Cognitive Behavior Therapy for Anxiety in Dementia

认知行为疗法治疗痴呆症焦虑

• 批准号: 7469580
• 负责人: MELINDA A STANLEY
• 金额: $ 21.19万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-15 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7469580
• 关键词: Address; Adherence; Adverse effects; Alzheimer' s Disease; Anxiety; Anxiety Disorders; Behavior Therapy; Caregivers; Caring; Clinical Trials; Cognitive; Cognitive Therapy; Competence; Comprehension; Condition; Cues; Data; Dementia; Development; Diagnosis; Disease; Elderly; Enrollment; Family member; Feedback; Frequencies; Friends; Goals; Health Benefit; Health Policy; Healthcare; High Prevalence; Hour; Impaired cognition; Intervention; Knowledge; Learning; Life; Manuals; Measures; Memory; Mental Depression; Mental Health; Outcome; Outcome Assessment; Patients; Pharmacological Treatment; Phase; Population; Problem behavior; Procedures; Public Health; Purpose; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Rate; Recruitment Activity; Relative (related person); Research Personnel; Retrieval; Severities; Sleep disturbances; Subgroup; Symptoms; Testing; Training; Week; Work; base; depressive symptoms; member; older patient; response; satisfaction; service utilization; size; skills

DESCRIPTION (provided by applicant): Anxiety occurs commonly in people with dementia, with significant impact on life function and healthcare, but virtually nothing is known about effective treatment strategies. Given limitations of pharmacological treatment for anxiety in this population and some evidence that cognitive behavior therapy (CBT) may be of value, we propose to develop, refine, and pilot test a manual for CBT of anxiety in dementia (CBT-AD). No such treatment yet has been developed or tested. CBT-AD will integrate empirically supported interventions for late-life anxiety with strategies that facilitate comprehension, encoding, and retrieval for people with dementia (e.g., memory cueing, spaced retrieval). Collaterals (defined as a family member, friend, or caregiver who spends at least 8 hours a week with the patient) will participate in assessment and treatment. Three phases of work will be needed. In Phase I (6 months), we will draft the CBT-AD manual and an associated measure of therapist adherence and competence, obtain input from a panel of experts and modify the manual and treatment integrity measure, train independent evaluators, and continue to refine therapist skills. In Phase II (8 months), we will conduct an open clinical trial of CBT-AD with 10 patients who have significant anxiety and mild to moderate dementia associated with a diagnosis of Alzheimer's disease. The CBT-AD manual will be revised based on input from patients, collaterals, therapists, investigators, and the expert panel. Fourteen patients will be recruited to allow for up to 30% attrition. In Phase III (22 months), we will conduct a small randomized controlled trial of CBT-AD (n = 20) versus enhanced usual care (EUC; n = 20) to estimate effect sizes for a subsequent R01 application. A total of 52 patients with anxiety and dementia (as defined in Phase II) will be recruited to allow for up to 30% attrition. Outcomes will address anxiety severity, coexistent symptoms, quality of life, service utilization, collateral burden, and treatment satisfaction. Outcome assessments will be conducted at baseline, 3-, and 6-months. If the data suggest positive outcomes, the next step will be a large, randomized controlled trial to examine more fully the effects of CBT-AD. The proposed study has significant potential public health benefits for a large subgroup of underserved older patients for whom evidence-based health care options do not yet exist. The project also has potentially important mental health policy implications if CBT-AD produces positive health care outcomes.

描述（由申请人提供）：焦虑通常发生在痴呆症患者中，对生活功能和医疗保健产生重大影响，但实际上对有效治疗策略一无所知。考虑到该人群中药理学治疗对焦虑的局限性，以及一些证据表明认知行为疗法（CBT）可能具有价值，我们建议开发，完善和试点测试痴呆症（CBT-AD）中CBT焦虑症手册（CBT-AD）。尚未开发或测试这种治疗方法。 CBT-AD将对痴呆症患者的理解，编码和检索的策略（例如记忆提示，间隔检索）的策略融合了对晚期焦虑的经验支持的干预措施。抵押品（定义为每周至少8个小时的家庭成员，朋友或照顾者）将参加评估和治疗。需要三个阶段的工作阶段。在第一阶段（6个月）中，我们将起草CBT-AD手册以及相关的治疗师依从性和能力的衡量标准，从专家小组中获取投入，并修改手动和治疗完整性措施，培训独立的评估者，并继续完善治疗师的技能。在第二阶段（8个月）中，我们将对CBT-AD进行开放临床试验，其中10例患者具有明显的焦虑，轻度至中度的痴呆症与诊断为阿尔茨海默氏病有关。 CBT-AD手册将根据患者，抵押品，治疗师，研究人员和专家小组的意见进行修订。将招募14名患者，以允许高达30％的损耗。在第三阶段（22个月）中，我们将对CBT-AD（n = 20）的小型随机对照试验与增强的常规护理（EUC; n = 20），以估算随后的R01应用的效应尺寸。总共招募了52例焦虑和痴呆症患者（在第二阶段中定义），以允许多达30％的损耗。结果将解决焦虑的严重性，共存的症状，生活质量，服务利用，抵押负担和治疗满意度。结果评估将在基线，3个月和6个月进行。如果数据表明积极的结果，下一步将是一项大型，随机的对照试验，以更全面地检查CBT-AD的影响。拟议的研究对大量服务不足的老年患者具有巨大的公共卫生益处，这些患者尚不存在循证医疗保健选择。如果CBT-AD产生积极的医疗保健结果，该项目还具有潜在的重要心理健康政策。