Attention Training for Underserved Youth With Anxiety

针对服务不足的焦虑青少年的注意力训练

基本信息

批准号：
9228682
负责人：
DENISE A CHAVIRA
金额：
$ 23.1万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-02-01 至 2020-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9228682
关键词：
Address Advanced Development Affect Aftercare Anxiety Anxiety Disorders Attention Case Series Child Chronic Clinical Treatment Communities Community Health Aides Community Healthcare Community Practice Community of Practice Computers Data Development Education Effectiveness Evidence based intervention Evidence based treatment Face Family Feedback Foundations Future Geographic Locations Goals Health Health Personnel Home environment Impairment Improve Access Intervention Latino Lead Literature Low income Measures Mental Health Mental Health Services Meta-Analysis Methods Modeling Modification National Institute of Mental Health Neurocognitive Outcome Patients Pattern Phase Poverty Preventive Intervention Principal Investigator Procedures Process Protocols documentation Provider Quality of Care Randomized Randomized Controlled Trials Recruitment Activity Reporting Risk Rural Sampling Services Severities Stimulus Strategic Planning Tablet Computer Testing Time Training Transportation Youth anxiety symptoms anxiety treatment anxious anxious individuals attentional bias attentional control base childhood anxiety cognitive control community based service comparative effectiveness computerized cost effectiveness effectiveness trial efficacy study ethnic minority population evidence base expectation improved indexing innovation literacy named group novel outreach personalized intervention potential biomarker programs reduce symptoms research study response service intervention success theories treatment responders treatment response

项目摘要

Project Abstract Recent efforts to improve existing treatments for anxiety have emerged from the established experimental literature on threat-related attention bias in anxiety. Attention Bias Modification (ABM) is a novel theory-driven treatment that utilizes computer-based attention training methods to directly but implicitly modify biased attention patterns in anxious individuals in service of symptom relief. The rapidly accumulating evidence base for ABM suggests it may be a promising new intervention for anxiety with an identified mechanism of action - attention bias change. While multiple reviews and meta-analyses are in general support of ABM efficacy, effectiveness studies are sparse particularly with underserved groups such as low income Latino and rural youth. Given data suggesting that anxiety may be more prevalent among Latinos, and that Latinos and rural youth underutilize mental health services, effectiveness studies are necessary to examine culturally informed and innovative evidence-based interventions in these communities. Indeed, ABM may prove to be an ideal intervention for underserved groups by addressing frequently cited barriers to treatment such as access, time, transportation, literacy, and clinician shortages. ABM is also a highly transportable, brief, computerized treatment requiring minimal training, which makes it accessible to a paraprofessional workforce, in this case, community health workers (CHW), who have been reported to have greater success in health outreach, recruitment, and education efforts in hard to reach communities. Efforts to understand the feasibility, acceptability, and effectiveness of a service delivery model which uses CHWs to administer evidence based treatments such as ABM are essential in order to improve access, quality of care, and cost-effectiveness of services for underserved and hard-to-reach communities. Moreover, we aim to develop an ABM paradigm that can be administered via a handheld electronic tablet device with a game-like format, which may increase youth engagement and thereby optimize attention bias change. The overarching goal of this study is to refine and test a developmentally sensitive and ecologically valid ABM paradigm for low-income and rural Latino youth as an initial step towards demonstrating its feasibility, acceptability and effectiveness. The proposed study will be conducted in two phases: 1) an open case series study that will provide initial feasibility data on multiple domains, including the neurocognitive protocol, face stimuli selection, CHW (i.e., promotora) training, and attention training procedures and: 2) a pilot RCT of ABM versus a control condition in 52 anxious Latino youth (26 per group) that will focus on the feasibility of ABM implementation and provide preliminary effectiveness data. This study will also explore the relationship between ABM and changes in neurocognitive correlates of cognitive control in samples of youth not typically recruited in efficacy studies. Our expectation is that feasibility and preliminary effectiveness findings from this project will inform the development of a future large-scale comparative effectiveness trial in rural and hard-to-reach communities, which will further advance the development of innovative, personalized interventions consistent with NIMH Strategic Plan's Objectives (3.1).

项目摘要最近改善现有焦虑疗法的努力是从已建立的实验中得出的关于焦虑中与威胁相关的注意偏差的文献。注意偏差修正（ABM）是一种新颖的理论驱动的利用基于计算机的注意力训练方法直接但隐式地修正偏见的治疗焦虑个体的注意力模式有助于缓解症状。迅速积累的证据基础 ABM 表明，它可能是一种有前景的焦虑新干预措施，具有明确的作用机制 - 注意偏差的改变。虽然多项评论和荟萃分析普遍支持 ABM 功效，有效性研究很少，特别是对于低收入拉丁裔和农村地区等服务不足的群体青年。鉴于数据表明焦虑在拉丁裔中可能更为普遍，并且拉丁裔和农村地区青年人未充分利用心理健康服务，有必要进行有效性研究来检查文化背景以及对这些社区的创新性循证干预措施。事实上，ABM 可能被证明是一种理想的通过解决经常提到的治疗障碍（例如获取、时间、交通、识字率和临床医生短缺。 ABM 也是一种高度可移植的、简短的、计算机化的治疗需要最少的培训，这使得辅助专业人员可以进行治疗，在这种情况下，据报道，社区卫生工作者 (CHW) 在卫生外展方面取得了更大的成功，在难以到达的社区开展招聘和教育工作。努力了解可行性，使用社区卫生工作者来管理基于证据的服务提供模式的可接受性和有效性 ABM 等治疗对于改善医疗服务的可及性、护理质量和成本效益至关重要为服务不足和难以到达的社区提供服务。此外，我们的目标是开发一种 ABM 范式可以通过手持电子平板设备以游戏形式进行管理，这可能会增加青少年的兴趣参与，从而优化注意力偏差的改变。本研究的总体目标是完善和为低收入和农村拉丁裔青年测试发展敏感且生态有效的 ABM 范式证明其可行性、可接受性和有效性的第一步。拟议的研究将是分两个阶段进行：1）开放案例系列研究将提供多个初步可行性数据域，包括神经认知协议、面部刺激选择、CHW（即 promotora）训练，以及注意力训练程序 2) 对 52 名焦虑的拉丁裔青年进行 ABM 试验随机对照试验与对照条件对照（每组26人）将重点关注ABM实施的可行性并提供初步成效数据。这项研究还将探讨 ABM 与神经认知相关因素变化之间的关系。对通常不在功效研究中招募的青少年样本进行认知控制。我们的期望是可行性该项目的初步有效性调查结果将为未来大规模的开发提供信息在农村和难以到达的社区进行比较有效性试验，这将进一步推动制定符合 NIMH 战略计划目标 (3.1) 的创新、个性化干预措施。