Increasing Access to Depressive Relapse Prophylaxis with Web-Based MBCT

通过基于网络的 MBCT 增加抑郁症复发预防的机会

基本信息

批准号：
8277780
负责人：
Zindel Segal
金额：
$ 18.62万
依托单位：
CENTRE FOR ADDICTION AND MENTAL HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2014-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8277780
关键词：
Acute Address Adopted Adult Affect Aftercare Americas Antidepressive Agents Anxiety Architecture Attention Awareness Beck depression inventory Caring Clinical Clinical Management Cognitive Therapy Colorado Communities Community Developments Custom Data Depressed mood Development Disease remission Drops Educational process of instructing Empirical Research Evaluation Exercise Family Feedback Focus Groups Generations Goals Health Maintenance Organizations Health Services Research Healthcare Individual Instruction Internet Intervention Investigation Knowledge Knowledge acquisition Learning Maintenance Major Depressive Disorder Manuals Mental Depression Mental Health Mental disorders Multimedia Online Systems Outcome Participant Patient Self-Report Patients Persons Pharmacotherapy Phase Population Heterogeneity Prevention Prevention program Preventive Preventive Intervention Primary Health Care Process Prophylactic treatment Public Health Public Health Practice Quality of life Randomized Controlled Trials Recording of previous events Recovery Recurrence Relapse Reporting Research Research Personnel Research Project Grants Residual state Resources Risk Safety Sampling Services Societies Source Stress Symptoms Testing Thinking Time Training Training Programs Translation Process United States Universities Vertebral column Work Writing addiction base clinical practice cost depressive symptoms design dysphoria emotion regulation evidence base group intervention improved indexing mindfulness mindfulness based cognitive therapy novel prevent prevention service primary care setting programs prophylactic prototype psychosocial public health relevance recurrent depression response satisfaction secondary outcome skills social theories therapy adherence therapy design therapy development treatment as usual usability web based interface web site

项目摘要

DESCRIPTION (provided by applicant): The Internet provides promising terrain for the development and delivery of novel treatments for mental illness. The possibility of effective Internet-based interventions, which can incorporate the needs and circumstances of diverse populations outside traditional treatment settings, must be thoroughly explored. An existing treatment, Mindfulness-based Cognitive-behavioral Therapy (MBCT), significantly reduces relapse rates in recurrent depression among general adult samples, and an internet-delivered preventive intervention based on MBCT ("eMBCT") is in conceptual development. A study investigating the feasibility, safety, acceptability, and preliminary efficacy of eMBCT in preventing depressive relapse/recurrence, is proposed. The project involves 3 phases: 1) conceptualizing the intervention based on theory and empirical research; 2) developing and standardizing the intervention, and 3) conducting an open trial to evaluate clinical and feasibility outcomes of eMBCT by assessing levels of depressive symptoms and proximal markers of relapse risk. Phase 1 will identify content domains, write learning objectives and list the specific mindfulness practices and depression awareness exercises contained in each of the 9 MBCT sessions that will form the backbone of eMBCT. In Phase 2, researchers at the Centre for Addiction and Mental Health, the University of Colorado at Boulder and Kaiser Permanente Colorado will work collaboratively with Allen Interactions, a leader in eLearning applications and custom web design, to develop a fully functional prototype of the eMBCT website. This process will be iterative and incremental, comprising the generation of web interactions and content and revisions of this material based on focus group and user testing with both patient and clinician/stakeholder samples (N=84). This will provide important data on eMBCT's usability, satisfaction, knowledge acquisition and acceptability. In Phase 3, a proof of concept open trial (N=50) with remitted depressed patients will be conducted. This trial will allow data gathering on the degree of patient engagement with eMBCT by comparing rates of attrition and homework compliance with indices reported for in-person MBCT groups. Pre and post treatment differences on depression scores and two variables shown to be strong predictors of relapse in other studies, namely rumination and degree of mindfulness, will also be examined. Given the negative, long-term, consequences of untreated relapse and recurrence risk in people recovering from depression, and the scarcity of MBCT resources in the community, the development of eMBCT has the potential to significantly benefit patients, their families, and society at large. PUBLIC HEALTH RELEVANCE: Relapse and recurrence following recovery from Major Depressive Disorder is a significant public health concern, with debilitating outcomes that carry enormous social costs in the United States of America. Mindfulness-Based Cognitive Therapy (MBCT) is one of the most promising recent developments in the effort to prevent relapse and recurrence of depression; however its dissemination within community mental health or primary care settings is considerably limited. eMBCT, a web-based version of MBCT will be developed and tested so that access to this preventive treatment can be extended to a broader audience of at risk individuals.

描述（由申请人提供）：互联网为开发和提供精神疾病的新疗法提供了有希望的地形。必须彻底探讨有效的基于Internet的干预措施，这些干预措施可以纳入传统治疗环境之外的不同人群的需求和情况。现有的治疗方法，基于正念的认知行为疗法（MBCT），大大降低了一般成人样本中复发性抑郁症的复发率，以及基于MBCT（“ EMBCT”）的互联网提供的预防干预措施正在概念发展中。提出了一项研究，研究了EMBCT在预防抑郁复发/复发方面的可行性，安全性，可接受性和初步疗效。该项目涉及3个阶段：1）根据理论和实证研究概念化干预措施； 2）制定和标准化干预措施，3）进行开放试验，通过评估抑郁症状的水平和复发风险的近端标记来评估EMBCT的临床和可行性结果。第1阶段将确定内容域，编写学习目标，并列出9个MBCT会话中每一个中包含的特定的正念实践和抑郁意识练习，这些练习将构成EMBCT的骨干。在第2阶段，科罗拉多大学博尔德分校和科罗拉多州的Kaiser Permanente Colorado的研究人员将与Allen Interactions合作，艾伦Interactions（Ellen Interactions）是电子学习应用程序和自定义网络设计的领导者，以开发EMBCT网站的功能齐全的原型。这个过程将是迭代的和增量的，包括基于焦点组和用户测试与患者和临床医生/利益相关者样本的焦点组和用户测试（n = 84）基于焦点组和用户测试的生成。这将提供有关EMBCT的可用性，满意度，知识获取和可接受性的重要数据。在第3阶段，将进行概念验证验证试验（n = 50），并将进行带有抑郁症患者的抑郁症。该试验将允许通过将流失率和家庭作业符合率与报告的MBCT组报告的指数进行比较，从而收集有关患者与EMBCT的患者参与度的收集。还将检查抑郁评分的治疗前和治疗后差异，两个变量在其他研究中证明是复发的有力预测指标，即反省和正念程度。鉴于未经治疗的复发和复发风险在抑郁症中康复的人以及社区中MBCT资源的稀缺性带来的负面，长期的后果，EMBCT的发展有可能显着使患者，家人和整个社会受益匪浅。公共卫生相关性：从重度抑郁症中恢复后，复发和复发是一个重大的公共卫生问题，使美国造成巨大社会成本的结果使人衰弱。基于正念的认知疗法（MBCT）是防止抑郁症复发和复发的最有希望的发展之一。但是，它在社区心理健康或初级保健环境中的传播非常有限。将开发和测试基于网络的MBCT版本EMBCT，以便可以将这种预防性治疗的访问范围扩展到更广泛的风险个人。