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

描述(申请人提供)：在过去的十年里，针对自杀和非自杀的自残行为的综合心理治疗干预措施的开发和经验测试得到了很大的努力。在将这些治疗纳入临床培训计划或培训临床医生进行心理治疗研究方面投入的努力较少。辩证行为疗法(DBT)在RFA中被认为是一种针对自我伤害行为的“经过科学验证的行为疗法”。这种疗法主要在培训临床心理学家的博士项目中教授。然而，精神病学家经常站在治疗自杀患者的第一线。我们建议为精神科住院医师开发、实施、评估和传播一个全面的心理治疗和研究培训课程，使用针对自我伤害行为的辩证行为疗法。我们建议在哥伦比亚大学为精神病学住院医师提供为期12个月的DBT临床/研究培训，其中包括授课研讨会、录像带评级和培训以及病例监督。该课程有两个完整的组成部分。一种是为住院医生提供全面的临床培训计划，以了解针对自残行为进行DBT的原则、概念和干预措施。同步研究课程将教授进行心理治疗研究的基本原则，特别是进行测试DBT在减少自我伤害行为方面的有效性的研究。教职员工将由高级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强化培训，以及每周一次的小组会诊团队监督会议，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个一小时的教学环节，涉及进行心理治疗疗效试验和自杀干预研究，主题包括研究设计、心理治疗试验的程序、精神病学家在心理治疗研究中的作用、数据分析、程序化和遵守。这项申请的具体目标是：1)开发一个核心课程，培训精神病学住院医师关于DBT临床干预和自杀和自残临床人群的研究方法；2)开发基于标准的DBT基本技能评估；3)将这种培训和评估传播到该国的其他精神病学住院医师培训计划。拟议的评估部分包括一项旨在评估DBT临床技能成就的新措施的开发和有效性测试。这一衡量标准将与可靠的DBT遵守评级进行比较。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。这一课程和评估计划的传播将通过在全国各地的住院医师培训管理会议、出版物、网站张贴和咨询住院医师培训方案的研讨会上进行。 公共卫生相关性：自杀和自残行为已被卫生局局长确定为高度优先的公共卫生问题。拟议的研究计划是教精神科住院医生进行辩证行为疗法(一种经验证明可以减少自残行为的心理疗法)，并进行心理治疗研究，以进一步测试DBT在减少自残行为方面的效果。拟议的课程将成为将此类培训纳入全国住院医师计划的典范，以有效减少和防止自杀和自残行为。

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.