Telehealth CBT to address social isolation in Veterans with chronic pain

远程医疗 CBT 可解决患有慢性疼痛的退伍军人的社会隔离问题

• 批准号: 10586190
• 负责人: LISHAM ASHRAFIOUN
• 金额: --
• 依托单位: VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10586190
• 关键词: Address; Adherence; Advertising; Aftercare; Award; Behavior; Behavioral; Behavioral Model; Belief; COVID-19 pandemic; Chronic Disease; Clinical; Clinical Trials; Cognitive; Cognitive Therapy; Data; Elements; Emotional; Evidence based intervention; Family; Feasibility Studies; Feedback; Feeling suicidal; Fright; Health Personnel; Individual; Intervention; Left; Loneliness; Manuals; Measurement; Measures; Mental Depression; Mental Health; Meta-Analysis; Morbidity - disease rate; Outcome; Outcome Assessment; Outcome Measure; Pain; Pain management; Participant; Pattern; Persons; Prevention; Problem Solving; Procedures; Process; Randomized; Reporting; Research; Research Support; Risk; Social Environment; Social Functioning; Social Interaction; Social Perception; Social isolation; Social support; Societies; Telephone; Thinking; Treatment outcome; Veterans; Walking; acceptability and feasibility; arm; behavioral response; chronic pain; chronic pain management; chronic pain patient; cognitive testing; depressive symptoms; direct application; effective intervention; efficacy evaluation; efficacy trial; evidence base; experience; functional disability; functional improvement; improved; innovation; mortality; negative affect; novel; pain catastrophizing; pain outcome; pain reduction; pandemic disease; physically handicapped; psychosocial; psychosocial stressors; randomized, clinical trials; recruit; satisfaction; skills; social; social engagement; social situation; suicide rate; telehealth; treatment duration; treatment strategy

Loneliness—a subjective emotional state characterized by the perception of social isolation—is a psychosocial stressor that is associated with increased mortality and chronic pain. Individuals who have chronic pain and report loneliness experience greater pain-related interference in activities, depression, and suicidal ideation. Importantly, there are potentially effective interventions that can be used to decrease loneliness; however, there are no studies that have directly intervened on loneness among Veterans with chronic pain. Cognitive-Behavioral Therapy for Loneliness (CBT-L) intervenes on loneliness by addressing negative beliefs that perpetuate loneliness, increase negative affect, and reduce one’s ability to engage in social activities. For a Veteran with chronic pain, this is critical as addressing negative affect, and having a sense that one has social support and engages social support are key aspects of increasing functioning. While CBT for Chronic Pain (CBT-CP) comprises skills to promote social functioning, more robust efforts may be needed to better address lonely while also addressing functional impairment. The proposed two-year study uses a novel application of a brief, phone-delivered, evidence-based intervention, CBT-L, to decrease loneliness by modifying socially-relevant maladaptive thinking patterns, increasing engagement in enjoyable and social activities, and improving problem solving skills. Participants will be recruited nationally using online advertising. The objectives of the current proposal are to adapt CBT-L to optimize its impact on Veterans with chronic pain, examine if the recruitment, retention, and treatment delivery is feasible and if CBT-L is acceptable to participants, and assess parameters of key outcomes among participants randomized to receive CBT-L versus CBT-CP to inform a subsequent larger clinical trial. To achieve these objectives, we will adapt a manual through an evidence-based, iterative process then conduct one-arm trial of CBT-L (n=8) in Veterans with chronic pain reporting loneliness. After refining the manual and procedures following the one-arm trial, we will randomize a total of 40 participants to receive either CBT-L or CBT-CP. We will assess loneliness, the quality and quantity of social interactions, and pain outcomes such as pain-related interference, and pain catastrophizing at baseline and after the treatment period. We will also track participant flow, therapist adherence to the manual, participant homework completion and participant satisfaction with the treatment.

孤独 - 以社会孤立感知为特征的主观情感状态，是一个 与死亡率增加和慢性疼痛有关的社会心理压力源。有个人 慢性疼痛和报告孤独感在活动，抑郁和 自杀的想法。重要的是，可以使用一些潜在的有效干预措施来减少 孤独；但是，没有研究直接介入退伍军人之间的孤独 慢性疼痛。孤独感（CBT-L）的认知行为疗法通过解决 消极的信念使孤独感，增加负面影响并降低参与的能力 社交活动。对于患有慢性疼痛的退伍军人，这对于解决负面影响至关重要，并且 感觉到一个人拥有社会支持，并参与社会支持是增加功能的关键方面。尽管 慢性疼痛（CBT-CP）的CBT包括促进社会功能的技能，更强大的努力可能是 需要更好地解决孤独，同时解决功能障碍。 拟议的为期两年的研究使用了简短的电话，循证的新型应用 干预，CBT-L 增加参与愉快和社交活动，并提高解决问题的能力。参与者会 使用在线广告在全国范​​围内招募。当前建议的对象是将CBT-L调整为 优化其对患有慢性疼痛的退伍军人的影响，检查招募，保留和治疗是否是否 是可行的，如果参与者可以接受CBT-L，并评估关键结果的参数 参与者随机接收CBT-L与CBT-CP，以告知随后的更大临床试验。 为了实现这些目标，我们将通过基于证据的迭代过程调整手册 在具有慢性疼痛报告孤独感的退伍军人中，进行CBT-L（n = 8）的一臂试验。完善 单臂试验后的手动和程序，我们将随机分配40名参与者以接收任何一个 CBT-L或CBT-CP。我们将评估孤独感，社交互动的质量和数量以及痛苦结果 例如与疼痛相关的干扰以及基线和治疗期后的疼痛灾难。我们将 还跟踪参与者的流动，治疗师遵守手册，参与者的作业完成和参与者 对治疗的满意。