CBT for Pediatric OCD: Effective Therapist Behaviors and Community Training Pilot

描述(由申请人提供)：社区治疗师很少使用有经验支持的干预措施，以前向社区环境传播经验性支持的行为治疗(ESBT)的尝试并不是基于对治疗过程的关键成分的了解，如果没有这一点，社区治疗师可能没有得到充分的培训。以原则为基础的培训使用积极的学习策略，并纳入关于保真度的反馈，有望在社区环境中应用和可持续地使用ESBTS。儿童强迫症有一个明确的治疗(暴露和反应预防)的理论基础，是一个理想的障碍，用来测试改进的培训模式，将理论、会议中的治疗师行为和患者结果联系起来。该项目的第一阶段(R21)将使用理论衍生的观察编码系统来检查接受CBT的儿童(N=160)在治疗期间的治疗行为，这些儿童接受了CBT，这是儿童强迫症(POTS)三个多点治疗试验的一部分。具体地说，我们将寻找治疗期间处方和被禁止的治疗师行为与改变(习惯性)的理论机制和患者治疗结果相关的证据。我们还将验证一个简短的保真度评级系统，该系统衡量指定和禁止的治疗师行为，为在社区环境中向治疗师提供关于这些行为的反馈做准备。第二阶段(R33)将使用R21数据开发和试点两种基于理论的CBT培训的随机试验，以治疗儿童强迫症的社区提供者。两个社区地点的治疗师(N=16人)将随机接受工作坊加每周监督或工作坊加电话咨询服务。所有治疗师将收到关于R21阶段使用保真度评级系统确定的处方和被禁止行为的定期反馈。我们将衡量治疗师级别的结果(例如，知识、熟练程度、满意度)和患者级别的结果(例如，症状、残疾、服务利用、满意度)，以评估培训和相关治疗的可行性和可接受性，并为R01试验做准备。这项研究的结果将为未来治疗师基于理论的培训计划的发展以及将暴露作为治疗其他焦虑症的工具的教学使用提供信息。

DESCRIPTION (provided by applicant): Community therapists rarely use interventions with empirical support and prior attempts to disseminate empirically supported behavioral treatments (ESBTs) to community settings have not been based on understanding key ingredients of the therapeutic process, without which community therapists may be inadequately trained. Principle-based training that uses active learning strategies and incorporates feedback about fidelity holds promise for application and sustainability of ESBTs in community settings. Pediatric OCD has a clear theory underlying treatment (Exposure and Response Prevention) and is an ideal disorder with which to test an improved training model linking theory, in-session therapist behavior, and patient outcome. The first phase (R21) of this project will use a theory-derived observational coding system to examine therapist behavior during treatment for a sample of children (N = 160) who received CBT as part of three multisite treatment trials for pediatric OCD (POTS). Specifically, we will look for evidence that prescribed and proscribed therapist behaviors during treatment are related to theoretical mechanism of change (habituation) and to patient treatment outcome. We will also validate a short fidelity rating system that measures prescribed and proscribed therapist behaviors, in preparation for providing feedback about those behaviors to therapists in community settings. The second phase (R33) will use R21 data to develop and pilot a randomized trial of two delivery formats of theory-based CBT training for community providers treating pediatric OCD. Therapists (N = 16) across two community sites will be randomized to receive a workshop plus weekly supervision or a workshop plus telephone consultation service. All therapists will receive regular feedback about prescribed and proscribed behaviors identified in the R21 phase using the fidelity rating system. We will measure therapist-level outcomes (e.g., knowledge, proficiency, satisfaction) and patient-level outcomes (e.g., symptoms, disability, service utilization, satisfaction) for purposes of assessing feasibility and acceptability of training and related treatment and in preparation for R01 trial. Results from this study will inform development of future theory-based training programs for therapists as well as teaching use of exposure as a tool for other anxiety disorders.