Depression can present a significant threat to long-duration space missions, and crews need the ability to recognize it and treat it effectively. In this continuation study, Dr. James A. Cartreine and colleagues are developing and evaluating a computer-based system that includes a module for the recognition and treatment of depression. It is intended for use both in preflight training and on the International Space Station. As a self-guided program, the computer-based system has strong potential for Earth benefits.
Self-Guided Depression Treatment on Long-Duration Spaceflights
James A. Cartreine, Ph.D.
Harvard - Beth Israel Deaconess Medical Center
In the first grant, program architecture was developed to organize the types of content and experiences users can find in the portal. Sample content about depression and interpersonal conflict was also developed as a prototype to demonstrate how training could be delivered through the system. The second NSBRI grant was to complete and evaluate the depression content, including self-treatment of depression.
The present project will design and produce an interactive media intervention program to assist persons manage real, ongoing conflicts on long-duration missions. A preliminary evaluation of the conflict intervention will be conducted in a variety of settings where individuals live, train, and work together: fire departments .The goal of this preliminary evaluation is to gather data on response rate, sample characteristics, and to estimate effect size, in preparation for a randomized controlled trial.
1) The primary deliverable will be a countermeasure to help crews manage interpersonal conflict. We have produced an interactive media intervention program to assist persons manage real, ongoing conflicts on LD missions. This intervention is based on cognitive-behavioral therapy and will help individuals to work out strategies with the assistance of a coach, on computer.
A second deliverable is preliminary data about the countermeasure. We will conduct an open trial to obtain data about the intervention’s potential effectiveness in settings that share some characteristics of the space setting (group living, small work groups). The open trial will also enable us to develop and assess our procedures and instruments for data collection, and estimate effect size, in preparation for a future randomized controlled trial. This appears to be the first standardized intervention (self-guided or otherwise) to be evaluated for the management of workplace conflicts between peers in any industry.
This interactive media program rounds out a suite of assessment, intervention and training tools for long-duration flyers, all accessible via a single portal: the Virtual Space Station (see Carter et al., 2005). Other major resources in the Virtual Space Station developed through NSBRI support include an intervention for depression, an intervention for chronic stress, and self-assessment of depression and conflict with tailored feedback.
Year 3 has involved the production and completion of the interactive media program for conflict intervention, which included these major activities: Scriptwriting, storyboard development, media production, programming and debugging.
The year has been tremendously busy and productive on all of the above fronts; each of which has posed their unique academic, intellectual, organizational and administrative challenges. Additionally, we have continued to maintain contact with the Houston Fire Department, the Phoenix Fire Department, and the San Diego Fire Department. The program will be evaluated at these sites during Year 4.
Unique Aspects of This Study
1) This software appears to be the first computer-automated behavioral intervention that tailors the intervention components to the user’s needs. Prior computer-automated treatments have provided the same clinical components to all users, without regard to whether the user needed them or not. This makes the intervention highly tailored to the unique status of the individual and also highly efficient, since users are only presented with content that is applicable to them.
2) Tailoring the Program to Users Follows a Unique Process. We have developed a set of algorithms that approximates an item-response procedure to decide whether users should receive domains of interventional content or not. Computer-adaptive testing is performed in the first intervention setting to create a “treatment plan” to help him or her manage the interpersonal conflict. Users answer questions from validated measures to determine whether or not a given content area will be presented to them. The assessments are only used to make a binary decision of whether a user should receive that interventional content. Once the user responses reach a numerical threshold (or cannot reach it), the program ceases asking questions in that domain and moves to the next. This application of computer-adaptive testing technology reduces the amount of questions needed to be answered by users to tailor their treatment, making the intervention more time-efficient.
3) This appears to be the first interactive media program ever developed to assist persons to formulate an action plan to manage a specific workplace conflict.
4) The planned evaluation of the program will be the first to evaluate the any intervention for conflict between co-workers across multiple settings in any industry.
Current computer-delivered behavioral interventions have generally guided users through a pre-determined set of activities designed to address a presenting problem. This study advances the field of automated, computer-based interventions by tailoring the contents of the intervention—and even the clinical topics presented—to the user’s needs. The conflict intervention program delivers a core set of interventions to assist users with their interpersonal conflict: problem solving, cognitive restructuring, and negotiation skills training. In addition, a series of empirically-supported self-assessments also evaluate whether a user should receive content to improve his or her assertiveness, ability to manage anger, or empathy (the ability to understand the other party’s point of view and emotional state). With this approach, the users receive content tailored to their particular needs, and they don’t waste time on unnecessary content.
Persons involved in intense workplace conflicts may also experience problems with sleep, anxiety, depression, alcohol abuse, stress, rumination, and others. These subsidiary problems can make managing interpersonal conflict challenging. This program incorporates empirically-supported measures of these problems to determine whether users would benefit from content on any or all of these seven topics. If so, the program provides optional content on the topic area.
Finally, to date, research on workgroup conflict has generally been phenomenological and descriptive. Despite the ubiquity of conflict between co-workers across all industries, and the potentially large costs of conflict in productivity, no prior studies have empirically evaluated a standardized intervention for workplace conflicts. We will do this in Year 4.