A Computer-Assisted Cognitive Behavioral Therapy Tool to Enhance Fidelity in CBO

计算机辅助认知行为治疗工具可增强 CBO 的保真度

• 批准号: 10208954
• 负责人: Michael Anthony Cucciare
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10208954
• 关键词: Anxiety; Anxiety Disorders; Caring; Clinic; Clinical; Cognitive Therapy; Communities; Computer Assisted; Computers; Disease; Effectiveness; Evidence based treatment; Future; Health Personnel; Hybrids; Instruction; Intervention; Measures; Mental Depression; Mental Health; Mental disorders; Methodological Studies; Methods; Modeling; Needs Assessment; Outcome; Outpatients; Patients; Post-Traumatic Stress Disorders; Protocols documentation; Provider; Psychotherapy; Randomized; Randomized Controlled Trials; Rural Community; Technology; Testing; Training; Veterans; base; design; evidence base; implementation tool; improved; medical specialties; primary care setting; programs; routine care; rural area; scale up; tool

DESCRIPTION (provided by applicant): Background and Significance: Randomized Controlled Trials (RTCs) have demonstrated that evidence-based psychotherapies (EBPs), particularly Cognitive Behavioral Therapy (CBT), are highly effective in treating anxiety and depression, the most common mental health disorders in primary care settings. Mental health (MH) providers in VA Community-Based-Out-Patient-Clinics (CBOCs) are often located in rural areas and isolated from educational opportunities. Almost half of Veterans now use CBOCs. Studies have shown that the quality of delivery of EBPs (fidelity) impacts clinical outcomes. This study will test a computer-assisted tool (CALM Tools for Living) that increases fidelity to CBT in treating depression and four common anxiety disorders, including PTSD. Although results of a large RCT, the CALM study, suggested that the tool contributed to fidelity to the CBT protocol, this hypothesis has not been tested. This study will test the tool in primarily rural CBOCs in VA VISN16. Objective: To modify a computer-assisted CBT tool to meet the needs of CBOC MH providers and Veterans, to evaluate the impact on providers' fidelity to the CBT model and clinical outcomes, and to assess how best to support future implementation. Specific Aims/Hypothesis: (1) Engage CBOC MH providers in modifying the computer-assisted CBT tool such that its content is relevant and acceptable to Veterans and providers. We hypothesize that the modified tool will be acceptable to both Veterans and providers. (2) Compare MH provider fidelity to CBT and clinical outcomes among providers who used the tool and those who did not. We hypothesize that clinicians who use the tool will have a higher fidelity to CBT and clinical outcomes among patients will be superior. (3) Prepare for future implementation of the tool in the VA. Methodology: This study will use a Type III hybrid effectiveness design. Methods common to the field of Instructional Design and Technology (IDT) will be used to modify the tool. Thirty-four CBOC MH providers will be trained in CBT and randomized to use the tool or not. Both groups will receive external facilitation to encourage the full implementation of CBT into practice on the clinic level. MH providers will treat 10 patients each. Patients will be assessed at baseline, 3, 6, and 12 months. Provider fidelity to the CBT protocol will be measured, and finally, a tool kit for future implementation of the tool wil be disseminated. Impact: We expect the intervention to improve the technical quality of MH treatment in CBOCs and improve clinical outcomes among Veterans.

描述（由申请人提供）： 背景和意义：随机对照试验（RTC）表明，基于证据的心理治疗（EBP），尤其是认知行为疗法（CBT），在治疗焦虑和抑郁症方面非常有效，这是初级保健环境中最常见的心理健康疾病。在基于VA社区的患者临床（CBOC）中，心理健康（MH）提供者通常位于农村地区，与教育机会隔离。 现在，几乎一半的退伍军人使用CBOC。研究表明，EBP的交付质量（保真度）会影响临床结果。这项研究将测试一种计算机辅助工具（用于生活的平静工具），以增加CBT治疗抑郁症和包括PTSD在内的四种常见焦虑症的保真度。尽管RCT的结果很大，但平静的研究表明该工具助长了CBT方案，但该假设尚未得到检验。这项研究将在VA Visn16中主要是农村CBOC中测试该工具。 目的：修改计算机辅助的CBT工具，以满足CBOC MH提供者和退伍军人的需求，以评估对提供商对CBT模型和临床结果的忠诚的影响，并评估如何最好地支持未来实施。 具体目的/假设：（1）让CBOC MH提供商修改计算机辅助的CBT工具，以使其内容与退伍军人和提供商相关且可以接受。 我们假设经验丰富的工具和提供者都可以接受。 （2）将使用该工具的提供商和不使用该工具的提供商中的MH提供者保真度与CBT和临床结果进行了比较。我们假设使用该工具的临床医生对CBT的保真度更高，并且患者的临床结果将是优越的。 （3）准备将来在VA中实施该工具。 方法论：本研究将使用III型混合有效性设计。教学设计和技术领域（IDT）常见的方法将用于修改工具。 34个CBOC MH提供商将接受CBT培训，并随机使用该工具。两组都将获得外部促进，以鼓励在诊所级别实施CBT的全面实施。 MH提供者将对待 每个患者。将在基线，3、6和12个月时评估患者。提供者对CBT协议的保真度将被衡量，最后，将传播用于未来实施该工具的工具套件。 影响：我们预计干预措施将提高CBOC中MH治疗的技术质量，并改善退伍军人的临床结果。

项目成果

Assessing fidelity of cognitive behavioral therapy in rural VA clinics: design of a randomized implementation effectiveness (hybrid type III) trial.

• DOI: 10.1186/s13012-016-0432-4
• 发表时间: 2016-05-10
• 期刊: Implementation science : IS
• 作者: Cucciare MA;Curran GM;Craske MG;Abraham T;McCarthur MB;Marchant-Miros K;Lindsay JA;Kauth MR;Landes SJ;Sullivan G
• 通讯作者: Sullivan G

A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics.

• DOI: 10.1016/j.jadr.2021.100202
• 发表时间: 2021-12
• 期刊: Journal of affective disorders reports
• 作者: Cucciare MA;Marchant K;Abraham T;Ecker A;Han X;White P;Craske MG;Lindsay J
• 通讯作者: Lindsay J

Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach.

• DOI: 10.2196/10277
• 发表时间: 2018-08-22
• 期刊: JMIR mental health
• 影响因子: 5.2
• 作者: Abraham TH;Marchant-Miros K;McCarther MB;Craske MG;Curran GM;Kearney LK;Greene C;Lindsay JA;Cucciare MA
• 通讯作者: Cucciare MA