Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists.
Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists.
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DOI：
10.1016/j.beth.2020.10.003
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发表时间：
2021-07
期刊：
影响因子：
3.7
通讯作者：
Machan J
中科院分区：
文献类型：
--
作者：
Benito KG;Herren J;Freeman JB;Garcia AM;Block P;Cantor E;Chorpita BF;Wellen B;Stewart E;Georgiadis C;Frank H;Machan J
这项研究测试了一种新的培训工具，暴露指南(EG)是否改善了会话中治疗师的行为(即质量指标)，这些行为与先前暴露疗法的临床试验中的青年结果有关。社区精神卫生机构(CMHA)的六名治疗师为八名患有强迫症(OCD)的青少年提供暴露疗法。采用随机分配到基线长度为6到16周的非同时多基线设计，治疗师接受每周会诊的“黄金标准”暴露疗法培训(基线阶段)，然后再加上EG培训和反馈(干预阶段)。主要结果是治疗师在会议期间暴露期间的行为，每周使用经过验证的编码系统进行观察。根据来自临床试验的先验基准对治疗师的行为进行评估。其他结果包括培训的可行性/可接受性、治疗师对病例情节的反应和对暴露的信念，以及独立评估者评估的临床结果。三名治疗师只在EG(干预)阶段达到了行为基准。两名治疗师在基线阶段达到了基准；其中一人随后离开了基准，但在开始EG阶段后又达到了基准。在所有治疗师中，在EG阶段达到基准的周百分比(86.4%)显著高于基线阶段(53.2%)。从治疗前到治疗后，青年参与者的强迫症症状和全球疾病严重程度都有了显著改善。结果提供了初步证据，将EG加入黄金标准培训可以改变CMHA设置中的治疗师行为。
This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e. indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a Community Mental Health Agency (CMHA) provided exposure therapy for eight youth with Obsessive Compulsive Disorder (OCD). Using a non-concurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received “gold-standard” exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to post-treatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.
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影响因子：
5.3
作者：
Sheehan, DV;Lecrubier, Y;Dunbar, GC
通讯作者：
Dunbar, GC
影响因子：
5.9
作者：
Sholomskas, DE;Syracuse-Siewert, G;Carroll, KM
通讯作者：
Carroll, KM
影响因子：
7.4
作者：
McGuire JF;Piacentini J;Lewin AB;Brennan EA;Murphy TK;Storch EA
通讯作者：
Storch EA
影响因子：
2.1
作者：
Ingoldsby, Erin M.
通讯作者：
Ingoldsby, Erin M.
DOI：
10.1080/15374416.2015.1046177
发表时间：
2016-03-03
影响因子：
4.2
作者：
Higa-McMillan, Charmaine K.;Francis, Sarah E.;Chorpita, Bruce F.
通讯作者：
Chorpita, Bruce F.