Web Based Therapist Training on Complicated Grief Therapy

复杂性悲伤（CG）是一种普遍存在的、使人衰弱的疾病， 损伤它在治疗和康复学上与重性抑郁症不同。CG在DSM 5中被列为 创伤和格雷夫病的亚型世界卫生组织将把CG作为一个独立的 ICD 11中的疾病，预计DSM 5.1小组委员会将效仿。传统形式的 治疗CG尚未成功。然而，一个短期的，人工化的 悲伤治疗（CGT）已经开发出来，并在NIMH赞助的三个大型随机 对照试验。与其他基于证据的治疗（EBT）一样，缺乏传播和实施是一个问题。 这是一个主要问题，在很大程度上是由于缺乏训练有素的临床医生。促进获得EBT培训， 被精神卫生专业组织和NIMH确定为国家优先事项。的一种方法 帮助传播治疗师培训的CG的EBT是通过使用新技术。在以前的NIMH资助 研究表明，基于互联网的技术可以成功地培训EBT的临床医生， 教学知识、临床技能和患者治疗结果。在当前应用程序中，我们将使用 新技术，为CGT开发一个全面的在线治疗师培训协议，包括三个 组成部分：1）涵盖教学材料的互动式在线教程; 2）基于网络的实时 在教学培训后进行视频会议小组监督，以练习和强化技能; 3）患者应用程序， 协助推行资产增值税，包括设立自动化文字讯息系统， 鼓励和支持患者在会话之间，并提高家庭作业的依从性。三十 将招聘临床实习医生。学员将按照自己的节奏参加在线教程，然后参加3个现场 小组视频会议监督会议。培训前和培训后的教学知识措施， 将获得临床技能和用户满意度评价。患者应用程序将并行开发 培训教材，并遵循一个平行但单独的评估过程。患者应用程序的评价 将通过焦点小组进行，其中16名患者是从目前正在接受治疗的治疗师的实践中招募的。 提供CGT。患者将被允许访问患者应用程序，并将探索应用程序两周， 然后他们会参加一个焦点小组，听取他们的意见。CGT治疗师的焦点小组也将 在第一阶段，我们将评估可行性，用户满意度，并生成试点数据， 这些组成部分在提高知识和技能方面的有效性。我们还将举行持续的会议， 与纽约州行为健康服务部主任合作，招募I期患者和非专业人员。 第二阶段的基础工作，在那里我们将整合和测试纽约州心理健康的培训方案 系统作为随机实用试验的一部分。会议将有助于确定分阶段实施的障碍和促进因素 二.执行。我们的目标是开发一种可行的公共卫生相关产品。 1

Complicated Grief (CG) is a prevalent and debilitating disorder associated with significant distress and impairment. It differs from major depression in its treatment and symptomatology. CG is listed in DSM5 as a subtype of Trauma and Greif Disorder. The World Health Organization will include CG as a stand-alone disorder in ICD11, and it is expected that the DSM 5.1 subcommittee will follow suit. Traditional forms of therapy have not been successful in the treatment of CG. However a short-term, manualized Complicated Grief Treatment (CGT) has been developed and found efficacious in three large NIMH sponsored randomized controlled trials. As with other evidence based treatments (EBTs), lack of dissemination and implementation is a major issue, due in large part to a shortage of trained clinicians. Facilitating access to training in EBTs has been identified as a national priority by both mental health professional organizations and NIMH. One way to help disseminate therapist training on EBT of CG is through the use of new technologies. In prior NIMH-funded studies, we have shown that internet-based technologies can successfully train clinicians in EBTs, improving both didactic knowledge, clinical skills, and patient treatment outcomes. In the current application, we will use new technologies to develop a comprehensive on-line therapist training protocol for CGT consisting of three components: 1) An interactive on-line tutorial covering the didactic material; 2) Live, web-based videoconference group supervision following didactic training to practice and reinforce skills; 3) A patient app to help facilitate implementation of CGT including automated text-messaging system to provide messages of encouragement and support to patients between sessions, and improve homework compliance. Thirty clinician-trainees will be recruited. Trainees will take the on-line tutorial at their own pace, followed by 3 live group videoconference supervision sessions. Pre- and post-training measures of didactic knowledge and clinical skill, and evaluations of user-satisfaction will be obtained. The patient app will be developed in parallel to the training package, and follow a parallel but separate evaluation process. Evaluation of the patient app will be done through focus groups with 16 patients recruited from the practices of therapists who are currently providing CGT. Patients will be provided access to the patient app and will explore the app for two weeks, after which they will attend a focus group to obtain their feedback. A focus group of CGT therapists will also be used to evaluate the app. In phase I, we will evaluate feasibility, user satisfaction, and generate pilot data on the effectiveness of these components in improving knowledge and skill. We will also have ongoing meetings with the Director of the NYS Division of Behavioral Health Services in order to recruit phase I patients and lay the groundwork for phase II, where we will integrate and test the training protocol in the NYS mental health system as part of a randomized pragmatic trial. Meetings will help identify the barriers and facilitators to phase II implementation. Our aim is to develop a viable public health-relevant product. 1