CBTpro: Scaling up CBT for psychosis using simulated patients and spoken language technologies

由精神分裂症谱系障碍和主要情绪障碍引起的精神病是最常见的精神病之一， 导致全球健康问题。建议采用循证心理治疗干预措施， 国家精神病治疗指南的护理标准，但很少获得。认知行为 精神病治疗（CBTp）是研究最充分的精神病性障碍的心理治疗，但较少 超过1%的美国心理健康提供者接受过这种干预的培训。到目前为止，还没有 可扩展的方式为心理健康提供者提供高质量和可持续的CBTp培训。主 这项小企业技术转让（STTR）提案的目标是开发和评估一个口头的 语言技术工具- CBTpro -支持CBTp的高质量技能培训。CBTpro将提供一个 在美国各地的常规护理环境中快速扩展和维持CBTp的方法，导致更多的临床医生 在全国范围内为精神病患者提供更高质量的CBTP。快速通道STTR提案 有两个阶段。第一阶段的目标是开发一个CBTpro原型，这需要三个核心 活动：目标1：了解社区利益相关者的需求，为软件设计和功能提供信息;目标2： 目标3：训练和验证机器学习算法， CBTp保真度评分。第二阶段的目标是在真实的世界实践中优化和测试CBTpro工具 设置.因此，在第二阶段，我们将目标1：进行实验室可用性研究（目标1a），然后进行现场测试 CBTpro原型（目标1b）与20名受训者;目标2：进行CBTpro的随机对照试验 培训与常规培训（N= 100提供者/ N=300客户），使用嵌套混合模型分析， 确定CBTpro对客户症状，功能和恢复的影响;目标3：采用NIMH 实验治疗方法，评估CBTpro影响临床的假设机制， 通过提高提供者对CBTp（调解）的忠诚度来获得结果，并测试 这些变量之间的关系受到客户技能获取（适度）的影响。该提案直接 解决了国家精神卫生研究所的战略目标，以改善传播， 实施和不断改进循证精神卫生服务（目标4.2）， 开发创新模式，以显着改善所接受的精神卫生服务的结果（目标 #36825;，尤其是通过新技术的应用。CBTpro有可能减少高个人 与严重精神疾病相关的社会成本，解决高发病率下的培训挑战 精神卫生系统的周转，支持监督员在质量保证和改进工作， 减少与心理健康劳动力短缺地区相关的健康差距。

Psychosis resulting from schizophrenia spectrum disorders and major mood disorders is one of the most disabling health concerns worldwide. Evidence-based psychotherapeutic interventions are recommended as standard of care by national psychosis treatment guidelines but are rarely accessible. Cognitive Behavioral Therapy for psychosis (CBTp) is the most well-researched psychotherapy for psychotic disorders, yet fewer than 1% of American mental health providers are trained in this intervention. To date, there has been no scalable way to offer high-quality and sustainable CBTp training to mental health providers. The primary objective of this Small Business Technology Transfer (STTR) proposal is to develop and evaluate a spoken language technology tool – CBTpro -- to support high-quality skills training in CBTp. CBTpro will provide a rapid means of scaling and sustaining CBTp in routine care settings across the US, resulting in more clinicians across the country providing higher quality CBTp to individuals with psychosis. This fast-track STTR proposal has two phases. The objective of Phase I is to develop a CBTpro prototype, which requires three core activities: Aim 1: understand community stakeholder needs to inform software design and functionality; Aim 2: develop CBTpro digital content; and Aim 3: train and validate machine learning algorithms to automatically score CBTp fidelity. The objective of Phase II is to optimize and test the CBTpro tool in real world practice settings. Accordingly, in Phase II, we will Aim 1: conduct a lab usability study (Aim 1a) followed by field testing of the CBTpro prototype (Aim 1b) with 20 trainees; Aim 2: conduct a randomized controlled trial of CBTpro training vs. training as usual (N= 100 providers / N=300 clients), using a nested mixed model analysis to determine the effect of CBTpro on client symptoms, functioning, and recovery; and Aim 3: adopting an NIMH experimental therapeutics approach, assess the hypothesized mechanism by which CBTpro affects clinical outcomes through increased provider fidelity to CBTp (mediation), and test whether the strength of the relationship between these variables is affected by client skill acquisition (moderation). This proposal directly addresses the National Institute of Mental Health’s strategic objectives to improve dissemination, implementation, and continuous improvement of evidence-based mental health services (Objective 4.2) and develop innovative models to dramatically improve the outcomes of mental health services received (Objective 4.3), particularly through the use of novel technology. CBTpro has the potential to reduce the high personal and societal costs associated with serious mental illness, redress the challenges of training amidst high rates of mental health system turnover, support supervisors in quality assurance and improvement efforts, and reduce health disparities associated with mental health workforce shortage areas.