2/2 Stepped, reward-exposure based therapy vs. PST in late life depression

2/2 阶梯式奖励暴露疗法与 PST 治疗晚年抑郁症的比较

• 批准号: 9142355
• 负责人: Patricia A. Arean
• 金额: $ 34.76万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-11 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9142355
• 关键词: Age; Alternative Therapies; Behavior Therapy; Behavioral; Biological; Biology; Caring; Characteristics; Clinical; Clinical Trials; Collaborations; Color; Communities; Depressed mood; Disease; Disease remission; Doctor of Medicine; Doctor of Philosophy; Educational process of instructing; Elderly; Executive Dysfunction; Female; Gender; Generations; Geriatrics; Hamilton Rating Scale for Depression; Health; Hour; Intervention; Major Depressive Disorder; Medical; Mental Depression; Mental Health; Modeling; Moods; Multicenter Studies; Neurobiology; Neurosciences; Nurses; Outcome; Participant; Patients; Persons; Pharmacotherapy; Physical activity; Policies; Population; Protocols documentation; Provider; Psychotherapy; Quality of life; Randomized; Recording of previous events; Recruitment Activity; Reporting; Research; Resources; Rewards; Sample Size; Science; Self Efficacy; Services; Severities; Site; Social Workers; Structure; Techniques; Time; Training; World Health Organization; World Health Organization Disability Assessment Schedule; aging population; base; community setting; comparative efficacy; cost; data management; design; disability; effective therapy; emotion dysregulation; evidence base; experience; geriatric depression; improved; non-demented; novel therapeutics; older patient; problem solving therapy; programs; response; skills; social; theories; therapy development; treatment adherence; treatment response

DESCRIPTION (provided by applicant): Engage is a novel therapy for late life depression, a disorder that worsens the outcomes of most medical illnesses, promotes disability, increases expense, and complicates medical care by clouding the clinical picture and undermining treatment adherence. Late-life depression has a modest response to pharmacotherapy, and although problem-solving therapy (PST) was found efficacious, it is rarely utilized by community clinicians. Engage targets behavioral domains of late-life depression grounded on neurobiological constructs using behavioral strategies of known efficacy selected for their simplicity. "Reward exposure" is the principal treatment vehicle of Engage. The first 3 sessions consist of direct "reward exposure" but the therapists search for barriers in 3 behavioral domains, i.e. "negativity bias", "apathy", and "emotional dysregulation", and add strategies targeting these domains when needed. Engage uses a structured, stepped-care approach and makes personalization part of the treatment itself. The primary hypothesis of the study is that Engage is non-inferior to problem solving therapy (PST), a treatment with demonstrated efficacy in late life depression. Its secondary hypotheses postulate that Engage requires fewer training hours than PST, is non-inferior to PST in reducing disability and in inducing remission of depression. Exploratory analyses will focus on long-term efficacy of Engage (over 26 and 52 weeks) as well as mechanisms and predictors of its effects. The participants will be 300 (150 from each Center) older (>60 years) non-psychotic, non-demented persons with unipolar major depression who will be randomly assigned to 9 sessions of Engage or PST. We bring to this project two research groups with a history of a successful collaboration in 2 two-center R01 supported psychotherapy studies, complementary expertise in clinical biology, intervention development, clinical trials, and experience in directing multicenter studies. This application responds to two IOM reports, which predict that the workforce in geriatrics will be overwhelmed by the aging population, a problem that will reach cataclysmic proportions when the Affordable Care Programs come into being. Older adults seek services in community settings where the providers of initial care for depression are social workers and nurses without in-depth training in psychotherapies. Engage is designed for such clinicians and, therefore, may have broad scalability (used by many professionals) and reach by offering to many depressed seniors access to effective psychotherapy. The stepped approach to personalization used by Engage may make it applicable to other populations.

描述（由申请人提供）：参与是一种针对晚期生活抑郁症的新型疗法，这种疾病会使大多数医学疾病的结果恶化，促进残疾，增加费用，并通过蒙上阴影临床和破坏治疗依从性来使医疗保健变得复杂。晚期抑郁症对药物治疗有适度的反应，尽管发现解决问题的疗法（PST）有效，但社区临床医生很少使用它。参与者使用已知疗效的行为策略以其简单性选择的行为策略，其后期抑郁症的行为领域基于神经生物学结构。 “奖励暴露”是参与的主要治疗工具。前3个会议包括直接的“奖励暴露”，但治疗师在3个行为领域中寻找障碍，即“消极偏见”，“冷漠”和“情绪失调”，并在需要时添加针对这些领域的策略。参与使用结构化的阶梯护理方法，并将个性化成为治疗本身的一部分。该研究的主要假设是，参与不适用于解决问题疗法（PST），这是一种在晚期抑郁症中表现出疗效的治疗方法。它的次要假设假设参与需要少于PST的训练时间，而不是PST减少残疾和诱导抑郁症的缓解。探索性分析将集中于参与的长期疗效（超过26周和52周）以及其效果的机制和预测指标。参与者的年龄较大（> 60岁）的非精神病性，非痴呆的人将有300名（来自每个中心150个），其单极重大抑郁症将被随机分配给9次参与或PST。我们将两个研究小组带入了两个研究小组，该小组在2个两中心R01支持心理疗法研究，临床生物学，干预开发，临床试验以及指导多中心研究方面的补充专业知识。该申请对两份IOM报告做出了回应，这些报告预测老年人的劳动力将被老龄化的人口所淹没，这一问题将在负担得起的护理计划中达到灾难性的比例。老年人在社区环境中寻求服务，在社区环境中，初始护理抑郁症的提供者是社会工作者和护士，没有深入的培训 心理治疗。参与是为此类临床医生设计的，因此可能具有广泛的可扩展性（许多专业人员使用），并通过向许多沮丧的老年人提供有效的心理治疗来触及。参与使用的个性化方法可能使其适用于其他人群。