CBT-I for Psychosis: Guidelines, Preliminary Efficacy, and Functional Outcomes

CBT-I 治疗精神病：指南、初步疗效和功能结果

• 批准号: 10222598
• 负责人: Elizabeth A Klingaman
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2021-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222598
• 关键词: Address; Aftercare; Attention; Behavior; Behavior Therapy; Caffeine; Cardiovascular Diseases; Caring; Characteristics; Client; Clinical; Cognitive Therapy; Cognitive deficits; Communities; Data; Distress; Educational Materials; Emotional; Evidence based practice; Goals; Gold; Growth; Guidelines; Health; Health Personnel; Health behavior; Individual; Intervention; Interview; Knowledge; Leadership; Life; Link; Literature; Measures; Mediating; Mediator of activation protein; Medical; Mental Health; Mental Health Services; Mentors; Meta-Analysis; Methods; Monitor; Motivation; Obesity; Obstructive Sleep Apnea; Outcome; Participant; Pharmaceutical Preparations; Physical Function; Physical activity; Pilot Projects; Population; Procedures; Process; Protocols documentation; Provider; Psychoses; Psychotic Disorders; Randomized; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Research Design; Research Training; Role; Sampling; Sleep; Sleep Disorders; Sleep disturbances; Sleeplessness; Smoking; Social Interaction; Societies; Specific qualifier value; Supervision; Symptoms; System; Testing; Training; Treatment outcome; Unhealthy Diet; Veterans; Visit; Work; career; clinical material; cognitive function; cognitive recovery; cognitive testing; comorbidity; comparison intervention; design; diet and exercise; disability; efficacy outcomes; efficacy trial; experience; follow-up; functional outcomes; handbook; health related quality of life; improved; physical conditioning; pilot trial; programs; psychiatric rehabilitation; psychosocial; public health relevance; recruit; satisfaction; severe mental illness; skills; sleep behavior; standard care; standard of care; substance use; trial comparing

 DESCRIPTION: Insomnia is a critical obstacle to the rehabilitation and recovery of Veterans with psychotic disorders. The VHA has made treatment of insomnia a high priority and has initiated a nationwide dissemination of Cognitive Behavioral Therapy for Insomnia (CBT-I) - an evidence-based practice and the first-line standard of care for insomnia - across the VHA system, but it is largely not provided to Veterans with psychosis and insomnia. This study involves developing empirically-derived guidelines for the clinical tailoring of CBT-I for Veterans with psychosis and insomnia, and testing the acceptability, feasibility, and preliminary efficacy of CBT-I for improving sleep-related functional outcomes. This work will yield a well- specified behavioral intervention that has the potential to improve not only sleep but also physical health functioning more broadly. Insomnia is highly prevalent among individuals with psychotic disorders and confers significant long-term negative impacts on their physical, emotional, psychosocial, and cognitive recovery. Many behaviors that contribute to insomnia (e.g., poor diet, exercise, substance use, and smoking) are associated with harmful medical conditions that are highly prevalent among Veterans with psychosis (e.g., obesity, cardiovascular disease, obstructive sleep apnea). Improving sleep may improve these medical conditions, yet Veterans with psychosis are largely not provided with CBT-I, the current gold standard treatment for insomnia. The proposed research will develop guidelines for the clinical tailoring of CBT-I for Veterans with psychotic disorders and study the preliminary feasibility, acceptability, and utility of the resulting progra in improving sleep and associated functional outcomes. The first step of this research will involve an iterative process of review of the extant literature, analysis and integration of information on sleep problems gathered through pilot work, and input from Veteran clients, expert consultants, mentors, and VA treatment providers to develop guidelines and materials for the clinical tailoring of CBT-I for Veterans with psychotic disorders. Using qualitative procedures we will complete an initial acceptability trial of CBT-I with six Veterans with psychosis and insomnia for further refinements of the guidelines. Finally, the proposed study will use a small randomized controlled feasibility and preliminary efficacy trial comparing CBT-I (n=30) to a Health and Wellness control intervention (n=30) to assess rates of recruitment, initial intervention engagement, attendance at intervention sessions, and therapist fidelity. Outcomes include insomnia symptoms and functioning (e.g., health-related quality of life, physical functioning, role limitations, life activities, social interactions, participation in society, and cognitive functioning). We will explore whether baseline clinical and sleep characteristics, physical comorbidities, and other health behaviors (e.g., smoking, caffeine use, physical activity) moderate the impact of CBT-I on insomnia and functional outcomes, improve as a result of participation in CBT-I, or mediate the effect of CBT-I on functioning. In addition, we will assess the durability of effects of CBT-I on insomnia symptoms and functioning at a 3 month follow-up visit. This project will include developing educational materials and guidelines for the clinical use of the CBT-I protocol, conducting an open trial of CBT-I in a small sample, and completing an RCT with 60 participants. We will monitor fidelity, feasibility, and acceptability; study Veterans' experiences; measure symptom and functional outcomes at post-treatment and 3-month follow-up; and evaluate potential moderators and mediators.

 描述： 失眠是康复和恢复精神疾病的退伍军人的关键障碍。 VHA使失眠症的治疗成为很高的优先事项，并启动了全国范围内的认知行为疗法的失眠症（CBT-I）（CBT-I） - 一种基于证据的实践和VHA系统的一线护理标准 - 但在很大程度上没有为具有精神病和内在症的退伍军人提供。这项研究涉及开发经验衍生的指南，以针对患有精神病和失眠的退伍军人对CBT-I的临床剪裁，并测试CBT-I对改善睡眠相关功能结果的可接受性，可行性和初步有效性。这项工作将产生明确指定的行为干预措施，不仅可以改善睡眠，而且可以更广泛地改善身体健康功能。 失眠在患有精神病患者中非常普遍，并承认对他们的身体，情感，社会心理和认知康复的长期负面影响。许多导致失眠症（例如饮食，运动，吸烟和吸烟）的行为与有害医疗状况相关，这些病情在精神病的退伍军人（例如，观察，心血管疾病，阻塞性睡眠呼吸暂停）中非常普遍。改善睡眠可能会改善这些医疗状况，但是患有精神病的退伍军人在很大程度上没有CBT-I（当前的失眠症​​金标准治疗方法）提供。拟议的研究将制定针对患有精神疾病的退伍军人的CBT-I临床剪裁指南，并研究由此产生的计划的初步可行性，可接受性和效用，以改善睡眠和相关的功能结果。这项研究的第一步将涉及对通过试验工作收集的有关睡眠问题的额外文献，分析和整合的迭代过程，以及资深客户，专家顾问，导师和VA治疗提供者的投入，以开发针对具有精神病患者的退伍军人的CBT-I临床量身定制的准则和材料。使用定性程序，我们将完成CBT-I的初步可接受性试验，并与六名患有精神病和失眠的退伍军人，以进一步改进准则。最后，拟议的研究将使用一个小的随机控制可行性和初步有效性试验，将CBT-I（n = 30）与健康和健康控制干预措施（n = 30）进行了比较，以评估招募率，初步干预参与，干预课程的出勤率以及治疗师的忠诚度。结果包括失眠症状和功能（例如，与健康相关的生活质量，身体机能，角色限制，生活活动，社交互动，参与社会和认知功能）。我们将探讨基线临床和睡眠特征，身体合并症和其他健康行为（例如吸烟，咖啡馆使用，体育锻炼）是否是否存在 缓解CBT-I对失眠和功能结果的影响，由于参与CBT-I而改善或介导CBT-I对功能的影响。此外，我们将评估CBT-I对失眠符号的影响的耐用性，并在3个月的随访访问中运行。 该项目将包括制定教育材料和指南，以临床使用CBT-I方案，在一个小样本中对CBT-I进行了公开试验，并与60名参与者完成了RCT。我们将监控保真度，可行性和可接受性；学习退伍军人的经验；测量治疗后和3个月随访时的症状和功能结果；并评估潜在的主持人和调解人。

项目成果

Perceived barriers to physical activity in older and younger veterans with serious mental illness.

患有严重精神疾病的老年和年轻退伍军人认为身体活动存在障碍。

• DOI: 10.1037/prj0000245
• 发表时间: 2018
• 期刊: Psychiatric rehabilitation journal
• 影响因子: 1.9
• 作者: Muralidharan,Anjana;Klingaman,ElizabethA;Molinari,Victor;Goldberg,RichardW
• 通讯作者: Goldberg,RichardW

The association between sleep dysfunction and psychosis-like experiences among college students.

• DOI: 10.1016/j.psychres.2016.12.009
• 发表时间: 2017-03
• 期刊: Psychiatry research
• 影响因子: 11.3
• 作者: Andorko ND;Mittal V;Thompson E;Denenny D;Epstein G;Demro C;Wilson C;Sun S;Klingaman EA;DeVylder J;Oh H;Postolache TT;Reeves GM;Schiffman J
• 通讯作者: Schiffman J

Targets for the Treatment of Insomnia in Veterans With Serious Mental Illness.

患有严重精神疾病的退伍军人失眠的治疗目标。

• DOI: 10.1097/pra.0000000000000240
• 发表时间: 2017
• 期刊: Journal of psychiatric practice
• 影响因子: 1.9
• 作者: Klingaman,ElizabethA;McCarthy,JulieM;Schwartz,ElanaK;Gehrman,PhilipR;Bennett,MelanieE
• 通讯作者: Bennett,MelanieE

Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns.

消费者对抗精神病药物监测预约的满意度：消费者与处方者沟通模式的作用。

• DOI: 10.1080/13651501.2017.1375530
• 发表时间: 2018
• 期刊: International journal of psychiatry in clinical practice
• 影响因子: 3
• 作者: Reich,CatherineM;Hack,SamanthaM;Klingaman,ElizabethA;Brown,ClaytonH;Fang,LiJuan;Dixon,LisaB;Jahn,DanielleR;Kreyenbuhl,JulieA
• 通讯作者: Kreyenbuhl,JulieA

Association between sleep, childhood trauma and psychosis-like experiences.

• DOI: 10.1016/j.schres.2018.02.052
• 发表时间: 2018-09
• 期刊: Schizophrenia research
• 影响因子: 4.5
• 作者: Andorko ND;Millman ZB;Klingaman E;Medoff D;Kline E;DeVylder J;Reeves G;Schiffman J
• 通讯作者: Schiffman J