The Development of a Therapist Feedback System for MDD in Community Mental Health

社区心理健康 MDD 治疗师反馈系统的开发

• 批准号: 8215766
• 负责人: Mary Beth Gibbons
• 金额: $ 23.17万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-16 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8215766
• 关键词: Adopted; Algorithms; Boston; Client; Clinic; Clinical; Code; Color; Communities; Community Mental Health Centers; Computers; Consultations; Data; Databases; Development; Diagnosis; Disease; Distress; Doctor of Philosophy; Early treatment; Equipment and supply inventories; Evaluation; Feedback; Focus Groups; Funding; Future; Goals; Grant; Health Services Research; Health system; Hour; Hylobates Genus; Individual; Intervention; Investigation; Major Depressive Disorder; Measurement; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Monitor; Monoclonal Antibody R24; National Institute of Mental Health; Outcome; Outcome Assessment; Outpatients; Paper; Pathology; Patients; Performance; Personality; Personality Assessment; Pharmaceutical Preparations; Phase; Preparation; Procedures; Process; Protocols documentation; Psychotherapy; Public Health; Public Sector; Publishing; Randomized; Randomized Controlled Trials; Recommendation; Recovery; Reporting; Research; Research Infrastructure; Research Personnel; Research Support; Resistance; Running; Sampling; Services; Site; Suggestion; Symptoms; System; Testing; Text; Time; Training; Translating; Treatment Failure; Treatment outcome; United States; Universities; Work; World Health Organization; base; computerized; cost; design; disability; effective intervention; effectiveness research; effectiveness trial; efficacy trial; experience; improved; instrument; intervention effect; meetings; novel strategies; pilot trial; programs; public health relevance; randomized trial; response; satisfaction; success; therapy development; user-friendly

DESCRIPTION (provided by applicant): The goal of the proposed research is to develop and evaluate the feasibility of a cost-efficient and easily disseminated intervention for improving psychotherapy outcomes for patients with major depressive disorder treated in the community mental health system. A number of studies have demonstrated promising results for feedback systems that identify potential treatment failures and provide outcome information that enables psychotherapists to alter the treatment process to maximize outcomes. Yet no investigations have evaluated the effects of feedback interventions in community mental health centers that are in dire need of cost-efficient and effective interventions to improve outcomes. Our goal is to develop a feedback system that provides information to therapists on the patient's early progress in treatment based on the BASIS-24 as well as important clinical information to guide treatment based on the Personality Assessment Inventory (PAI). We propose a two phase intervention development program in which we will 1) evaluate the feasibility of computerized assessment of the BASIS-24 and PAI, 2) conduct therapist focus groups to develop community friendly feedback reports, and 3) conduct a pilot randomized controlled trial of the feedback system in the community mental health center for the purpose of evaluating the feasibility of the research protocol and the acceptability of the feedback intervention to the community mental health system.. We will randomize therapists delivering services at two community mental health centers to either receive feedback or not receive feedback on the early progress of new patients entering treatment for major depressive disorder. All patients diagnosed with major depressive disorder at the mental health agency will complete the BASIS-24 at baseline and at each treatment session as part of regular clinic procedures. Therapists of patients in the feedback group will receive a brief report based on the BASIS-24 prior to the early sessions of treatment that indicates the patient's progress to date. The report will also include a color code system that indicates to the therapist whether the patient is on track to improve in treatment based on the estimated recovery curves. For patients who are predicted to do poorly, the report will indicate to the therapist that the patient should complete the PAI following the session. The patient will complete the PAI on a computer following his/her therapy session and a clinical report that includes useful clinical recommendations will be given to the therapist prior to the next session. This pilot trial will provide the necessary feasibility and acceptability data to support a future fully-powered trial and to justify the potential success of this feedback system clinically. PUBLIC HEALTH RELEVANCE: Major depressive disorder is a severe and disabling disorder afflicting 7% of individuals in the United States annually and approximately 17% of individuals across their lifetime (Kessler et al., 2005). Depression has been ranked as the fourth greatest public health problem by the World Health Organization (Murray & Lopez, 1996) and is considered the most likely illness to result in disability (Murray & Lopez, 1996). Despite multiple investigations demonstrating that both medications as well as psychotherapeutic interventions are effective in the treatment of major depressive disorder (APA, 2000), response rates in well-done efficacy trials still reach only 40 to 60% (DeRubeis et al., 2005; Bielski, Ventura, & Chang, 2004; Keller et al., 2000), and response rates for public sector clients are less than 30% (Rush, Trivedi, Carmody, et al., 2004). While many have suggested that outcomes in community-based settings could be improved through the dissemination of empirically-supported psychotherapies (Stirman, Crits-Christoph, & DeRubeis, 2004; Barlow et al., 1999; Chorpita et al., 2002; Henggler et al., 1995), such efforts have a variety of hurdles, including the cost of training therapists in new methods, and resistances of therapists to adopting new approaches that are discrepant from their own preferred style of therapy. The current research paradigm represents an alternative way to improve outpatient mental health outcomes, through performance feedback to the therapist that has the potential to improve mental health outcomes in community clinics in a feasible and sustainable way.

描述(申请人提供)：拟议研究的目标是开发和评估一种成本效益高和易于传播的干预措施的可行性，以改善在社区精神卫生系统接受治疗的严重抑郁障碍患者的心理治疗结果。许多研究表明，反馈系统可以识别潜在的治疗失败，并提供结果信息，使心理治疗师能够改变治疗过程，以最大限度地提高结果，这一系统取得了良好的结果。然而，还没有调查评估社区精神卫生中心反馈干预的效果，这些中心迫切需要具有成本效益和有效的干预措施来改善结果。我们的目标是开发一个反馈系统，向治疗师提供基于BASIC-24的患者早期治疗进展的信息，以及基于个性评估问卷(PAI)指导治疗的重要临床信息。我们提出了两个阶段的干预发展计划：1)评估Basis-24和PAI的计算机评估的可行性；2)引导治疗师焦点小组开发社区友好的反馈报告；3)在社区精神卫生中心进行反馈系统的试点随机对照试验，目的是评估研究方案的可行性和反馈干预对社区精神卫生系统的可接受性。我们将随机挑选在两个社区精神卫生中心提供服务的治疗师，让他们要么接受反馈，要么不接受关于新患者进入重度抑郁障碍治疗的早期进展的反馈。作为常规临床程序的一部分，所有在精神卫生机构被诊断为严重抑郁障碍的患者都将在基线和每次治疗期间完成基数24。反馈组患者的治疗师将在早期治疗之前收到一份基于24小时的简要报告，表明患者迄今的进展。该报告还将包括一个色码系统，该系统根据估计的康复曲线向治疗师指示患者是否在治疗中有所改善。对于预计效果不佳的患者，报告将向治疗师指示，患者应在疗程结束后完成PAI。患者将在治疗结束后在计算机上完成PAI，并在下一次治疗之前向治疗师提供一份包括有用的临床建议的临床报告。这项试点试验将提供必要的可行性和可接受性数据，以支持未来的全功率试验，并在临床上证明该反馈系统的潜在成功。 公共卫生相关性：严重抑郁障碍是一种严重的致残障碍，在美国，每年有7%的人和大约17%的人一生中都会受到影响(Kessler等人，2005年)。抑郁症已被世界卫生组织列为第四大公共卫生问题(Murray&Lopez，1996)，并被认为是最有可能导致残疾的疾病(Murray&Lopez，1996)。尽管多项研究表明，药物和心理治疗干预措施在治疗严重抑郁障碍方面都有效(APA，2000)，但在做得好的疗效试验中，有效率仍然只有40%至60%(DeRubeis等人，2005年；Bielski，Ventura&Chang，2004年；Keller等人，2000年)，公共部门客户的有效率不到30%(Rush，Trivedi，Carmody等人，2004年)。虽然许多人建议通过传播经验性支持的心理疗法(Stirman，Crits-Christoph，&DeRubeis，2004；Barlow等人，1999；ChorPita等人，2002；Henggler等人，1995)，可以通过传播经验支持的心理疗法来改善社区环境中的结果，但这种努力存在各种障碍，包括以新方法培训治疗师的成本，以及治疗师对采用与他们自己喜欢的治疗方式不同的新方法的抵制。目前的研究范式代表了一种改善门诊患者精神健康结果的替代方法，通过向治疗师提供绩效反馈，有可能以可行和可持续的方式改善社区诊所的精神健康结果。

项目成果

Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.

在随机心理社会干预试验中重复评估抑郁症状：分析症状随时间变化的最佳实践。

• DOI: 10.1080/10503307.2022.2073289
• 发表时间: 2023
• 期刊: Psychotherapy research : journal of the Society for Psychotherapy Research
• 作者: Crits-Christoph,Paul;Gallop,Robert;Duong,Lang;Zoupou,Eirini;ConnollyGibbons,MaryBeth
• 通讯作者: ConnollyGibbons,MaryBeth