Assessing change in short-term therapy for depression using ESM

使用 ESM 评估抑郁症短期治疗的变化

基本信息

批准号：
8150365
负责人：
KARI M EDDINGTON
金额：
$ 17.26万
依托单位：
UNIVERSITY OF NORTH CAROLINA GREENSBORO
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-28 至 2013-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8150365
关键词：
Address Adult Affect Aftercare Area Behavior Behavioral Brief Psychotherapy Characteristics Chronic Cognition Complex DSM-IV Data Data Collection Depressed mood Developed Countries Development Diagnostic Effectiveness Endogenous depression Environment Etiology Face Failure Goals Health Benefit Incentives Individual Individual Differences Informal Social Control Intervention Knowledge Lead Link Major Depressive Disorder Measures Mental Depression Methodology Methods Microscopic Modality Morbidity - disease rate Motivation Nature Outcome Study Participant Patients Pattern Persons Prevention Process Psychotherapy Public Health Randomized Recording of previous events Relapse Reporting Research Research Design Research Personnel Research Project Grants Research Subjects Sampling Series Signal Transduction Structure Symptoms System Techniques Telephone Testing Therapeutic Intervention Time Treatment outcome Voice Work base depressive symptoms disability experience follow-up improved innovation meetings novel programs psychologic public health relevance response self system therapy sound theories translational approach treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Outcome studies have shown that several forms of psychotherapy are effective for depression, but questions about how, why, and when these treatments work remain. The proposed study answers the call for innovative research designs that allow for more intensive, individualized data collection that can address complex questions about the dynamic nature of treatment-related change. In this R21 application, we propose a proof-of-concept study using an innovative application of experience sampling methodology (ESM) that combines the idiographic advantages of single-subject research with the statistical advantages associated with larger samples and multilevel analyses. ESM involves sampling aspects of behavior occurring in the participant's everyday environment, thereby enhancing ecological validity and reducing retrospective bias. Thirty-four adults with primary major depressive disorder will be randomly assigned to 16 weeks of either self-system therapy (SST), a new short-term, empirically-supported psychotherapy for depression that targets deficits in incentive motivation and goal pursuit, or treatment-as-usual (TAU). Participants will complete a battery of individual difference and diagnostic measures at pretreatment. One week of intensive ESM will be collected at both pre- and post-treatment, during which participants will be signaled at random times during each day to answer questions about current functioning in several domains (e.g., affect, cognition, and goal pursuit) delivered via a phone-based interactive voice response (IVR) system. Throughout the 16 weeks of treatment, participants will complete similar IVR assessments on two randomly-selected days per week. The proposed study will test three main hypotheses. (1) Patients in SST will show greater increases in engagement with promotion goals and activities as well as greater increases in goal-related daily experiences of positive affect over the course of treatment compared to patients in TAU. (2) Patients in SST will show greater decreases in engagement with prevention goals and activities as well as greater decreases in goal- related daily experiences of negative affect over the course of treatment compared to patients in TAU. (3) Within the SST condition, a history of failure to pursue or achieve promotion goals and individual differences in chronic regulatory orientation (i.e., strength of orientation toward promotion and prevention goals) will moderate the effects of SST on changes in depressive symptoms and on daily experiences of promotion goal engagement. The proposed research will have a significant impact on an important public health problem and will expand our knowledge of how psychotherapy for depression works. The data to be obtained from this study will provide a sound empirical and theoretical framework for larger-scale programmatic research on the nature of treatment-induced change processes in patients with depression. PUBLIC HEALTH RELEVANCE: Depression is a major public health concern and a leading cause of morbidity and disability in industrialized nations. The proposed project will examine how adults with clinical depression change over the course of short-term psychotherapy by assessing how they are functioning in their daily lives. This project will lead to a more comprehensive understanding of how therapy affects patients' everyday functioning, and it has direct relevance for improving treatment outcomes.

描述（由申请人提供）：结果研究表明，几种形式的心理治疗对抑郁症有效，但有关如何，为什么以及何时工作的问题。拟议的研究回答了对创新研究设计的呼吁，该设计允许更密集，个性化的数据收集，可以解决有关与治疗相关变化的动态性质的复杂问题。在此R21应用程序中，我们提出了一项概念验证研究，使用经验抽样方法（ESM）的创新应用，将单个受试者研究的独立优势与与较大样本和多层次分析相关的统计优势结合在一起。 ESM涉及对参与者日常环境中发生的行为的样本，从而提高生态有效性并减少回顾性偏见。患有主要重度抑郁症的成年人将随机分配到16周的自我系统疗法（SST），这是一种新的短期，经验上支持的抑郁症的心理治疗，以靶向激励动机和目标追求或治疗 - 与众不同（TAU）。参与者将在预处理时完成一系列的个体差异和诊断措施。在治疗前后，将收集一周的密集ESM，在此期间，每天都会随机发出信号，以回答有关通过基于电话的交互式语音响应（IVR）系统传递的几个域（例如情感，认知和目标追求）当前功能的问题。在整个16周的治疗中，参与者将在每周两天随机选择的天数完成类似的IVR评估。拟议的研究将检验三个主要假设。（1）与TAU相比，SST中的患者将显示出更大的增加与促进目标和活动的参与度以及与目标相关的日常影响的日常影响的增加。（2）与TAU相比，SST的患者在预防目标和活动中的参与度将更大，并且在治疗过程中与目标相关的每日负面影响经历的减少更大。（3）在SST条件下，未能追求或实现促进目标的历史以及在慢性调节方向的个人差异（即，促进和预防目标的方向强度）将减轻SST对抑郁症状变化以及日常促进目标参与体验的影响。拟议的研究将对一个重要的公共卫生问题产生重大影响，并将扩大我们对抑郁症心理治疗的知识。从这项研究中获得的数据将为抑郁症患者的治疗引起的变化过程的性质进行大规模的程序化研究提供一个合理的经验和理论框架。公共卫生相关性：抑郁症是工业化国家发病和残疾的主要原因和主要原因。拟议的项目将通过评估他们在日常生活中的运作方式来研究在短期心理治疗过程中患有临床抑郁症的成年人的变化。该项目将使人们对治疗如何影响患者的日常功能有更全面的了解，并且在改善治疗结果方面具有直接相关性。