Adapting Marital Therapy in Older Adults with Depression

对患有抑郁症的老年人进行婚姻治疗

• 批准号: 7145993
• 负责人: JILL Serafin COMPTON
• 金额: $ 17.49万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-26 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7145993
• 关键词: behavior therapy; behavioral /social science research tag; clinical depression; clinical research; clinical trials; dyadic interaction; focus groups; geriatrics; handbook; health care personnel education; health services research tag; human old age (65+); human subject; human therapy evaluation; interview; marriage /marital status; marriage counseling; mental health education; mental health personnel; motivation; patient care planning; patient oriented research; videotape /videodisc

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is a prevalent and serious psychiatric condition among older adults that has been associated with many individual and interpersonal problems in later life. Psychotherapy and pharmacotherapy have been used with success in this population, yet non-response, partial response, and relapse rates continue to be significant and there remains a need for improved interventions for this population. Marital therapy has shown promise as a treatment for depression and coexisting marital distress in younger populations, and may provide a beneficial addition to treatment for coupled older adults with depression. The purpose of this R34 application is to develop and test a depression-specific couple therapy treatment manual for depressed older adults (60+) with relationship distress. The new intervention will be adapted from Integrative Behavioral Couple Therapy (IBCT), an empirically supported treatment that incorporates both acceptance and change strategies. Several modifications to IBCT have been proposed to develop a treatment for older depressed adults, including the addition of motivational interviewing strategies to address ambivalence about treatment, psychoeducation classes to provide information and support, expanded assessment of relationship histories, routine use of behavioral exchange as a behavioral activation strategy, and focus on depression-related relationship patterns and problems. The first stage of this research (Stage 1a) will focus on the manual development process, and will include consultation with a panel of experts in geriatric depression (Drs. Steffens and Arean) and couple interventions (Drs. Christensen and Baucom). Modifications will be made to the manual in accordance with information gathered from 8-10 pilot cases, study therapists, team discussion, videotaped sessions, and feedback provided by the expert panel. In the second stage (Stage 1b), efforts will focus on conducting a pilot randomized clinical trial (RCT) to test the new treatment manual. The RCT will include 2 treatment arms: (1) Combination Treatment (Couple Therapy for Late-Life Depression plus Medication) and (2) Medication Only. The primary aims of the RCT are to examine the acceptability and feasibility of the new manual, revise therapist training procedures, and estimate the degree of change and variability of response to Combination Treatment relative to Medication Only on the primary outcomes of depression and relationship quality at post and 6-months follow-up.

描述（由申请人提供）：重度抑郁症（MDD）是老年人中一种普遍且严重的精神疾病，与晚年的许多个人和人际关系问题有关。心理治疗和药物治疗已在该人群中取得成功，但无反应、部分反应和复发率仍然很高，仍然需要改进针对该人群的干预措施。婚姻治疗已显示出作为年轻人群抑郁症和共存婚姻困扰的治疗方法的前景，并且可能为患有抑郁症的老年人提供有益的补充治疗。此 R34 应用程序的目的是为患有关系困扰的抑郁老年人（60 岁以上）开发和测试针对抑郁症的夫妻疗法治疗手册。新的干预措施将改编自夫妻综合行为疗法（IBCT），这是一种结合了接受和改变策略的经验支持疗法。为了开发针对老年抑郁症患者的治疗方法，人们对 IBCT 进行了一些修改，包括增加动机访谈策略来解决治疗的矛盾心理、提供信息和支持的心理教育课程、扩大对关系历史的评估、常规使用行为交换作为治疗方法。行为激活策略，并关注与抑郁相关的关系模式和问题。这项研究的第一阶段（阶段 1a）将重点关注手册开发过程，并将包括与老年抑郁症专家小组（Steffens 博士和 Arean 博士）和夫妻干预（Christensen 博士和 Baucom 博士）进行咨询。将根据从 8-10 个试点案例、研究治疗师、团队讨论、录像会议以及专家小组提供的反馈收集的信息对手册进行修改。在第二阶段（第1b阶段），重点是开展试点随机临床试验（RCT）来测试新的治疗手册。 RCT 将包括 2 个治疗组：(1) 联合治疗（晚年抑郁症联合治疗加药物治疗）和 (2) 仅药物治疗。 RCT 的主要目的是检查新手册的可接受性和可行性，修改治疗师培训程序，并估计联合治疗相对于仅药物治疗的反应的变化程度和可变性，包括抑郁症和关系质量的主要结果。术后和 6 个月的随访。