Clinical Trial of the Fit Families Multicomponent Obesity Intervention for African American Adolescents and Their Caregivers: Next Step from the ORBIT Initiative

项目摘要/摘要。肥胖是所有种族/民族的重大公共卫生问题 群体、年龄、性别和地理区域，但一些群体受到的影响比其他群体更不成比例。 与非西班牙裔相比，少数民族青少年，特别是AAA，肥胖的可能性不成比例 29，30这项拟议的研究旨在改善一个全面的多成员家庭-- 由社区卫生工作者(CHWS；治疗师)提供的基于行为干预(FIT家庭)的 非裔美国人(AA)肥胖青少年(AAAO)。这个应用程序扩展了一个研究计划， 遵循肥胖相关行为干预试验(Orbit)开发行为治疗，31 通过利用我们最近的工作，使用创新的人工智能技术来彻底检查 会话内治疗过程(即，作用机制)，特别是CHW同理心在 在治疗AAAO及其主要照顾者的同时，发展和维持治疗联盟(TA)。 助教被认为是治疗的基本要素。32助教由三个特征组成：1.情感纽带 治疗师和病人之间；2.病人和治疗师之间关于治疗目标的协议；以及3. 就治疗任务达成一致。33 TA是一种动态的、双向的和协同的治疗元素， 不同种族、年龄和性别的客户和治疗师之间的关系。治疗师的同理心很重要 在建立和维持一个强大的TA方面，其结果由治疗联盟调解。移情 与特定的干预措施相比，治疗结果的差异更大34，并一致地预测患者 35不幸的是，对关键的促进性人际关系技能的分析，如治疗师的同理心 在技术上具有挑战性，因为另一个人的行为意图是微妙的、与背景相关的(例如，治疗师和客户不同 在个性、背景、文化价值观等方面)、互动性(双向和协同性)； 以多种方式表达(音调、生理)。要更好地理解同理心，需要经验 方法和分析工具，可以识别实际临床接触中的同理心行为，从而产生 行为改变。我们将通过两个与同理心相关的措施来实现同理心。 和治疗结果：1)移情的准确性，定义为CHW对客户的准确理解 状态；2)人际生理同步性(IPS)，定义为治疗师和患者之间的相关性 随时间推移的IPS(即心率[HR]、HR变异性、皮肤电反应、语音特征)。这项研究使用了这些 理解同理心、治疗联盟和治疗之间关系的两种共情测量 结果。此外，这项研究还将探索移情效应是如何基于种族和性别而改变的 治疗师-客户二元组的一致性/不一致性。面向未来的临床翻译，音频和生理学 收集的数据将被用来为不同程度的移情建立分类模型。然后，这种模式可以 用于为治疗师的培训提供实时反馈，以改善他们的共情反应。

PROJECT SUMMARY/ABSTRACT. Obesity is a significant public health concern among all racial/ethnic groups, ages, gender, and geographic areas, but some groups are more disproportionately affected than others. Ethnic minority adolescents, especially AAs, are disproportionately likely to be obese relative to non-Hispanic White adolescents.29,30 The proposed study is designed to improve a comprehensive multicomponent family- based behavioral intervention (FIT Families) delivered by Community Health Workers (CHWs; therapists) for African American (AA) adolescents with obesity (AAAO). This application expands a program of research that has followed the Obesity Related Behavioral Intervention Trials (ORBIT) for developing behavioral treatments,31 by capitalizing on our recent work using innovative artificial intelligence technologies to thoroughly examine within-session therapy processes (i.e., mechanisms of action), specifically the role of CHW empathy in the development and maintenance of the therapeutic alliance (TA) while treating AAAO and their primary caregivers. TA is considered an essential element of therapy.32 The TA is composed of three features: 1. Emotional bond between therapist and client; 2. Agreement between the client and therapist on the goals of treatment; and 3. Agreement on the tasks of therapy.33 TA is a dynamic, bidirectional, and synergistic element of therapy with implications across differences in race, age, and gender of the client and therapist. Therapist empathy is critical in establishing and maintaining a strong TA, with outcomes mediated by the therapeutic alliance. Empathy accounts for more variance in therapy outcome than specific interventions34 and consistently predicts client change.35 Unfortunately, analysis of crucial facilitative interpersonal skills such as therapist empathy is technically challenging as the intent of another's behavior is nuanced, contextual (e.g., therapists and client differ in personality, background, cultural values, etc.), and interactive (bidirectional and synergistic); and can be expressed in multiple ways (voice tone, physiology]). To better understand empathy, requires empirical approaches and analytical tools that can discern empathetic behaviors in actual clinical encounters that produce behavior change. We will operationalize empathy through two measures that are each associated with empathy and treatment outcomes: 1) Empathic accuracy, defined as the CHW's accurate understanding of the client's state; and 2) Interpersonal physiological synchrony (IPS), defined as the correlation between therapist and client IPS over time (i.e., heart rate [HR], HR variability, galvanic skin response, voice features). This study uses these two empathy measures to understand the relationship between empathy, therapeutic alliance, and treatment outcomes. Further, the study will explore how empathy effects change based on the race and gender concordance/discordance of therapist-client dyads. Toward future clinical translation, the audio and physiological data collected will be used to build classification models for differing degrees of empathy. This model could then be used to provide real-time feedback for therapists training to improve their empathic responses.