Using the Multiphase Optimization Strategy to Adapt Cognitive Processing Therapy

使用多阶段优化策略来适应认知处理疗法

• 批准号: 10313147
• 负责人: Rebecca Kaufman Sripada
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10313147
• 关键词: Address; Adherence; Age; Characteristics; Cognition; Cognitive; DSM-V; Distress; Dose; Dropout; Drops; Effectiveness; Elderly; Elements; Engineering; Ensure; Evidence based treatment; Exclusion Criteria; Experimental Designs; Future; Goals; Health; Health Priorities; Health Services Accessibility; Individual; Institute of Medicine (U.S.); Intervention; Logistics; Measures; Mediating; Mediator of activation protein; Mental Health; Methodology; Methods; Outcome; Participant; Patient Preferences; Performance; Personal Satisfaction; Persons; Post-Traumatic Stress Disorders; Process; Productivity; Provider; Psychotherapy; Quality of life; Randomized; Research; Research Priority; Service delivery model; Severities; Symptoms; System; Testing; Therapeutic; Time; Training Programs; Trauma; Treatment Effectiveness; Veterans; Work; base; brief intervention; clinical practice; clinically significant; design; effective intervention; effectiveness testing; effectiveness trial; evidence base; experience; experimental study; follow-up; implementation science; improved; improved outcome; innovation; medical specialties; multi-component intervention; multiphase optimization strategy; novel; personalized intervention; personalized medicine; physically handicapped; post 9/11; premature; reduce symptoms; sex; substance use; suicidal risk; telehealth; theories; treatment response; uptake

Background: One third of post-9/11 Veterans in VHA suffer from posttraumatic stress disorder (PTSD), and among those who initiate Cognitive Processing Therapy (CPT), up to 70% drop out before receiving an adequate dose of treatment. Unfortunately, Veterans who drop out prematurely may never receive the most effective components of CPT. Thus, there is an urgent need to use empirical approaches to identify the most effective components of CPT, so that CPT can be adapted into a briefer format. The long-term goal of this line of research is to adapt, test, and implement brief, evidence-based treatment for Veterans with PTSD. The overall objective of the current application is to adapt CPT into a brief, effective format. The rationale is that identifying the most effective intervention components and delivering only those components will make CPT deliverable in a shorter timeframe, thus improving efficiency, reducing drop-out related to poor treatment response, and ensuring that Veterans receive the most beneficial components of treatment, which will significantly improve their quality of life. Significance/Impact: Upon completion of this project, we expect to have produced an empirically-based, brief version of CPT. This contribution is likely to improve clinical practice for Veterans with PTSD by providing the most effective components at an earlier session, thus increasing the overall effectiveness of treatment and mitigating the negative consequences of untreated PTSD, such as lost productivity, substance use, later-life physical disability, reduced quality of life, and increased risk of suicide. Innovation: The status quo for PTSD treatment is lengthy psychotherapy in a specialty mental health setting, which is rarely delivered in its entirety. The proposed research is innovative because it will use a novel engineering-inspired framework, the multiphase optimization strategy (MOST), to adapt this effective psychotherapy into a brief format. Developing a brief, empirically-based version of CPT will open new horizons for PTSD treatment by expanding CPT access to treatment settings where lengthier treatments are not feasible. It will also provide effective options for Veterans who desire a briefer treatment course. Specific Aims: Specific Aim 1: Using a highly efficient experimental design, identify which of five CPT components contribute meaningfully to reduction in PTSD symptoms. We will test the effectiveness of each component and each two-way interaction between components. Specific Aim 2: Identify mediators of component effectiveness. We hypothesize that effects will be mediated by engagement/adherence and change in posttraumatic cognitions. Exploratory Aim 1: Identify moderators of component effectiveness. Methodology: The MOST is an innovative engineering-inspired framework that uses an optimization trial to assess the performance of individual intervention components within a multicomponent intervention such as CPT. Guided by the MOST framework, the goal of the proposed project is to empirically inform an abbreviated version of CPT via a highly efficient fractional factorial design. Veterans (N = 270) at two VAMCs with clinically significant PTSD symptoms who meet minimal inclusion/exclusion criteria will be randomized to receive one or more CPT components. This design will test the effectiveness of each component and each two-way interaction between components, as measured by PTSD symptom reduction on the Clinician-administered PTSD scale for DSM-5 (CAPS-5) across six months of follow-up. Implementation/Next Steps: Upon completion of these aims, our expected outcome is an adapted, abbreviated version of CPT that consists of the most effective elements of the intervention. The adapted intervention will be primed for a future large scale, fully powered effectiveness trial. The adapted intervention can be easily disseminated through the VA CPT training program and will have a positive impact on the health and wellbeing of Veterans with PTSD.

背景：VHA中9/11后退伍军人的三分之一患有创伤后应激障碍（PTSD），而 在开始认知处理疗法（CPT）的人中，最多70％的人退出 足够的治疗剂量。不幸的是，过早退出的退伍军人可能永远不会收到最多的 CPT的有效组成部分。因此，迫切需要使用经验方法来识别最多的 CPT的有效组成部分，以便将CPT改编成Briefer格式。这条线的长期目标 研究是为了适应，测试和实施对PTSD的退伍军人的简短，基于证据的治疗。这 当前应用的总体目的是将CPT调整为简短，有效的格式。理由是 确定最有效的干预组件并仅交付这些组件将使CPT 在较短的时间内交付，从而提高了效率，减少了与治疗不佳有关的辍学 回应，并确保退伍军人获得最有益的治疗组成部分，这将 显着改善了他们的生活质量。 意义/影响力：该项目完成后，我们预计会产生基于经验的简短 CPT的版本。这项贡献可能会通过提供PTSD的退伍军人来改善临床实践 在较早的会议上最有效的组成部分，从而提高了治疗的总体有效性和 减轻未经处理的PTSD的负面后果，例如生产力损失，药物使用，后期寿命 身体残疾，生活质量降低以及自杀风险增加。 创新：PTSD治疗的现状是在专业心理健康环境中冗长的心理治疗， 很少能全面交付。拟议的研究具有创新性，因为它将使用小说 工程启发的框架，多相优化策略（大多数），以适应这种有效的 心理治疗成一种简短的格式。开发简短的基于经验的CPT版本将开放新的视野 通过扩大CPT的访问，无法进行PTSD治疗，而治疗设置较长 可行的。它还将为希望获得Briefer治疗课程的退伍军人提供有效的选择。 具体目的：特定目标1：使用高效的实验设计，确定五个CPT中的哪些 组件有意义地减轻PTSD症状。我们将测试每个人的有效性 组件和组件之间的每种双向相互作用。特定目标2：确定调解人 组件有效性。我们假设效果将由参与/依从性和变化介导 在创伤后认知中。探索目的1：确定组件有效性的主持人。 方法论：最多的是一种创新的工程启发的框架，它使用优化试验来 评估多组分干预措施中个体干预组件的性能，例如 CPT。在最多的框架下，拟议项目的目标是经验告知缩写 CPT的版本通过高效的分数阶乘设计。退伍军人（n = 270），在两个VAMC上 符合最小纳入/排除标准的重要PTSD症状将被随机接收或接收一个或 更多的CPT组件。该设计将测试每个组件的有效性和每个双向 组件之间的相互作用，通过减少PTSD症状在临床医生管理的症状上测量 在六个月的随访中，DSM-5（CAPS-5）的PTSD量表。 实施/下一步：完成这些目标后，我们的预期结果是适应的， CPT的缩写版本由干预的最有效元素组成。适应 干预措施将用于未来的大规模，完全动力的有效性试验。改编的干预措施 可以通过VA CPT培训计划轻松传播，并将对健康产生积极影响 和PTSD的退伍军人福祉。