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： 失眠是患有精神障碍的退伍军人康复和康复的一个关键障碍，VHA 将失眠的治疗列为重中之重，并已在全国范围内推广失眠认知行为疗法 (CBT-I)——一种基于证据的实践和方法。失眠的一线护理标准 - 整个 VHA 系统，但基本上不提供给患有精神病和失眠的退伍军人。这项研究涉及制定根据经验得出的临床定制指南。 CBT-I 适用于患有精神病和失眠的退伍军人，并测试 CBT-I 改善睡眠相关功能结果的可接受性、可行性和初步功效。这项工作将产生明确的行为干预措施，不仅有可能改善。睡眠以及更广泛的身体健康功能。 失眠在精神障碍患者中非常普遍，并对他们的身体、情感、心理社会和认知恢复产生显着的长期负面影响。与患有精神病的退伍军人中普遍存在的有害医疗状况（例如肥胖、心血管疾病、阻塞性睡眠呼吸暂停）有关，改善睡眠可能会改善这些医疗状况，但患有精神病的退伍军人基本上没有得到改善。 CBT-I 是目前治疗失眠的黄金标准。拟议的研究将为患有精神障碍的退伍军人制定 CBT-I 的临床定制指南，并研究由此产生的方案在改善睡眠和相关方面的初步可行性、可接受性和效用。这项研究的第一步将涉及审查现有文献、分析和整合通过试点工作收集的有关睡眠问题的信息以及退伍军人客户、专家顾问、导师和 VA 治疗提供者的意见的迭代过程。开发和材料为了对患有精神病的退伍军人进行 CBT-I 的临床定制，我们将使用定性程序对六名患有精神病和失眠的退伍军人完成 CBT-I 的初步可接受性试验，以进一步完善指南。小型随机对照可行性和初步疗效试验，将 CBT-I (n=30) 与健康和保健控制干预措施 (n=30) 进行比较，以评估招募率、初始干预参与度、干预会议出席率和治疗师忠诚度。我们将探讨失眠症状和功能（例如，与健康相关的生活质量、身体功能、角色限制、生活活动、社会互动、社会参与和认知功能）。健康行为（例如吸烟、咖啡因摄入、体力活动） 缓和 CBT-I 对失眠和功能结果的影响，因参与 CBT-I 而得到改善，或调节 CBT-I 对功能的影响。此外，我们将评估 CBT-I 对功能的影响的持久性。 3 个月随访时的失眠症状和功能。 该项目将包括 CBT-I 方案临床使用的教育材料和指南，进行小样本 CBT-I 开放试验，并完成 60 名参与者的随机对照试验。我们将监测保真度、开发可行性和可接受性。 ；研究退伍军人的经历；测量治疗后和 3 个月随访的症状和功能结果；并评估潜在的调节因素和调节因素。

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