Adaptation of a Behavioral Treatment for Latinos with Panic Disorder and Asthma

对患有恐慌症和哮喘的拉丁裔进行行为治疗

基本信息

批准号：
7772025
负责人：
JONATHAN M. FELDMAN
金额：
$ 24.9万
依托单位：
YESHIVA UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-12-01 至 2012-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7772025
关键词：
Adverse effects Affect Aftercare Agonist Albuterol Arousal Asthma Behavior Therapy Biofeedback Breathing Caribbean region Clinical Cognitive Therapy Comorbidity Confusion DSM-IV Data Detection Development Diagnosis Disease Dominican Education Educational process of instructing Elements Ethnic Origin Ethnic group Feasibility Studies Feedback Focus Groups Future Goals Grant Guidelines Health Care Costs Health behavior Individual Intervention Interview Interviewer Latino Lead Manuals Methodology Mission Modification Morbidity - disease rate Music Therapy National Institute of Mental Health New York Panic Panic Disorder Participant Patients Pharmaceutical Preparations Phase Pilot Projects Placebo Control Placebos Prevalence Protocols documentation Psyche structure Public Health Puerto Rican Quality of life Randomized Randomized Controlled Trials Recruitment Activity Reporting Research Research Design Respiration Rest Risk Self Management Severities Structure Symptoms Testing Therapeutic Training Urban Hospitals active method arm base blind design efficacy testing experience follow-up heart rate variability inner city preference programs psychoeducation public health relevance randomized placebo controlled trial

项目摘要

DESCRIPTION (provided by applicant): This application is being submitted to the NIMH DAHBR Health and Behavior Research Branch Co- Morbidity Program. This is a pilot study designed to culturally adapt for Latinos a behavioral treatment for comorbid panic disorder (PD) and asthma, and examine its efficacy versus an active placebo treatment. This R34 proposal is a follow-up to an R21 study, which developed the Panic-Asthma Treatment and showed promising results for reducing panic and asthma symptoms. There is a large degree of symptom similarity between PD and asthma. Confusion between panic and asthma symptoms can result in serious errors in self- management of both disorders. Patients with PD and asthma need a tailored intervention because what may be therapeutic for one condition can potentially exacerbate the other condition. The intervention teaches participants to differentiate between panic and asthma symptoms, and how to apply self-management strategies for each. The treatment also includes elements of cognitive behavioral therapy for PD that are safe for patients with asthma, and combines it with asthma education and heart rate variability biofeedback therapy. The research plan will involve two aims: 1) Cultural adaptation of the Panic-Asthma Treatment and 2) a randomized, placebo-controlled pilot study. Participants will be primarily recruited from two major, inner-city hospitals in the Bronx, NY. Diagnosis of PD will be based on the Structured Clinical Interview for DSM-IV. Diagnosis of asthma will be based on national guidelines. The first year of the project will be devoted to approximately 5 focus groups with Latino (primarily Puerto Rican) participants, pilot treatment and participant feedback. The protocol will be adapted based on key cultural issues that are systematically observed during Phase 1. During Years 2-3, 40 participants with PD and asthma will be randomized into two treatment arms: Panic-Asthma Treatment and an active placebo condition involving music therapy and paced breathing at resting respiration rates. Each treatment will involve 8 weekly sessions. An interviewer, who will be blind to treatment condition, will conduct assessments at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up. The primary hypotheses are that participants in the Panic-Asthma treatment group will have greater decreases than subjects in the placebo condition on the PD severity scale and albuterol use (i.e., rescue asthma medication) from pre-test to post-test and across 3-month follow-up. Albuterol use is important to examine because it may be an indicator of confusion between panic and asthma symptoms. Reductions in albuterol use may lead to improvements in panic symptoms due to fewer side effects. The goals of this study are highly relevant to the mission of NIMH to develop efficacious, culturally relevant behavioral treatments of co-occurring mental and physical disorders. This R34 study will generate feasibility data (e.g., initial effect sizes, recruitment and retention rates, treatment credibility, etc.) to design a future full- scale randomized, placebo-controlled trial via an R01 grant. PUBLIC HEALTH RELEVANCE: The development of a behavioral treatment for Latinos with comorbid panic disorder and asthma has great potential to reduce the immense public health costs of both disorders. Panic disorder is over-represented in patients with asthma, and asthma disproportionately affects Puerto Rican individuals. The Panic-Asthma treatment will be adapted to incorporate the specific, cultural issues relevant to Latinos.

描述（由申请人提供）：本申请将提交给 NIMH DAHBR 健康与行为研究分部共病计划。这是一项试点研究，旨在在文化上适应拉丁美洲人对共病恐慌症 (PD) 和哮喘的行为治疗，并检查其与积极安慰剂治疗相比的疗效。 R34 提案是 R21 研究的后续研究，R21 研究开发了恐慌哮喘治疗方法，并在减少恐慌和哮喘症状方面显示出有希望的结果。 PD 和哮喘之间的症状有很大程度的相似性。恐慌和哮喘症状之间的混淆可能会导致这两种疾病的自我管理出现严重错误。患有帕金森病和哮喘的患者需要量身定制的干预措施，因为对一种病症有效的治疗可能会加剧另一种病症。该干预措施教会参与者区分恐慌和哮喘症状，以及如何针对每种症状应用自我管理策略。该治疗还包括对哮喘患者安全的帕金森病认知行为疗法，并将其与哮喘教育和心率变异性生物反馈疗法相结合。该研究计划将涉及两个目标：1）恐慌哮喘治疗的文化适应；2）随机、安慰剂对照的试点研究。参与者将主要从纽约州布朗克斯区的两家主要市中心医院招募。 PD 的诊断将基于 DSM-IV 的结构化临床访谈。哮喘的诊断将基于国家指南。该项目的第一年将致力于大约 5 个由拉丁裔（主要是波多黎各人）参与者参加的焦点小组、试点治疗和参与者反馈。该方案将根据第一阶段系统观察到的关键文化问题进行调整。在第 2-3 年期间，40 名患有 PD 和哮喘的参与者将被随机分为两个治疗组：恐慌哮喘治疗和涉及音乐治疗的主动安慰剂治疗并以静息呼吸频率进行有节奏的呼吸。每次治疗每周进行 8 次。访谈员对治疗情况不知情，将在治疗前、治疗中、治疗后和3个月随访时进行评估。主要假设是，从测试前到测试后以及整个 3 个月，恐慌性哮喘治疗组的参与者在 PD 严重程度和沙丁胺醇的使用（即哮喘救援药物）方面比安慰剂组的受试者有更大的下降。月随访。检查沙丁胺醇的使用情况很重要，因为它可能是混淆恐慌和哮喘症状的一个指标。由于副作用较少，减少沙丁胺醇的使用可能会改善恐慌症状。这项研究的目标与 NIMH 的使命高度相关，即针对同时发生的精神和身体疾病开发有效的、文化相关的行为疗法。这项 R34 研究将生成可行性数据（例如，初始效应大小、招募和保留率、治疗可信度等），以通过 R01 拨款设计未来的全面随机、安慰剂对照试验。公共卫生相关性：针对患有惊恐障碍和哮喘的拉丁裔患者开发一种行为疗法，有望降低这两种疾病带来的巨大公共卫生成本。惊恐障碍在哮喘患者中所占比例过高，而哮喘对波多黎各人的影响尤为严重。恐慌性哮喘治疗将适应与拉丁裔相关的具体文化问题。