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

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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.