Internet-based Self-Management Intervention for Prolonged Grief

基于互联网的长期悲伤自我管理干预

• 批准号: 7540959
• 负责人: BRETT T LITZ
• 金额: $ 20.93万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-12-14 至 2010-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7540959
• 关键词: Address; Anxiety; Behavior; Bereavement; Boston; Cancer Center; Cancer Patient; Caring; Cessation of life; Chronic; Clinical; Clinical Trials; Cognition; Consensus; Dana-Farber Cancer Institute; Data; Development; Disease; Early treatment; Family member; Feedback; Goals; Gray unit of radiation dose; Grief reaction; Health; Homicide; Hospice Programs; Hospitals; Individual; Institute of Medicine (U.S.); Internet; Intervention; Laws; Life; Literature; Malignant Neoplasms; Measures; Mediation; Medical; Mental Health; Mental disorders; Methods; Monitor; Morbidity - disease rate; Neonatal Intensive Care Units; Online Systems; Palliative Care; Participant; Patients; Population; Post-Traumatic Stress Disorders; Prevention program; Preventive Intervention; Productivity; Protocols documentation; Provider; Psychiatry; Public Health; Quality-Adjusted Life Years; Research; Resources; Risk; Safety; Secondary Prevention; Self Care; Self Efficacy; Self Management; Severities; Solutions; Stigmatization; Suicide; Survivors; Symptoms; Techniques; Technology; Testing; Time; Touch sensation; Treatment Efficacy; Treatment Protocols; Universities; Woman; Work; base; caregiving; clinical infrastructure; clinically significant; cognitive behavior therapy; compliance behavior; cost; depression; design; evidence base; functional disability; hospice environment; medical schools; medical specialties; meetings; oncology; pilot trial; prevent; programs; psychosocial; skills; social; tool; trauma centers; treatment response; yearning

DESCRIPTION (provided by applicant): Prolonged Grief Disorder (PGD) is a psychiatric condition more severe and unremitting than normative grief, occurring in about 10% of bereavement. It is marked by prolonged yearning for the deceased, bitterness, interpersonal disengagement, and a sense of meaninglessness. PGD is associated with considerable functional impairment, physical and mental health morbidity, lost productivity, suicide, and lowered quality adjusted life years. At present, there are no evidence-based, secondary prevention interventions for PGD. The long-term goal of this research is to address the need for an efficacious, cost-effective, resource-efficient, and readily tolerated secondary prevention intervention for those at risk for developing PGD. The primary objective is to develop and pilot-test an internet-based self-management intervention for PGD that employs empirically derived cognitive-behavioral therapy (CBT) strategies to promote stable, active routines, self-care, accommodation of loss, enhanced self-efficacy, reengagement in pleasurable activities, and reattachment with significant others. The proposed work capitalizes on established CBT techniques and recent research on using the internet to deliver CBT interventions, and is intended to provide the necessary development and pilot work for a large clinical trial. The key hypothesis is that this intervention will reduce PGD symptoms and associated functional impairments. We hypothesize that participation in the intervention will be high due to the increased anonymity and accessibility afforded by the internet, which reduces stigmatization, increases treatment compliance, and, in turn, will increase treatment response. We will accomplish the objectives by pursuing these specific aims: (1) Search the loss and PGD literature and collaborate with experts to develop an experiential and skills-based, 6- week, therapist-assisted self-management protocol; (2) Develop a tool to assess the maladaptive cognitions and perceived barriers that may prevent PGD patients engaging in effective self-care, and reengaging their social circle (and implement the tool in the intervention); (3) Develop and refine an interactive, easy-to-negotiate internet interface with underlying data capture and treatment monitoring capabilities to implement the protocol; (4) Validate and standardize the treatment protocol and internet interface based on feedback from experts, care providers, and patients; (5) Conduct a pilot trial to determine feasibility, safety, efficacy of the intervention, the usefulness of the internet treatment delivery and monitoring technology, and further refine the intervention based on feedback from participants who complete the protocol.

描述（由申请人提供）：长期的悲伤障碍（PGD）是一种精神病病，比丧亲约10％发生的精神病更为严重和不舒服。它的标志是对死者，痛苦，人际交往和毫无意义的渴望。 PGD​​与大量功能障碍，身心健康发病率，生产力失去，自杀以及质量调整后的寿命降低有关。目前，PGD尚无基于证据的二级预防干预措施。这项研究的长期目标是解决有效，具有成本效益，资源有效且易于容忍的二级预防干预措施的需求，以便患有PGD风险的人。主要目标是开发和试验基于Internet的PGD的自我管理干预措施，该干预采用经验得出的认知行为疗法（CBT）策略，以促进稳定的，积极的常规，自我保健，自我保健，损失的适应，增强的自我效能，增强的自我效能感，在愉悦的活动中重新获得愉悦的活动以及与其他大量其他人相处。拟议的工作利用了既定的CBT技术和有关使用Internet提供CBT干预措施的最新研究，并旨在为大型临床试验提供必要的开发和试点工作。关键假设是，这种干预将减少PGD症状和相关的功能障碍。我们假设，由于互联网提供的匿名和可及性的增加，参与干预措施将很高，从而降低了污名化，增加了治疗依从性，进而将增加治疗反应。我们将通过追求这些特定目标来实现目标：（1）搜索损失和PGD文献，并与专家合作开发基于体验和技能的6-周，治疗师辅助辅助自我管理方案； （2）开发一种工具来评估适应不良的认知和感知的障碍，以防止PGD患者从事有效的自我保健并重新接触社交圈（并在干预中实施工具）； （3）开发和完善互动，易于调用的Internet界面，具有潜在的数据捕获和治疗监控功能以实现协议； （4）根据专家，护理提供者和患者的反馈，验证和标准化治疗方案和互联网界面； （5）进行试点试验，以确定可行性，安全性，干预措施的功效，互联网处理交付和监测技术的有用性，并根据完成协议的参与者的反馈进一步完善干预措施。