DBT for Self-Harm: A Clinical/Research Training for Psychiatry Residents

描述（由申请人提供）：在过去的十年中，很多努力都是针对针对自杀和非自杀自残行为的综合心理治疗干预的发展和实证测试。将这些疗法纳入临床培训项目或培训临床医生进行心理治疗研究的努力较少。辩证行为疗法（DBT）在RFA中被确定为一种针对自残行为的“经过科学验证的行为治疗”。这种疗法主要在培养临床心理学家的博士课程中教授。然而，精神科医生经常站在治疗有自杀倾向患者的第一线。我们建议为精神科住院医师开发、实施、评估及推广一套综合心理治疗及研究训练课程，以辩证行为疗法治疗自残行为。我们建议对哥伦比亚大学精神病学住院医师进行为期12个月的DBT临床/研究培训，包括教学研讨会、录像带评级和培训以及病例监督。课程有两个组成部分。一是全面的临床培训项目，让住院医师了解实施DBT治疗自残行为的原则、概念和干预措施。一个同时进行的研究课程将教授进行心理治疗研究的基本原则，特别是进行研究测试DBT在减少自残行为方面的功效。教师将由资深DBT培训师和研究人员组成。临床部分将包括为期5天的临床DBT强化课程，以及每周的小组咨询和团队监督会议，以及通过同行录像带编码和评级进行15小时的临床培训。研究部分将包括25个一小时的教学课程，涉及心理治疗疗效试验的实施和自杀干预研究，主题包括研究设计、心理治疗试验的程序、精神科医生在心理治疗研究中的作用、数据分析、手册化和依从性。这个应用程序的具体目的是：1)开发一个核心课程，培训精神科住院医生在DBT临床干预和研究方法方面与自杀和自残临床人群；2)建立基于标准的DBT基本技能评价体系；3)将此培训和评估推广到国内其他精神病学住院医师培训项目。建议的评估部分包括开发和有效性测试的新措施，旨在评估临床技能的成就在DBT。该措施将与可靠的DBT依从性评分进行比较。DBT原则、干预措施和研究方法的基本知识将通过期末考试进行评估。该课程和评估计划将通过住院医师培训行政会议、出版物、网站发布和全国住院医师培训项目咨询等形式进行传播。

DESCRIPTION (provided by applicant): Over the past decade, much effort has been directed toward the development and empirical testing of comprehensive psychotherapy interventions designed to target suicidal and non-suicidal self-injurious behaviors. Less effort has been devoted to incorporating these treatments into clinical training programs, or to training clinicians to conduct psychotherapy research. Dialectical Behavior Therapy (DBT) was identified in the RFA as a "scientifically validated behavioral treatment" for self-harm behaviors. The treatment is primarily taught in doctoral programs that train clinical psychologists. Yet, psychiatrists are often on the front lines of treating suicidal patients. We propose to develop, implement, evaluate and disseminate a comprehensive psychotherapy and research training curriculum for psychiatry residents using Dialectical Behavior Therapy for self- harm behaviors. We propose a 12-month DBT clinical/research training for psychiatry residents at Columbia University that combines didactic seminars, videotape rating and training, and case supervision. The curriculum has two integrated components. One is a comprehensive clinical training program for residents to learn the principles, concepts and interventions of conducting DBT for self-harm behaviors. A concurrent research curriculum will teach basic principles of conducting psychotherapy research, specifically to conduct research testing the efficacy of DBT in the reduction of self-harm behaviors. The faculty will consist of senior DBT trainers and researchers. The clinical component will include a 5 -day clinical DBT intensive along with weekly group consultation team supervision sessions and 15 hours of clinical training through peer videotape coding and rating. The research component will consist of 25 one- hour didactic sessions related to the conduct of psychotherapy efficacy trials and suicide intervention research on topics of study design, procedures for psychotherapy trials, the role of the psychiatrist in psychotherapy research, data analysis, manualization and adherence. The specific aims of this application are to: 1) develop a core curriculum for training psychiatry residents in DBT clinical interventions and research methods with suicidal and self-harming clinical populations; 2) develop a criterion-based evaluation of basic skill in DBT; 3) disseminate this training and the evaluation to other psychiatry residency training programs in the country. The proposed evaluation component includes the development and validity testing of a new measure designed to assess the achievement of clinical skill in DBT. This measure will be compared with reliable DBT adherence ratings. Basic knowledge of DBT principles, interventions and research methodology will be assessed by a final examination. The dissemination of this curriculum and evaluation plan will take place through workshops at residency training administrative conferences, publications, website postings, and consultation to residency training programs throughout the country. PUBLIC HEALTH RELEVANCE: Suicide and self-harm behaviors have been identified by the Surgeon General to be high priority public health concerns. The proposed research plan is to teach psychiatry residents to conduct Dialectical Behavior Therapy (a psychotherapy empirically shown to reduce self-harm behaviors), and to conduct psychotherapy research to further test the efficacy of DBT in reducing self-harm behaviors. The proposed curriculum will serve as a model to incorporate such trainings into residency programs throughout the country to effectively reduce and prevent suicide and self-harm behaviors.