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具有经验支持的干预措施，并且之前将经验支持的行为治疗（esbt）传播到社区环境的尝试并不是基于对治疗过程的关键成分的理解，没有这些因素，社区治疗师可能没有得到充分的培训。基于原则的培训采用主动学习策略，并结合对保真度的反馈，为esbt在社区环境中的应用和可持续性带来了希望。儿科强迫症有一个明确的理论基础治疗（暴露和反应预防），是一种理想的障碍，用于测试一个改进的培训模型，将理论、治疗过程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治疗期间的治疗师行为，这些儿童样本（N = 160）接受CBT治疗，作为儿科强迫症（POTS）的三个多站点治疗试验的一部分。具体来说，我们将寻找证据，证明在治疗过程中规定的和禁止的治疗师行为与改变（习惯化）的理论机制和患者的治疗结果有关。我们还将验证一个短保真度评级系统，该系统可以衡量治疗师规定的和被禁止的行为，为在社区环境中向治疗师提供有关这些行为的反馈做准备。第二阶段（R33）将使用R21数据开发和试点一项随机试验，为社区提供者治疗儿童强迫症提供两种基于理论的CBT培训。来自两个社区站点的治疗师（N = 16）将随机接受工作坊加每周监督或工作坊加电话咨询服务。所有治疗师都将定期收到关于在R21阶段使用保真度评定系统确定的规定和禁止行为的反馈。我们将测量治疗师水平的结果（如知识、熟练程度、满意度）和患者水平的结果（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提供信息，并将暴露作为治疗其他焦虑症的工具进行教学。

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.