mobilework-V或标准CBT-D带有 传统技能练习方法（即纸和铅笔）。这项研究的具体目的是： 主要目的1）评估CBT-D是否使用CBT Mobilework-V增强（以下称为CBT- 与传统的CBT-D相比，D+）促进了更大的CBT理解和技能获取。 主要目的2a）检查CBT-D+ 12周后，检查抑郁症状的短期效应 标准CBT-D。 主要目的2B）检查在治疗后6个月的抑郁症状的长期影响 CBT-D+干预与传统CBT-D。