Optimizing Fidelity to Family-Based Treatment for Adolescent Anorexia Nervosa

优化青少年神经性厌食症家庭治疗的保真度

• 批准号: 9054930
• 负责人: JAMES D LOCK
• 金额: $ 29.07万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-06 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9054930
• 关键词: Address; Adolescent; Adoption; Anorexia Nervosa; Archives; Assessment tool; Behavior Therapy; Body Weight Changes; Chicago; Chronic; Clinical; Clinical Treatment; Code; Communities; Comparative Study; DSM-IV; Data; Databases; Disease; Early Intervention; Early treatment; Education; Educational workshop; Evidence based treatment; Family; Family Relationship; Family psychotherapy; Feedback; Instruction; Intervention; Knowledge; Lead; Learning; Life; Measures; Medical; Mental disorders; Methods; Monitor; Morbidity - disease rate; Nature; Online Systems; Outcome; Participant; Patient-Focused Outcomes; Patients; Phase; Pilot Projects; Property; Psychometrics; Randomized; Resources; Role; Schools; Site; Supervision; Time; Training; Training Programs; Treatment Cost; Treatment outcome; Universities; Weight Gain; base; clinical practice; comparative; comparative treatment; cost; design; dissemination research; evidence base; experience; follow-up; implementation research; meetings; mortality; novel; peer; prevent; primary outcome; programs; psychosocial; research data dissemination; secondary outcome; success; therapy design; trial comparing

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.

描述（由申请人提供）：本申请响应RFA-MH-12-050“优化经验支持的精神障碍行为治疗的保真度”。由于基于证据的方法与常见临床实践之间存在重大差距，因此迫切需要传播针对精神障碍的有效心理社会治疗。造成这种差距的一个因素是临床设置中治疗师对人工治疗的忠诚度较低。神经性厌食症（AN）是一种严重的疾病，具有显著的精神和医学发病率、死亡率和高昂的治疗费用。青少年AN的唯一基于证据的治疗是基于家庭的治疗（FBT）。然而，FBT导致临床成功的关键组成部分的作用（例如，促进父母联盟，外化，使用家庭聚餐，以及关于AN威胁生命性质的心理教育）尚未与结果进行评估。此外，重要的是制定更有效的培训策略，以促进采用循证治疗。虽然治疗师可能会接受使用FBT的培训，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，以及如何在FBT方面最有效地培训治疗师，都是没有答案的问题。为了解决这些知识上的差距，我们提出了以下两阶段设计的目标。在第一阶段（R21）： 1)改进现有的FBT保真度评估工具，并检查其心理测量特性；2)研究FBT保真度及其组成部分与患者预后的关系；3)探讨FBT保真度的预测因素；4)制定FBT的重点培训（FT）和监督计划。在第二阶段（R33），我们计划：1)通过进行FT与标准培训（ST）的小型试点RCT，评估对两种类型的FBT培训进行比较研究的可行性；并且，探索每组治疗师治疗的患者的比较结果。为了完成第一阶段（R21）的目标，我们将使用FBT对从以前的研究中选择的磁带中的档案数据进行编码和分析。在第2阶段（R33），我们计划通过随机选择30名治疗师（15名治疗师，每个治疗师中嵌套3名受试者）接受两种培训计划中的任何一种来比较FT和ST。主要结果将是可行性（例如，征聘、减员、评估、资源成本），以便进行充分有力的比较研究。