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.

中文翻译：

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同伴提供的基于认知行为疗法的干预减少社区居住的糖尿病和慢性疼痛成年人的抑郁和压力：一项集群随机试验

背景 在农村社区，为医学复杂的个体寻找有效的、可获得的治疗选择，例如专业提供的认知行为疗法 (CBT) 是一项挑战。目的 我们检查了一项基于 CBT 的计划是否旨在增加身体活动，尽管由受过同伴教练培训的社区成员提供的糖尿病患者慢性疼痛也能改善抑郁症状和感知压力。方法 集群随机对照试验的参与者接受了为期 3 个月的电话生活方式改变计划，该计划包含综合 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、减压和认知重组相关的技能。注意控制接受一般健康建议，接触次数相同，但没有 CBT 元素。使用流行病学研究中心抑郁和感知压力量表评估抑郁症状和压力。评估发生在基线、3 个月和 1 年。结果 在 177 名有随访数据的参与者中，96% 是非洲裔美国人，79% 是女性，74% 的人报告年收入低于 20,000 美元。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]）。同样，干预参与者报告在 3 个月（β = -2.48，p < .0001 [95% CI -2.48，-2.02]）和 1 年（β = -1.62，p < .0001）和 1 年（β = -1.62，p <. 0001 [95% CI -2。37，-0.86]）。结论 这个由同伴提供的基于 CBT 的项目改善了糖尿病和慢性疼痛患者的抑郁症状和压力。培训社区成员可能是在农村和资源不足社区提供基于 CBT 的干预措施的可行策略。临床试验注册 NCT02538055。