Optimizing Fidelity to Family-Based Treatment for Adolescent Anorexia Nervosa

描述（由申请人提供）：本申请响应RFA-MH-12-050“优化精神疾病经验支持行为治疗的保真度”。“迫切需要传播有效的精神障碍心理社会治疗方法，因为循证方法和普通临床实践之间存在重大差距。造成这种差距的一个因素是临床治疗师对临床环境中手动治疗的忠诚度低。神经性厌食症（AN）是一种严重的疾病，与显着的精神和医疗发病率，死亡率和高治疗费用。唯一可用于青少年AN的循证治疗是家庭治疗（FBT）。然而，导致临床成功的FBT关键成分的作用（例如，促进父母联盟、外化、使用家庭聚餐和关于AN危及生命性质的心理教育），尚未评价与结果的关系。此外，重要的是，更有效的培训策略，以促进采用循证治疗。虽然治疗师可能会被训练使用FBT，但所需的关键干预措施，评估这些干预措施的最可靠方法，识别忠诚度的有效策略，忠诚度与结果的关系，以及如何最有效地培训治疗师使用FBT都是未回答的问题。为了解决这些知识差距，我们提出了以下两阶段设计目标。在第1阶段（R21）：1）完善现有的FBT保真度评估工具，并检查其心理测量学特性; 2）检查FBT保真度及其组成部分与患者结局的关系; 3）探索FBT保真度的预测因素; 4）制定FBT的重点培训（FT）和监督计划。在第2阶段（R33），我们计划1）通过进行一项FT与标准训练（ST）的小型试点RCT，评估在FBT中进行两种类型训练的比较研究的可行性;并探索每组治疗师治疗的患者的比较结局。为了实现第1阶段（R21）的目标，我们将使用FBT对从先前研究中选择的磁带中的存档数据进行编码和分析。在第2阶段（R33），我们计划通过随机分配30名治疗师（15名治疗师，每名治疗师嵌套3名受试者）接受两种培训计划之一来比较FT和ST。主要结果是可行性（例如，招募、自然减员、成套评估、资源成本），以进行充分有力的比较研究。

DESCRIPTION (provided by applicant): This application responds to RFA-MH-12-050 "Optimizing Fidelity of Empirically-Supported Behavioral Treatments for Mental Disorders." There is a critical need to disseminate effective psychosocial treatments for mental disorders as there is a significant gap between evidenced-based approaches and common clinical practice. One factor that contributes to this gap is low therapist fidelity to manualized treatments in clinial settings. Anorexia Nervosa (AN) is a serious disorder associated with significant psychiatric and medical morbidity, mortality, and high treatment costs. The only evidence based treatment available for adolescent AN is Family-Based Treatment (FBT). However, the role of key components of FBT that lead to clinical success (e.g., promoting parental alliance, externalization, use of a family meal, and psycho-education about the life-threatening nature of AN), have not been evaluated in relation to outcome. Moreover, it is important that more efficient training strategies be developed to promote adoption of evidence based treatments. Although therapists can likely be trained to use FBT, the key interventions needed, the most reliable methods for assessing these interventions, efficient strategies for identifying fidelity, he relationship of fidelity to outcome, and how best to train therapists efficiently in FBT are all unanswered questions. To address these gaps in knowledge, we propose the following aims in a 2-Phase design. In Phase 1 (R21): 1) To refine an existing fidelity assessment instrument for FBT and examine its psychometric properties; 2) To examine the relationship of FBT fidelity and its components to patient outcome; 3) To explore predictors of fidelity in FBT; 4) To develop a Focused Training (FT) and supervision program for FBT. During Phase 2 (R33) we plan to 1) To assess the feasibility of conducting a comparison study of two types of training in FBT by conducting a small pilot RCT of FT versus Standard Training (ST); and, explore the comparative outcomes of the patients treated by therapists in each group. To accomplish the aims of Phase 1 (R21) we will code and analyze archival data from tapes selected from previous studies using FBT. During Phase 2 (R33) we plan to compare FT to ST by randomizing 30 therapists (15 therapists with 3 subjects nested in each therapist) to receive either one of the two training programs. The primary outcome will be feasibility (e.g., recruitment, attrition, assessment battery, resource costs) to conduct a sufficiently powered comparative study.