Cognitive Behavior Therapy for Depression Enhanced with a Mobile Therapy

通过移动疗法增强抑郁症的认知行为疗法

• 批准号: 7645199
• 负责人: Larry David Jamner
• 金额: $ 46.21万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-17 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7645199
• 关键词: Address; Adherence; Aftercare; Behavior; Behavior Therapy; Behavioral; Caring; Cellular Phone; Child; Classification; Client; Client satisfaction; Clinical Trials; Communication; Communities; Competence; Cues; Data; Development; Devices; Dimensions; Distress; Ecology; Effectiveness; Environment; Event; Family; Frequencies; Friends; Future; Goals; Hamilton Rating Scale for Depression; Healthcare; Home environment; Individual; Interpersonal Relations; Intervention; Knowledge; Learning; Life; Location; Maintenance; Major Depressive Disorder; Measures; Mediation; Mediator of activation protein; Medical; Monitor; Mood Disorders; Moods; Outcome; Outcome Measure; Prevalence; Process; Productivity; Questionnaires; Ramp; Recurrence; Relapse; Resources; Sampling; Signal Transduction; Social Environment; Societies; Spouses; Staging; System; Testing; Therapeutic; Thinking; Time; Translational Research; Treatment outcome; Unipolar Depression; Work; base; behavior change; catalyst; cognitive behavior therapy; depressed; depression; depressive symptoms; design; disability burden; effective therapy; experience; follow-up; improved; innovation; meetings; negative mood; next generation; programs; psychosocial; public health relevance; skill acquisition; skills; social; therapy design; therapy outcome; tool

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is a common and highly debilitating form of mood disorder with a lifetime prevalence of approximately 16%. MDD presents individual sufferers and their families with significant psychosocial challenges and is associated with a substantial burden of disability, reduced productivity, and sizeable strains on health care resources. Without follow-up maintenance treatment, MDD has a recurrence rate of about 80%. Cognitive-behavioral therapy (CBT) is a highly effective treatment for unipolar depression, but relapse rates are still high, ranging from 25-70% over two years. Homework assignments (HA) negotiated in therapy sessions are widely recognized as a core component of CBT and as crucial to positive treatment outcomes, yet remain one of the most poorly understood aspects of the intervention. A major goal of this study is to leverage the enormous therapeutic potential inherent in HA. We propose to evaluate the effects on CBT outcomes of a highly innovative mobile therapy system representing a next generation advance in our ability to personalize and contextualize the delivery of HA. This translational research effort represents a first step focused on evaluating the effectiveness of CBT when combined with a mobile smartphone system designed to enhance the acquisition of two overarching skill sets: a) behavioral activation (e.g., more pleasurable activities, increased accomplishment, reduced avoidance) and b) systematic testing and reformulation of automatic thoughts resulting in reduced depressogenic thinking. This project will examine the extent to which personalization and contextualization improve the efficacy of CBT by comparing CBT for depression personalized with a mobile therapy smartphone system (eCBT; n=45) with standard CBT (n=45) in a community sample of clients seeking treatment for depression (MDD). Personalization of CBT will include programming the mobile therapy system to track client behaviors and automatically detect where a client is and who else is there (social context) and then deliver situation- appropriate strategies for challenging or testing the maladaptive automatic thinking that these contexts elicit. Using client and therapist input, the eCBT device will also cue and track HAs, provide a menu of tailored interventions from which the client can choose, and record moods on an ongoing basis as well as before and after specific interventions. CBT for depression personalized with a mobile therapy smartphone system (eCBT) will be compared with standard CBT on treatment outcome measures collected at baseline, 8 weeks (mid-treatment), 12-16 weeks (immediately post-treatment), and 6-month post-treatment (follow-up). We predict that eCBT will be associated with greater reductions in symptomatic moods, thoughts, and behaviors and more positive trajectories at these assessment points. Day-by-day changes in moods and behaviors will also be monitored and compared across conditions. If successful, the results of this study may have a significant impact on how the `bridges between sessions' (i.e., HA) are utilized in CBT for depression. The findings of this study may inform the design of interventions that produce more rapid treatment gains with greater resiliency against relapse. Public Health Relevance: Major Depressive Disorder presents individual sufferers and their families with significant psychosocial challenges and is associated with a substantial burden of disability and reduced productivity. Cognitive- behavioral therapy (CBT) has been shown to be a highly effective treatment for unipolar depression, however, relapse estimates for CBT range from 25-70% over two years and from 15-50% within one. If successful, the results of this study may have a significant impact on how the `bridge-between sessions' are utilized in CBT for depression and will inform the design of interventions that produce more rapid treatment gains with greater resiliency against relapse.

描述（由申请人提供）：重度抑郁症 (MDD) 是一种常见且高度衰弱的情绪障碍，一生患病率约为 16%。 MDD 给个体患者及其家人带来了重大的社会心理挑战，并与严重的残疾负担、生产力下降和医疗保健资源的巨大压力有关。如果不进行后续维持治疗，MDD的复发率约为80%。认知行为疗法 (CBT) 是单相抑郁症的一种高效治疗方法，但复发率仍然很高，两年内复发率为 25-70%。在治疗过程中商定的家庭作业（HA）被广泛认为是 CBT 的核心组成部分，对于积极的治疗结果至关重要，但仍然是干预措施中最不为人所知的方面之一。这项研究的一个主要目标是利用 HA 固有的巨大治疗潜力。我们建议评估高度创新的移动治疗系统对 CBT 结果的影响，该系统代表了我们个性化和情境化 HA 交付能力的下一代进步。这项转化研究工作代表着第一步，重点是评估 CBT 与移动智能手机系统相结合时的有效性，该系统旨在增强两种总体技能的获取：a) 行为激活（例如，更愉快的活动、增加成就感、减少回避） b) 系统测试和重新表述自动思维，从而减少抑郁性思维。该项目将通过在寻求治疗的客户社区样本中比较使用移动治疗智能手机系统（eCBT；n=45）和标准 CBT（n=45）对抑郁症进行个性化治疗的 CBT 来检查个性化和情境化在多大程度上提高了 CBT 的功效。抑郁症治疗（MDD）。 CBT 的个性化将包括对移动治疗系统进行编程，以跟踪客户行为并自动检测客户在哪里以及其他人在场（社交背景），然后提供适合情境的策略来挑战或测试这些背景引发的适应不良的自动思维。利用客户和治疗师的输入，eCBT 设备还将提示和跟踪 HA，提供定制干预措施菜单供客户选择，并持续记录以及特定干预前后的情绪。将使用移动治疗智能手机系统 (eCBT) 进行的针对抑郁症的个性化 CBT 与标准 CBT 在基线、8 周（治疗中期）、12-16 周（治疗后立即）和 6 个月收集的治疗结果指标进行比较治疗后（随访）。我们预测，eCBT 将与症状情绪、思想和行为的更大程度减少以及这些评估点的更积极的轨迹相关。情绪和行为的日常变化也将被监测并在不同条件下进行比较。如果成功，这项研究的结果可能会对如何在 CBT 治疗抑郁症中利用“疗程之间的桥梁”（即 HA）产生重大影响。这项研究的结果可能会为干预措施的设计提供信息，从而产生更快的治疗效果，并具有更强的抗复发能力。 公共卫生相关性：重度抑郁症给患者及其家人带来了重大的社会心理挑战，并与严重的残疾负担和生产力下降有关。认知行为疗法（CBT）已被证明是治疗单相抑郁症的一种非常有效的方法，然而，CBT 的复发率估计在两年内为 25-70%，在一年内为 15-50%。如果成功，这项研究的结果可能会对如何在 CBT 治疗抑郁症中利用“疗程之间的桥梁”产生重大影响，并将为干预措施的设计提供信息，从而产生更快速的治疗效果，并具有更大的抗复发能力。