The DBT-SUD In-Session Response to Dysfunctional Behavior for ACT Teams

描述（由申请人提供）：患有严重和持续性精神疾病（SPMI）的人通常会经历物质使用障碍（SUD）和边缘型人格障碍（BPD），导致严重和复杂的个人成本和公共卫生问题。虽然自信的社区治疗（ACT）是有效的SPMI的人，它是不太清楚的程度，这种方法充分满足物质依赖BPD客户的需求。辩证行为疗法（DBT）是一种有效的心理社会治疗与BPD和共同发生SUD的个人。在过去的十年中，ACT中DBT的这种组合方法已被确定为临床实践的一个有前途的方向，更多的ACT团队正在使用DBT与他们最难治疗的客户（包括BPD和SUD）合作。传播基于证据的做法仍然是NIDA的高度优先事项。一些障碍限制了在社区精神卫生和药物滥用治疗环境中获得这些有效做法的机会。根据NIDA传播循证实践的优先事项，该第二阶段赠款提议大幅扩大创新的基于计算机的培训（CBT）计划的开发，旨在教授ACT提供者有效的DBT策略，以减少BPD和BPD-SUD客户中的会话功能失调行为。具体而言，我们建议扩大内容，包括更多的DBT辩证和文体策略，并将增加各种基于案例的场景，以进一步促进兴趣，并确保直接适用于临床实践。我们还将扩大互动练习，包括广泛的基于表现的学习机会，使学习者沉浸在治疗环境中。我们将使用迭代开发过程来构建所有新内容，通过进行广泛的在线审查和与DBT专家、ACT专家和目标受众（即，ACT提供者），以及通过与ACT提供者的“现场”可用性测试。然后，我们将使用随机对照试验（RCT）来测试该计划的功效和有效性，将CBT与包括专家咨询和在线讨论板在内的增强CBT条件进行比较。在这项随机对照试验中，我们将评估ACT提供者在治疗BPD和BPD-SUD客户时的知识和回忆以及自我效能。此外，我们将扩大结果评估，包括每个ACT提供者和模拟ACT客户之间基于绩效的角色扮演。将在培训前和培训后以及培训后4周和12周的随访中对参与者进行评估。主张社区治疗是为严重和持续性精神疾病患者提供服务的一种有效方法;然而，目前尚不清楚这种方法是否对边缘型人格障碍或物质使用障碍患者有效，这些患者中有很大一部分接受了主张社区治疗。辩证行为疗法（DBT）是一种有效治疗边缘型人格障碍和物质使用障碍的方法，经常受到ACT提供者的追捧，以更有效地满足客户的需求。该项目的目的是开发和评估一个创新的基于计算机的培训计划，该计划将教授ACT提供者各种DBT策略，最终改善具有这些复杂需求的客户的临床结果。

DESCRIPTION (provided by applicant): Persons with severe and persistent mental illness (SPMI) commonly experience both Substance Use Disorders (SUDs) and Borderline Personality Disorder (BPD), resulting in serious and complex personal costs and public health problems. Although Assertive Community Treatment (ACT) is efficacious for persons with SPMI, it is less clear the extent to which this approach adequately meets the needs of substance dependent BPD clients. Dialectical Behavior Therapy (DBT) is an efficacious psychosocial treatment for individuals with BPD and co-occurring SUDs. Over the past decade, this combined approach of DBT within ACT has been identified as a promising direction for clinical practice, and more ACT teams are using DBT to work with their most difficult-to-treat clients (including those with BPD and SUDs). Dissemination of evidence-based practices remains a high priority at NIDA. A number of barriers limit accessibility to these effective practices in community-based mental health and substance abuse treatment settings. In line with NIDA's priority to disseminate evidence-based practices, this Phase II grant proposes to substantially expand development of an innovative computer-based training (CBT) program aimed at teaching ACT providers effective DBT strategies to reduce in-session dysfunctional behaviors among their BPD and BPD-SUD clients. Specifically, we propose to expand the content to include more DBT dialectical and stylistic strategies, and will add a variety of case-based scenarios to further facilitate interest and to ensure direct applicability to clinical practice. We will also expand interactive exercises to include extensive performance-based learning opportunities that immerse the learner within the treatment context. We will use an iterative process of development in building all new content, ensuring usability and satisfaction by conducting extensive online reviews and individual interviews with DBT experts, ACT experts, and the target audience (i.e., ACT providers), as well as through "live" usability tests with ACT providers. We will then move to a test of the program's efficacy and effectiveness using a randomized controlled trial (RCT) comparing the CBT to an enhanced CBT condition that includes expert consultation and an online discussion board. In this RCT, we will evaluate gains in knowledge and recall, as well as self-efficacy among ACT providers in treating their clients with BPD and BPD-SUD. Additionally, we will expand the outcome assessment to include a performance-based role-play between each ACT provider and a mock ACT client. Participants will be assessed pre- and post-training, and at 4- and 12-week post-training follow-up. Assertive Community Treatment (ACT) is an effective service delivery approach for persons with severe and persistent mental illness; however, it is unclear as to whether it is effective for individuals with Borderline Personality Disorder or Substance Use Disorders, a high proportion of who are served by ACT. Dialectical Behavior Therapy (DBT), an effective treatment for individuals with Borderline Personality Disorder and Substance Use Disorders, is often sought after by ACT providers to more effectively respond to the needs of their clients. The intent of this project is to develop and evaluate an innovative computer-based training program that will teach ACT providers various DBT strategies that will ultimately improve clinical outcomes among their clients with these complex needs.