Optimizing Fidelity of Interpersonal Psychotherapy for Depression

描述(由申请人提供)：人际心理治疗(IPT)是一种描述良好和经验性验证的抑郁症治疗方法。虽然它的有效性是无懈可击的，但它在社区中往往是低保真度的，降低了它的有效性。这反过来又会减少 社区治疗患者的有效率和恢复率。本提案是针对NIMH RFA-MH-12-505《优化精神障碍经验性行为治疗(ESBT)的保真度》提出的。本RFA特别要求提案开发和测试：1)评估基于理论的ESBT保真度组件的方法；以及2)增强和保持临床医生在社区环境中实施ESBT保真度的干预措施。对此，我们建议进行一项涉及IPT的两个阶段的研究。第一阶段将是一个为期两年的项目，目的是开发和验证衡量IPT交付遵守情况和质量的保真度工具。具体步骤包括审查所有可用的心理治疗依从性工具，审查由IPT和其他心理治疗专家提供的定性反馈的IPT录像带，并随后制定IPT忠诚度的原型测量。然后将使用结果研究中的IPT存档样本对这一措施进行试点测试，使我们能够将遵守特定的IPT策略和技术与症状和诊断结果相关联。我们将制定最终的IPT依从性衡量标准，IPT专家将使用该指标对IPT治疗过程中具有代表性的样本进行评级。我们还将使用该工具对认知和心理动力学治疗过程进行评级，以此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，其中将使用保真度衡量标准来评估社区中4种不同的IPT培训方法，目的是确定培养对IPT的忠诚度并优化患者结果的培训方法的可行性。这些方法包括传统的由教师指导的教学培训，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培训将在为洛杉矶和加州其他社区的多样化和低收入人口提供服务的社区精神卫生机构进行，所有这些机构都与PI有着密切的联系。总而言之，我们的目标是开发和测试IPT治疗交付的保真度衡量标准：1)具有内容有效性；2)具有高度的预测性和区分性有效性；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.