基于同伴提供的认知行为疗法的干预措施可减少社区居住的糖尿病合并慢性疼痛成年人的抑郁和压力：一项聚类随机试验。

Peer-delivered Cognitive Behavioral Therapy-based Intervention Reduced Depression and Stress in Community Dwelling Adults With Diabetes and Chronic Pain: A Cluster Randomized Trial.

机构信息

Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.

Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

出版信息

Ann Behav Med. 2021 Oct 4;55(10):970-980. doi: 10.1093/abm/kaab034.

DOI:10.1093/abm/kaab034

PMID:33969866

Abstract

BACKGROUND

Finding effective, accessible treatment options such as professional-delivered cognitive behavioral therapy (CBT) for medically complex individuals is challenging in rural communities.

PURPOSE

We examined whether a CBT-based program intended to increase physical activity despite chronic pain in patients with diabetes delivered by community members trained as peer coaches also improved depressive symptoms and perceived stress.

METHODS

Participants in a cluster-randomized controlled trial received a 3-month telephonic lifestyle modification program with integrated CBT elements. Peer coaches assisted participants in developing skills related to adaptive coping, diabetes self-management goal-setting, stress reduction, and cognitive restructuring. Attention controls received general health advice with an equal number of contacts but no CBT elements. Depressive symptoms and stress were assessed using the Centers for Epidemiologic Studies Depression and Perceived Stress scales. Assessments occurred at baseline, 3 months, and 1 year.

RESULTS

Of 177 participants with follow-up data, 96% were African Americans, 79% women, and 74% reported annual income <$20,000. There was a significant reduction in perceived stress in intervention compared to control participants at 3-months (β = -2.79, p = .002 [95% CI -4.52, -1.07]) and 1 year (β = -2.59, p < .0001 [95% CI -3.30, -1.87]). Similarly, intervention participants reported significant decreases in depressive symptoms at 3-months (β = -2.48, p < .0001 [95% CI -2.48, -2.02]) and at 1 year (β = -1.62, p < .0001 [95% CI -2.37, -0.86]).

CONCLUSIONS

This peer-delivered CBT-based program improved depressive symptoms and stress in individuals with diabetes and chronic pain. Training community members may be a feasible strategy for offering CBT-based interventions in rural and under-resourced communities.

CLINICAL TRIAL REGISTRATION

NCT02538055.

摘要

背景

在农村社区中，为患有慢性疼痛的医学复杂个体寻找有效的、可获得的治疗选择，例如专业提供的认知行为疗法（CBT），具有挑战性。

目的

我们研究了一种基于 CBT 的计划，该计划旨在通过经过培训的社区成员作为同伴教练来增加糖尿病患者的身体活动，同时改善抑郁症状和感知压力，该计划是否可行。

方法

参加者参加了一项基于群组的随机对照试验，该试验接受了为期 3 个月的电话生活方式改变计划，其中包括整合了 CBT 元素。同伴教练帮助参与者发展与适应性应对，糖尿病自我管理目标设定，减轻压力和认知重构相关的技能。对照组接受了一般健康建议，并进行了相同数量的联系，但没有 CBT 元素。使用流行病学研究抑郁和感知压力量表评估抑郁症状和压力。评估在基线，3 个月和 1 年进行。

结果

在有随访数据的 177 名参与者中，96％是非洲裔美国人，79％是女性，74％的人报告年收入<20,000 美元。与对照组相比，干预组在 3 个月（β=-2.79，p=.002 [95％CI-4.52，-1.07]）和 1 年（β=-2.59，p<.0001 [95％CI-3.30，-1.87]）时的感知压力显着降低。同样，干预组在 3 个月（β=-2.48，p<.0001 [95％CI-2.48，-2.02]）和 1 年（β=-1.62，p<.0001 [95％CI-2.37，-0.86]）时的抑郁症状也显着下降。