CBT for Pediatric OCD: Effective Therapist Behaviors and Community Training Pilot

针对儿科强迫症的 CBT：有效的治疗师行为和社区培训试点

• 批准号: 8282394
• 负责人: Kristen G Benito
• 金额: $ 22.3万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-06 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8282394
• 关键词: Active Learning; Age; Anxiety Disorders; Award; Behavior; Behavior Therapy; Child; Child Behavior; Childhood; Client satisfaction; Code; Cognitive Therapy; Communities; Consultations; Data; Development; Disease; Educational process of instructing; Educational workshop; Effectiveness; Extinction (Psychology); Feedback; Future; Intervention; Knowledge; Knowledge acquisition; Life; Link; Maintenance; Measures; Modeling; Obsession; Outcome; Parenting behavior; Parents; Patients; Phase; Preparation; Prevention; Process; Provider; Public Health; Randomized; Relative (related person); Reporting; Sampling; Services; Site; Supervision; Symptoms; System; Techniques; Telephone; Testing; Therapeutic; Training; Training Programs; Treatment outcome; Validation; Variant; Work; base; community intervention; community setting; disability; improved; innovation; meetings; pilot trial; programs; prototype; randomized trial; response; satisfaction; service utilization; theories; tool; treatment trial; trial comparing

DESCRIPTION (provided by applicant): Community therapists rarely use interventions with empirical support and prior attempts to disseminate empirically supported behavioral treatments (ESBTs) to community settings have not been based on understanding key ingredients of the therapeutic process, without which community therapists may be inadequately trained. Principle-based training that uses active learning strategies and incorporates feedback about fidelity holds promise for application and sustainability of ESBTs in community settings. Pediatric OCD has a clear theory underlying treatment (Exposure and Response Prevention) and is an ideal disorder with which to test an improved training model linking theory, in-session therapist behavior, and patient outcome. The first phase (R21) of this project will use a theory-derived observational coding system to examine therapist behavior during treatment for a sample of children (N = 160) who received CBT as part of three multisite treatment trials for pediatric OCD (POTS). Specifically, we will look for evidence that prescribed and proscribed therapist behaviors during treatment are related to theoretical mechanism of change (habituation) and to patient treatment outcome. We will also validate a short fidelity rating system that measures prescribed and proscribed therapist behaviors, in preparation for providing feedback about those behaviors to therapists in community settings. The second phase (R33) will use R21 data to develop and pilot a randomized trial of two delivery formats of theory-based CBT training for community providers treating pediatric OCD. Therapists (N = 16) across two community sites will be randomized to receive a workshop plus weekly supervision or a workshop plus telephone consultation service. All therapists will receive regular feedback about prescribed and proscribed behaviors identified in the R21 phase using the fidelity rating system. We will measure therapist-level outcomes (e.g., knowledge, proficiency, satisfaction) and patient-level outcomes (e.g., symptoms, disability, service utilization, satisfaction) for purposes of assessing feasibility and acceptability of training and related treatment and in preparation for R01 trial. Results from this study will inform development of future theory-based training programs for therapists as well as teaching use of exposure as a tool for other anxiety disorders. PUBLIC HEALTH RELEVANCE: The current study will use a theory-based model to examine therapist behavior in a sample of children who received CBT as part of one of three multi-site treatment trials for pediatric OCD (Pediatric OCD Treatment Study; POTS). The first phase will use an observational coding system (R21 phase); and the second phase will use the R21 phase data to develop and pilot a training program for community therapists treating children (age 5-17) with OCD. Therapists will be randomized to receive one of two different formats for delivery of a theory-based training and maintenance program with fidelity feedback (R33 phase). We will test feasibility and acceptability of the training program in both formats as well as accompanying measures of therapist, and patient-level outcomes, including maintenance of gains.

描述（由申请人提供）：社区治疗师很少使用有经验支持的干预措施，并且之前向社区环境传播经验支持的行为治疗（ESBT）的尝试并不是基于对治疗过程的关键要素的理解，否则社区治疗师可能无法充分理解治疗过程的关键要素。训练有素。基于原则的培训采用主动学习策略并结合有关忠诚度的反馈，为 ESBT 在社区环境中的应用和可持续性带来了希望。儿科强迫症有一个明确的治疗理论（暴露和反应预防），并且是一种理想的疾病，可以用来测试将理论、治疗师在治疗中的行为和患者结果联系起来的改进的训练模型。该项目的第一阶段 (R21) 将使用理论衍生的观察编码系统来检查治疗师在治疗儿童样本 (N = 160) 期间的行为，这些儿童接受了 CBT，作为儿科强迫症 (POTS) 的三个多站点治疗试验的一部分。具体来说，我们将寻找证据证明治疗期间规定和禁止的治疗师行为与理论变化机制（习惯化）和患者治疗结果相关。我们还将验证一个简短的忠诚度评级系统，该系统可衡量规定和禁止的治疗师行为，准备向社区环境中的治疗师提供有关这些行为的反馈。第二阶段 (R33) 将使用 R21 数据为治疗儿科强迫症的社区提供者开发和试点两种基于理论的 CBT 培训交付形式的随机试验。两个社区站点的治疗师 (N = 16) 将被随机分配接受研讨会加每周监督或研讨会加电话咨询服务。所有治疗师都将收到有关使用忠诚度评级系统在 R21 阶段确定的规定和禁止行为的定期反馈。我们将衡量治疗师层面的结果（例如，知识、熟练程度、满意度）和患者层面的结果（例如，症状、残疾、服务利用、满意度），以评估培训和相关治疗的可行性和可接受性，并为 R01 做准备审判。这项研究的结果将为治疗师未来基于理论的培训项目的开发以及教学使用暴露作为其他焦虑症的工具提供信息。 公共健康相关性：当前的研究将使用基于理论的模型来检查接受 CBT 的儿童样本的治疗师行为，作为儿科强迫症的三个多中心治疗试验（儿科强迫症治疗研究；POTS）之一的一部分。第一阶段将使用观测编码系统（R21阶段）；第二阶段将使用 R21 阶段数据为治疗强迫症儿童（5-17 岁）的社区治疗师制定和试点培训计划。治疗师将被随机接受两种不同形式中的一种，以提供基于理论的培训和维护计划，并提供保真度反馈（R33 阶段）。我们将测试两种形式的培训计划的可行性和可接受性，以及治疗师的伴随措施和患者层面的结果，包括收益的维持。