Optimizing Fidelity of Interpersonal Psychotherapy for Depression

描述（由申请人提供）：人际心理治疗（IPT）是一种描述良好且经经验验证的抑郁症治疗方法。虽然它的功效是不容置疑的，但它在社区中的保真度往往很低，降低了它的有效性。这反过来又减少了 在社区接受治疗的病人的反应率和康复率。 本提案是为了响应NIMH RFA-MH-12-505“优化精神障碍经验支持行为治疗（ESBT）的保真度”而提交的。“该RFA特别要求提案开发和测试：1）评估理论衍生ESBT保真度组件的方法; 2）增强和保持临床医生在社区环境中实施ESBT的保真度的干预措施。 有见及此，我们建议分两个阶段进行研究，当中会涉及知识产权交易。第一阶段将是一个为期两年的项目，以开发和验证一个忠诚的工具，以衡量遵守和交付的IPT质量。具体步骤包括审查所有可用的心理治疗依从性工具和审查IPT录像带与IPT和其他心理治疗专家的定性反馈，随后开发的IPT保真度的原型措施。然后将使用来自结果研究的IPT存档样本对该措施进行试点测试，使我们能够将对特定IPT策略和技术的依从性与症状和诊断结果相关联。我们将制定最终的IPT依从性指标，IPT专家将使用该指标对IPT治疗疗程的代表性样本进行评分。我们还将使用该工具来评估认知和心理动力治疗课程，作为建立判别效度的一种手段。 第二阶段将是一个为期三年的项目，其中保真度测量将用于评估社区中IPT培训的4种不同方法，目的是建立培养IPT保真度和优化患者结局的培训方法的可行性。这些方法包括传统的教师主导的教学培训，然后是：1）个案监督; 2）基于社区的咨询; 3）基于互联网的培训;或4）“自学”控制条件。IPT培训将在洛杉矶和其他加州社区的社区精神卫生机构进行，这些机构为多样化和低收入人群提供服务，所有这些社区都与PI有密切的联系关系。 总之，我们的目标是开发和测试IPT治疗交付的保真度的测量：1）具有内容效度; 2）具有高度的预测和区分效度; 3）可靠; 4）全面; 5）反映IPT的阶段; 6）在社区中使用是可行的。

DESCRIPTION (provided by applicant): Interpersonal Psychotherapy (IPT) is a well-described and empirically validated treatment for depression. Though its efficacy is unassailable, it is ofte delivered with low fidelity in the community, decreasing its effectiveness. This in turn diminishes the response and recovery rates of patients treated in the community. This proposal is submitted in response to NIMH RFA-MH-12-505, "Optimizing Fidelity of Empirically- Supported Behavioral Treatments (ESBT) for Mental Disorders." This RFA specifically requests that proposals develop and test: 1) methods for assessing theory-derived ESBT fidelity components; and 2) interventions that enhance and maintain the fidelity with which clinicians implement ESBT's in community settings. In response, we propose to conduct a two-phase study involving IPT. Phase I will be a two year project to develop and validate a fidelity instrument to measure the adherence and quality of the delivery of IPT. Specific steps include a review of all available psychotherapy adherence instruments and review of IPT videotapes with qualitative feedback by IPT and other psychotherapy experts, with subsequent development of a prototype measure of IPT fidelity. This measure will then be pilot tested using archived samples of IPT from outcome studies, allowing us to correlate adherence to specific IPT tactics and techniques to symptomatic and diagnostic outcome. We will develop a final IPT adherence measure which will be used by IPT experts to rate a representative sample of IPT therapy sessions. We will also use the instrument to rate cognitive and psychodynamic therapy sessions as a means of establishing discriminant validity. Phase II will be a three year project in which the fidelity measure will be used to evaluate 4 different methods of IPT training in the community, with the goal of establishing the feasibility of training methods that foster fidelity to IPT and optimize patient outcomes. These methods include a traditional instructor- led didactic training followed by either: 1) individual case supervision; 2) community-based consultation; 3) internet-based training; or 4) an "autodidactic" control condition. The IPT training will occur in community mental health agencies serving a diverse and low-income population in Los Angeles and other California communities, all of which have a close liaison relationship with the PI. In sum, our goals are to develop and test a measure of the fidelity of IPT treatment delivery which: 1) has content validity; 2) has a high degree of predictive and discriminative validity; 3) is reliable; 4 is comprehensive; 5) reflects the stages of IPT; and 6) is feasible for use in the community.