Individualized Assessment and Treatment Program for TMD: Coping as a Mechanism

这是对母研究“个性化评估和 TMD的治疗方案：应对作为一种机制”（U 01 DE 028520）。目前，母研究 从事探索在何种程度上应对技能本身的培训是一个重要的机制， 心理社会治疗目前的补编旨在为扩大 检查治疗机制，包括治疗关系因素（治疗师支持，同情， 确认）。本补充文件是对特别关注通知（NOSI）NOT-DE-22-002的回应。 心理社会治疗对颞下颌关节紊乱病（TMD）有效，但其机制 这些治疗的作用尚不清楚。大多数心理治疗的研究，包括父母U 01， 侧重于相对具体的心理社会机制，包括应对技能的获得，疼痛， 管理自我效能，减少灾难化，增加正念，接受，并准备 改变行为以减轻疼痛。母研究中的2种治疗师提供的治疗是打包的 CBT或个性化评估和治疗（IATP）。在这项研究中未测试的是常见的治疗方法 在疼痛结果研究中经常出现的影响因素。这些常见的非特异性治疗 影响因素包括（尤其）：治疗联盟、解释和理解、情感表达、 强化;信息;保证和支持。因为父U 01的两个条件都涉及 类似水平的治疗师参与，治疗师支持和其他治疗非特异性变量不能 测试清楚。评估这些因素的一种方法是引入一种明确不包含 这些因素;即，不需要雇佣治疗师或医疗监督的治疗 专业人士目前还没有发表的研究，其中治疗师主导的治疗进行了比较 到基于移动的应用的治疗。 因此，我们建议对移动的应用治疗条件（painTrainer©）进行试点测试， 在母研究的基础上增加额外的治疗条件，并在来年向20名患者提供。这 条件将提供父研究的CBT条件的内容，但将在没有治疗师的情况下进行 contact.如果发现该移动的应用程序可信且可接受，则可将其用于其他比较 治疗师进行的治疗。因此，在某种程度上，我们将能够解析认知的影响- 行为治疗内容本身和治疗师支持因素。测试这种移动的的额外好处是 它的应用是，它可能在未来提供一种手段，以扩大疼痛管理的范围， 专业人员到偏远和服务不足的人群。

This is a proposal for an administrative supplement to the parent study, “Individualized Assessment and Treatment Program for TMD: Coping as a Mechanism” (U01 DE028520). The parent study is currently engaged in exploring the extent to which the training of coping skills per se is an important mechanism of psychosocial treatment. The current supplement seeks to lay the groundwork for expanding the range of treatment mechanisms examined to include therapeutic relationship factors (therapist support, empathy, acknowledgment). This supplement is in response to Notice of Special Interest (NOSI) NOT-DE-22-002. Psychosocial treatments have been effective for temporomandibular disorders (TMD), but the mechanisms of action for these treatments are unclear. Most studies of psychosocial treatment, including the parent U01, have focused on relatively specific psychosocial mechanisms, including coping skills acquisition, pain management self-efficacy, decrease in catastrophizing, increased mindfulness, acceptance, and readiness to change behavior to ameliorate pain. The 2 therapist-delivered treatments in the parent study are packaged CBT or Individualized Assessment and Treatment (IATP). Left untested in this study are common therapeutic factors that often emerge as influential in pain outcome research. These common, non-specific therapeutic factors include (especially): the therapeutic alliance; interpretation and understanding; emotional expression; reinforcement; information; and reassurance and support. Because both conditions of the parent U01 involve similar levels of therapist involvement, therapist support and other treatment-non-specific variables cannot be tested clearly. One way to assess these factors is to introduce a pain treatment that explicitly does not contain these factors; i.e., a treatment that does not employ therapists or require supervision by health care professionals. There are currently no studies published in which therapist-led treatments have been compared to a mobile application-based treatment. We therefore propose to pilot test a mobile application treatment condition (painTrainer©) added as an additional treatment condition to the parent study, and provided to 20 patients in the coming year. This condition will deliver the content of the CBT condition of the parent study, but will do so with no therapist contact. If this mobile application is found credible and acceptable it may be used in additional comparisons with treatments conducted by therapists. Thus at some point we will be able to parse the effects of cognitive- behavioral treatment content per se and therapist support factors. An additional benefit of testing such a mobile application is that it might in the future provide a means to expand the reach of pain management professionals to remote and underserved populations.