Pandemic Acceptance and Commitment Therapy (Pan-ACT): Feasibility and Acceptability of Telehealth Delivery with Older Veterans

流行病接受和承诺疗法（Pan-ACT）：老年退伍军人远程医疗服务的可行性和可接受性

• 批准号: 10655582
• 负责人: LORI L. DAVIS
• 金额: --
• 依托单位: TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10655582
• 关键词: Accounting; Address; Adult; Aftercare; Aging; Anxiety; Attention; Behavior; Behavioral; COVID-19; COVID-19 mortality; COVID-19 pandemic; Climacteric; Clinical; Cognitive Therapy; Coping Skills; Data; Data Collection; Development; Diagnosis; Distress; Effectiveness; Effectiveness of Interventions; Elderly; Emotional; Enrollment; Feedback; Fright; Health; Impairment; Infection; Influenza vaccination; Intervention; Knowledge; Label; Life; Loneliness; Measures; Medical; Mental Depression; Mental Health; Method Acceptability; Methods; Modality; Modeling; Morbidity - disease rate; Nutritional; Outcome; Outcome Measure; Participant; Personal Satisfaction; Persons; Pilot Projects; Population; Prevention Measures; Procedures; Protocols documentation; Psychological Impact; Quality of life; Quasi-experiment; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Research; Research Personnel; Risk; Risk Factors; SARS-CoV-2 exposure; Sampling; Schedule; Science; Self Efficacy; Social Distance; Social isolation; Suicide; United States; Veterans; Virus; Well in self; acceptability and feasibility; age group; arm; behavior change; behavioral health; chronic pain; cohort; coping; design; effective therapy; electronic data; emotional distress; evidence base; experience; flexibility; follow-up; functional disability; group intervention; human old age (65+); improved; improved outcome; infancy; insight; invention; loved ones; male; medical appointment; military veteran; mindfulness; mortality; negative affect; pandemic disease; pandemic impact; pilot trial; post-pandemic; psychiatric comorbidity; psychologic; psychosocial; research study; skills; social; stay-at-home order; stressor; suicide rate; telehealth; timeline; treatment effect; willingness

Significance: Accounting for over 80% of COVID-19 related deaths in the United States, adults ages 65 and older have been disproportionately impacted by this pandemic more than any other age group. As a result, they may bear a heavy psychological burden in the months and years to come. Older adults have been labeled “vulnerable” to COVID-19 and strongly encouraged to adhere to “social distancing.” This prevention measure is meant to mitigate the spread of the virus but has increased older adults’ risk of social isolation and loneliness, which are two known correlates of increased morbidity and mortality in late life. Pandemic-related restrictions have decreased older adults’ life-space mobility and negatively affected their physical and nutritional well- being, impairing their quality of life and potentially increasing their vulnerability to poorer outcomes if exposed to COVID-19. Research has documented a plethora of pandemic-related stressors that are common among older adults (e.g., fear of infection, loss of loved ones, financial repercussions) and the culminating psychological impact. Telehealth-adapted evidence-based psychological interventions are needed to address the psychosocial and physical toll of the pandemic among older Veterans. Acceptance and Commitment Therapy (ACT) decreases emotional suffering, improves well-being, promotes and supports healthy behavior changes, and treats a wide range of diagnoses by increasing psychological flexibility through mindfulness, acceptance, and values-based behaviors. Higher psychological flexibility has been associated with pandemic- related coping and well-being. Randomized studies of ACT with older adults are few but promising, and most research studies with this population have used a group format. While research on telehealth delivery of ACT for older adults is limited, preliminary results indicate it is feasible and as effective as ACT delivered in person. Specific Aim: The proposed study will pilot a 10-session telehealth Pandemic ACT group intervention (i.e., Pan-ACT group) with Veterans ages 65 and older who are experiencing pandemic-related emotional and physical distress. Methods and Procedures: Twenty-five older Veterans will be enrolled in this single-arm feasibility pilot trial. The intervention will be delivered weekly in 90-minute sessions of groups of {four} to five Veterans. {Feasibility and acceptability of study procedures will be measured by referred-to-enrolled rate, telehealth access and capability, electronic data collection of outcome measures, and qualitative feedback on data collection procedures and measures. Feasibility and acceptability of the intervention will be measured by attendance; attrition; homework completion; participant ratings of the intervention’s feasibility, acceptability, and fit; qualitative feedback; and treatment fidelity.} Preliminary responsiveness of outcomes measures will be explored. Participants will complete measures of pandemic-related emotional and physical distress, psychological flexibility, depression, anxiety, social connectedness, perceived health, {functional impairment}, and meaningful engagement {at baseline, posttreatment, and one-month follow-up. A brief midpoint assessment at week 5 of the group will consist of measures of social connectedness and functional impairment. Qualitative data will be gathered on perceived efficacy to implement intervention skills and specific emotional or behavioral changes participants have noticed in themselves as a result of the intervention.} Conclusion: {This proposal directly aligns with the RR&D RFA to examine COVID-19-specific rehabilitation interventions. The telehealth Pan-ACT Group is a mental and behavioral health rehabilitation intervention that focuses on helping older Veterans develop or recover coping skills that were lost or are no longer effective during the ongoing COVID-19 pandemic.} The proposed study leverages the investigators’ strengths and expertise to address a major research and clinical gap, gather new knowledge for an urgent need, and inform the development of a full-scale randomized controlled trial to evaluate the intervention’s effectiveness.

意义：占美国199年相关死亡的80％以上，年龄在65岁和65岁的成年人 与其他任何年龄段相比，这一大流行的影响不成比例。因此， 在接下来的几个月和几年中，他们可能会受到严重的心理燃烧。老年人已被标记 Covid-19的“容易受到伤害”，并强烈鼓励坚持“社会疏远”。这种预防措施是 是为了减轻病毒的传播，但增加了老年人的社会隔离和孤独风险， 这是晚期发病率和死亡率增加的两个已知相关性。大流行有关的限制 老年人的寿命流动性成长，并对他们的身体和营养良好产生了负面影响 存在，损害他们的生活质量，并有可能增加其对较差结果的脆弱性 到19号。研究已经记录了大量与大流行有关的压力源，这些压力源很常见 老年人（例如，担心感染，失去亲人，财务影响）和最终 心理影响。需要针对远程医疗的循证心理干预措施来解决 老年退伍军人大流行的社会心理和身体损失。接受和承诺 治疗（ACT）减少情感痛苦，改善幸福感，促进和支持健康的行为 改变，通过通过正念提高心理灵活性来治疗广泛的诊断， 接受和基于价值的行为。更高的心理灵活性与大流行有关 与老年人的行为随机研究很少，但有希望，大多数 该人群的研究使用了小组格式。关于远程医疗交付行为的研究 对于老年人的有限，初步结果表明它是可行的，并且与亲自交付的法案一样有效。 具体目的：拟议的研究将驾驶10条远程医疗大流行ACT小组干预（即 Pan-Act群体）与65岁及以上的退伍军人经历了与大流行有关的情感和 身体困扰。 方法和程序：将参加这项单臂可行性试验试验的二十五名老兵。 该干预措施将每周在90分钟的{四}组中进行，分别为五名退伍军人。 {可行性 研究程序的可接受性将以转介到注册率，远程医疗访问和 能力，结果数据收集的结果数据以及数据收集的定性反馈 程序和措施。干预的可行性和可接受性将通过出席衡量； 损耗;作业完成；参与者对干预的可行性，可接受性和合身性的评分； 定性反馈；和治疗保真度。}结果措施的初步响应能力将是 探索。参与者将完成与大流行有关的情绪和身体困扰的测量 心理灵活性，抑郁，动画，社会联系，感知健康，{功能障碍}， 有意义的参与{基线，治疗后和一个月的随访。简短的中点 该小组第5周的评估将包括社会联系和功能的度量 损害。定性数据将收集有关感知效率以实施干预技能和具体的效率 由于干预的结果，参与者已经注意到了情绪或行为变化。} 结论：{该提案直接与RR＆D RFA保持一致，以检查Covid-19特定的康复 干预措施。远程医疗pan-Act小组是一种心理和行为健康康复干预措施 专注于帮助年长的退伍军人发展或恢复丢失或不再有效的应对技巧 在正在进行的COVID-19大流行期间。}拟议的研究利用了研究人员的优势和 解决重大研究和临床差距的专业知识，收集新知识以迫切需要，并告知 开发全尺度随机对照试验，以评估干预措施的有效性。