Real-Time Mobile Cognitive Behavioral Intervention for Serious Mental Illness

针对严重精神疾病的实时移动认知行为干预

• 批准号: 8892258
• 负责人: Colin A. Depp
• 金额: $ 52.59万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-10 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8892258
• 关键词: Accounting; Adherence; Administrator; Adopted; Adoption; Affective Symptoms; Aftercare; Attitude; Awareness; Behavioral; Belief; Bipolar Disorder; Bypass; California; Car Phone; Clinical; Cognitive; Cognitive Therapy; Communities; County; Data; Data Collection; Databases; Devices; Diagnosis; Diagnostic; Disease; Ecological momentary assessment; Economics; Effectiveness; Elements; Emergency medical service; Excess Mortality; Face; Goals; Health; Health Technology; Health system; Healthcare; Hospitalization; Hybrids; Impaired cognition; Individual; Intervention; Intervention Trial; Lead; Location; Machine Learning; Maps; Measures; Mediating; Mediator of activation protein; Medicaid; Mental Health; Mental Health Services; Meta-Analysis; Methods; Monitor; Moods; Neurocognitive; Operating System; Outcome; Outcome Study; Participant; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Policies; Provider; Psychopathology; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Resources; Schizophrenia; Self-control as a personality trait; Services; Social Functioning; Social Interaction; Socialization; Staging; Symptoms; Technology; Time; Training; Variant; Withholding Treatment; Work; arm; base; clinically significant; cloud based; cognitive ability; coping; cost; cost effectiveness; design; disability; disorder later incidence prevention; effective intervention; evidence base; experience; follow-up; functional outcomes; handheld mobile device; health care service utilization; implementation research; improved; in vivo; indexing; innovation; insight; medication compliance; monitoring device; new technology; personalized intervention; predictive modeling; primary outcome; psychologic; psychosocial; psychotic symptoms; research study; secondary outcome; service utilization; severe mental illness; standard care; theories; therapy design; treatment response

DESCRIPTION (provided by applicant): This project responds to RFA MH 13-260 "Harnessing Advanced Health Technologies to Drive Mental Health Improvement," and is led by a New/Early Stage Investigator. Bipolar disorder (BD) and Schizophrenia (SZ) are leading causes of disability and are the costliest disorders to treat among serious mental illnesses. Ample evidence exists that evidence-based psychotherapies such as cognitive behavioral therapy (CBT) produce clinically significant improvements in symptoms of BD and SZ, and yet only 5% of patients in the community can access these treatments. Access to CBT for serious mental illnesses is limited by the restricted pool of trained providers, the resource intensity of these treatments, and cessation of reimbursement for psychological services in many public mental health systems. Our research in BD and SZ over the past five years indicates that mobile phones can provide automated yet personalized cognitive behavioral intervention that is feasible, acceptable, and associated with improvements in symptoms, medication adherence and socialization. Our intervention, called CBT2go, integrates ecological momentary assessment with personalized interventions delivered in the moment that symptoms and related experiences occur. We have developed an innovative platform that functions on various screen types, operating system, or data access technologies, and we have begun to incorporate innovative features into CBT2go, including location-based data and personalized predictive modeling, that can potentially lead to transformative mobile interventions. We propose a research study with the overarching aims of evaluating the effectiveness of CBT2go, gathering necessary data to refine its innovative features, and examining its costs, facilitators, and barries to implementation in a public mental health system. We propose a randomized controlled trial with three arms: 1) CBT2go, 2) an ecological momentary assessment only condition to control for self-monitoring and device contact, and 3) standard care. A total of 255 participants with either BD or SZ will be recruited from a large public mental health system that has minimal access to CBT. Participants will be assessed at baseline, 6 weeks (mid-treatment), 12 weeks (post-treatment) and 24 weeks (follow-up). The primary outcome of the study will be clinician rated global psychopathology, and secondary outcomes will include medication adherence, social functioning, and mental health service utilization. Recognizing that not all participants wil benefit, we propose to examine differential effectiveness in sub-groups. We will also examine mechanisms of change to inform mobile intervention design, focusing on the impact of CBT2go on cognitive insight and dysfunctional attitudes, which are two mediators of change in traditionally delivered CBT. Drawing from experience in implementation research, we will employ a mixed methods approach to assessing the facilitators, barriers, and costs of adoption of CBT2go from perspectives of consumers, technology experts, administrators and front-line clinicians. This study will lay the groundwork for CBT2go to be adapted and implemented with high fidelity in healthcare settings.

描述（由申请人提供）：该项目对RFA MH 13-260做出了回应，“利用先进的健康技术来推动心理健康改善”，并由新的/早期阶段调查员领导。双相情感障碍（BD）和精神分裂症（SZ）是残疾的主要原因，是严重精神疾病中最昂贵的疾病。有足够的证据表明，循证心理治疗（例如认知行为疗法（CBT））在BD和SZ的症状上可以显着改善，但社区中只有5％的患者可以接受这些治疗。在许多公共心理卫生系统中，训练有素的提供者的资源强度，这些治疗方法的资源强度以及停止对心理服务的报销，访问严重精神疾病的访问受到限制。在过去的五年中，我们在BD和SZ方面的研究表明，手机可以提供自动化但个性化的认知行为干预措施，这些干预措施是可行的，可接受的，并且与症状，药物依从性和社交化的改善相关。我们的干预措施（称为CBT2GO）将生态时刻评估与症状和相关经历的那一刻所提供的个性化干预措施相结合。我们已经开发了一个创新的平台，该平台可在各种屏幕类型，操作系统或数据访问技术上发挥作用，并且我们已经开始将创新功能纳入CBT2GO，包括基于位置的数据和个性化的预测建模，可以潜在地导致变革性的移动干预措施。我们提出了一项研究研究，其总体目的是评估CBT2GO的有效性，收集必要的数据以完善其创新功能，并检查其成本，促进者和在公共心理健康系统中实施的障碍。我们提出了一个带有三个臂的随机对照试验：1）CBT2GO，2）仅控制自我监控和设备接触的生态时刻评估条件，以及3）标准护理。总共有255名BD或SZ参与者将从一个大型公共心理健康系统中招募，该系统最少可以访问CBT。参与者将在基线，6周（中期），12周（治疗后）和24周（随访）进行评估。该研究的主要结果将是临床医生评定的全球心理病理学，次要结果将包括药物依从性，社会功能和心理健康服务利用率。认识到并非所有参与者都会受益，我们建议检查子组中的差异效果。我们还将研究变革的机制，以告知移动干预设计，重点是CBT2GO对认知洞察力和功能障碍态度的影响，这是传统交付的CBT变化的两个调解人。从实施研究的经验中，我们将采用一种混合方法来评估从消费者，技术专家，管理人员和前线临床医生的角度来评估CBT2GO采用CBT2GO的成本。这项研究将为CBT2GO在医疗机构中以高保真度的适应和实施奠定基础。