Feasibility Study of Compassion Meditation Intervention for Older Veterans in Primary Care with Anxiety or Mood Disorders

对初级保健中患有焦虑或情绪障碍的老年退伍军人进行同情冥想干预的可行性研究

• 批准号: 10383129
• 负责人: Barton W. Palmer
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10383129
• 关键词: Adherence; Adolescent; Age; Aging; Anxiety; Anxiety Disorders; Award; Awareness; Behavioral; Biological Markers; Clinic; Clinical; Cognitive; Compassion; Data; Development; Effectiveness; Elderly; Emotions; Enrollment; Feasibility Studies; Focus Groups; Fostering; Future; Goals; Group Structure; Health; Health Care Costs; Healthcare Systems; High Prevalence; Home; Inflammation; Inflammatory; Inflammatory Response; Intervention; Intervention Studies; Interview; Length; Link; Medical; Meditation; Mental Depression; Mental Health; Mental Health Services; Meta-Analysis; Minority; Modification; Mood Disorders; Moods; Morbidity - disease rate; Nature; Outcome; Outcome Measure; Participant; Patients; Personal Satisfaction; Physiological; Population; Population Analysis; Post-Traumatic Stress Disorders; Primary Health Care; Psychiatry; Psychological Factors; Psychology; Randomized Controlled Trials; Recommendation; Recovery; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk; Sampling; Severities; Stigmatization; Stress; Symptoms; Testing; Training; Veterans; anxiety symptoms; base; cardiovascular risk factor; care seeking; clinically significant; comorbidity; depressive symptoms; design; disability; effective therapy; emotional distress; experience; follow-up; functional restoration; group intervention; health care service utilization; healthy aging; impression; improved; interest; mortality; novel; optimism; physical conditioning; positive emotional state; preference; programs; protective effect; psychiatric symptom; psychoeducational; psychologic; psychological distress; psychosocial; resilience; response; self esteem; social; social stigma; treatment group; university student; willingness; young adult

Older Veterans show a high prevalence of clinically significant psychological distress such as anxiety and depressive symptoms. This high prevalence includes patients seen in Primary Care clinics. These symptoms are not only aversive in themselves, they are also associated with risk of psychosocial disability, increased medical comorbidity, early mortality, and increased health care costs. Although these concerns similarly exist among younger Veterans, the situation is particularly problematic among older Veterans as older age is associated with low utilization of mental health services. Prior research focused on identifying barriers to mental health care utilization among older Veterans have repeatedly pointed to the perceived stigma of symptom-focused treatments, which can be perceived by some Veterans as being “deficit-focused”. Therefore, it may be useful to develop effective strengths-based interventions. Compassion meditation (CM) training is a promising strengths-focused candidate in this regard, in that prior research, albeit with civilian samples, has suggested CM training promotes positive emotions and well-being, while reducing anxiety, depression, and other negative emotions. There has been less research with Veteran samples, but one study by Lang and colleagues also suggested effectiveness for Veterans with PTSD. CM has not been adapted or tested in the context of treating older Veterans with anxiety or depression. The proposed project will collect pilot data to establish feasibility for a future randomized controlled trial (RCT) of manualized CM group intervention to restore functioning in older Veterans identified through VA Primary Care clinics as having clinically significant psychological distress. This non-randomized feasibility study represents a critical initial step in adapting CM and evaluating its potential as an effective strengths-focused treatment for use with this population. Participants will include up to 40 Veterans age > 55 years identified through the Primary Care Mental Health Integrated program at the VA San Diego Healthcare System with mild-to-moderate anxiety or depressive symptoms. Twenty to 30 of these participants will be enrolled in a 10-week CM training group (with 8-10 participants in each group). The groups will be conducted with a manualized CM intervention, although part of the goal of the feasibility study is to identify and adapt the intervention to the needs of this specific population. Key questions for the feasibility study include determining participants' willingness to enroll, adherence and completion of the intervention, as well as to determine appropriate modifications in the intervention to make it maximally acceptable and appropriate to older Veterans. We will also be collecting pilot data regarding the potential of the intervention to improve well-being, symptom severity, and/or positive psychological factors. There is a growing interest in the field in expanding outcome measures beyond subjective behavioral reports, thus, we will also explore the feasibility of using inflammatory biomarkers as a non-behavioral indicator of CM intervention response. As part of establishing feasibility for a subsequent large-scale RCT, 10 additional participants will be enrolled in a 10-session manualized psychoeducational group focused on topics in healthy aging. The latter group will be conducted to examine the feasibility and appropriateness of employing this as a control condition in a follow-up RCT. Participants will also be interviewed after completion of the CM or psychoeducational groups in order to obtain their subjective impressions and recommendations for the content and structure of the groups. Given the preliminary nature of this line of research for this population, analyses will be primarily descriptive rather than focused on hypothesis testing.

年长的退伍军人表现出临床上重要的心理困扰的高度，例如动画和 抑郁症状。这种高患病率包括在初级保健诊所看到的患者。这些症状 它们本身就是厌恶的，它们还与心理社会残疾的风险相关，增加 医疗合并症，早期死亡率和增加的医疗保健成本。尽管这些问题同样存在 在年轻的退伍军人中，年龄较大的老兵尤其有问题 与精神卫生服务的利用率低相关。先前的研究重点是确定 老年退伍军人中的心理保健利用一再指出 以症状为中心的治疗，一些退伍军人可以将其视为“以赤字为中心”。因此，它 可能对制定有效的基于优势的干预措施有用。同情冥想（CM）训练是 在这方面，有前途的以优势为重点的候选人，在先前的研究中，尽管有平民样本，但 建议的CM培训促进积极的情绪和幸福感，同时减少动画，抑郁和 其他负面情绪。对退伍军人样本的研究较少，但是Lang和 同事还建议使用PTSD的退伍军人有效。 CM尚未在 治疗焦虑或抑郁的老年退伍军人的背景。拟议的项目将收集试点数据 确定未来的手动CM组干预随机对照试验（RCT）的可行性 通过VA初级保健诊所确定的老年退伍军人的恢复功能是具有临床意义的 心理困扰。这项非随机可行性研究代表了适应CM的关键初步步骤 并评估其潜力是以这种有效的优势治疗，以与该人群一起使用。 参与者将包括多达40名通过初级保健精神健康确定的退伍军人> 55岁 弗吉尼亚州圣地亚哥医疗保健系统的综合计划，具有轻度至中度的动画或抑郁症 症状。这些参与者中有20至30名将参加为期10周的CM培训小组（8-10 每个小组的参与者）。这些小组将通过手动CM干预进行，尽管 可行性研究的目的是识别并适应该特定人群的需求。 可行性研究的关键问题包括确定参与者的入学意愿，依从性和 干预的完成，并确定干预中的适当修改以进行干预 Maxly可以接受，适合年长的退伍军人。我们还将收集有关 改善福祉，症状严重程度和/或积极心理因素的干预措施的潜力。 在扩大主观行为报告以外的结果方面，对该领域的兴趣越来越大， 因此，我们还将探讨使用炎症生物标志物作为商业行为指标的可行性 干预响应。作为确定随后的大规模RCT的可行性的一部分，另外10个 参与者将入学一个10条经验的心理教育群体，该小组专注于健康的主题 老化。将进行后来的小组，以检查使用该小组的可行性和适当性 后续RCT中的控制条件。参与者也将在CM完成后面试或 心理教育群体以获取其内容的主题印象和建议 和组的结构。鉴于该人群的这一研究线的初步性质，分析 将是主要的描述性，而不是专注于假设检验。