Computer-Based Training in DBT Validation Strategies

描述(由申请人提供)：在NIDA，循证疗法的传播仍然是一个高度优先的问题。在常规临床环境中，许多障碍限制了循证治疗的可及性。物质使用障碍(SODS)与边缘性人格障碍(BPD)并存，构成严重而复杂的公共卫生问题。物质滥用者的辩证行为疗法(DBT-SUD)是一种综合的心理社会治疗方法，对患有BPD的物质依赖者有效。 在第一阶段，我们开发和评估了一个创新的基于计算机的培训(CBT)原型，强调了使用原型开发的迭代过程为药物治疗提供者提供DBT-SUD验证战略。验证策略是DBT-SUD使用的核心治疗策略之一。我们在随机对照试验(RCT)中测试了原型的有效性，比较了DBT-SUD CBT(n=12)和对照CBT(n=12)在来自常规药物治疗环境的治疗提供者样本中的有效性。结果表明，DBT-SUD CBT在获得知识、回忆课程策略、提高治疗药物成瘾的BPD患者的自我效能以及在随后几周的治疗环境中使用技能方面都是有效的。我们建议在第二阶段显著扩展本课程的内容及其评估。我们将再次使用迭代开发过程，依赖于广泛的最终用户测试以及来自科学顾问小组和DBT-SUD专家的反馈。完成后，我们将开始一项随机对照试验(n=120)，将CBT(n=40)与其他“标准”培训方法进行比较，特别是讲师指导的培训(n=40)和文本(n=40)。除了第一阶段评估的结果变量外，我们还将包括一项基于绩效的测试，评估第二阶段技能的临床应用。在临床应用测试中，受试者将参加一个角色扮演情景，他们将扮演DBT-SUD治疗师，而研究助理将扮演虚构的客户。这些角色扮演将被录像并编码，以便于遵守。

DESCRIPTION (provided by applicant): Dissemination of evidence-based therapies remains a high priority at NIDA. A number of barriers limit accessibility to evidence-based therapies in routine clinical settings. Substance use disorders (SUDs) co-occurring with borderline personality disorder (BPD) pose serious and complex public health problems. Dialectical Behavior Therapy for Substance Abusers (DBT-SUD) is a comprehensive psychosocial treatment, efficacious for substance-dependent individuals with BPD. In Phase I, we developed and evaluated an innovative computer-based training (CBT) prototype highlighting DBT-SUD Validation strategies for drug treatment providers using an iterative process of prototype development. Validation strategies are among the core treatment strategies used in DBT-SUD. We tested the prototype's efficacy in a randomized controlled trial (RCT) comparing the DBT-SUD CBT (n = 12) to a control CBT (n = 12) in a sample of treatment providers from routine drug treatment settings. Results demonstrated that the DBT-SUD CBT was efficacious at producing knowledge gains, recall of course strategies, increased self-efficacy in treating drug-addicted BPD patients, and use of skills in therapeutic settings in subsequent weeks. We propose to significantly expand this course content and its evaluation in Phase II. We will again use an iterative process of development, relying on extensive end-user testing and feedback from a panel of scientific advisors and DBT-SUD experts. Upon completion, we will begin a RCT (n = 120) to compare the CBT (n = 40) to other 'standard' training methods, specifically instructor-led training (n = 40) and text (n = 40). In addition to the outcome variables assessed in Phase I, we will include a performance-based test assessing clinical application of skills for Phase II. In the clinical application test, subjects will take part in a role-play scenario where they will act as DBT-SUD therapist, and a research assistant will act as a fictional 'client'. These role-plays will be video-taped and coded for adherence.