Utilizing Mobile Technology for DBT Skills Generalization with BPD-SUD Clients

利用移动技术与 BPD-SUD 客户进行 DBT 技能泛化

• 批准号: 7611527
• 负责人: Linda A Dimeff
• 金额: $ 15.87万
• 依托单位: BEHAVIORAL TECH RESEARCH, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-15 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7611527
• 关键词: Alcohol or Other Drugs use; Anger; Applications Grants; Behavior; Behavior Therapy; Behavioral; Borderline Personality Disorder; Businesses; Client; Clinical; Clinical Trials; Cognitive; Collaborations; Complex; Coping Behavior; Custom; Development; Developmental Process; Device Designs; Devices; Dialectical behavior therapy; Educational process of instructing; Effectiveness; Environment; Evaluation; Event; Experimental Designs; Feedback; Frequencies; Funding; Goals; Health Personnel; Hour; Individual; Instruction; Knowledge; Learning; Methods; Monitor; National Institute of Drug Abuse; New York City; Outcome; Participant; Patients; Phase; Pilot Projects; Principal Investigator; Process; Program Description; Public Health; Randomized; Recording of previous events; Recruitment Activity; Research; Schools; Self Efficacy; Self-Injurious Behavior; Small Business Innovation Research Grant; Staging; Substance Use Disorder; Substance abuse problem; Suicide attempt; Technology; Telephone; Testing; Text; Training; Training Programs; base; burnout; community based treatment; content retention; depression; design; distress tolerance; emotion regulation; follow-up; improved; in vivo; innovation; mindfulness; programs; prototype; psychosocial; public health relevance; satisfaction; skills; social; substance abuser; suicidal; therapy design; tool; treatment as usual; treatment program; usability

DESCRIPTION (provided by applicant): Substance use disorders (SUD) co-occurring with borderline personality disorder (BPD) pose serious and complex public health problems. Dialectical Behavior Therapy for Substance Abusers (DBT) is an efficacious psychosocial treatment for substance dependent individuals with BPD (Linehan, 1993a, b; Lynch et al., 2007). This is a Phase I Small Business Innovation Research (SBIR; R43/44) grant application to NIDA to support the development of an innovative product: the DBT Field Coach, a mobile technology program installed on a smart phone designed to enhance effective generalization of DBT Skills (Linehan, 1993b) in individuals with BPD and SUD. The current application represents a cooperative partnership between the Principal Investigator's small business concern, Behavioral Tech Research, Inc., a company with an impressive history of developing innovative training programs for psychosocial treatments, and the New School for Social Research. The proposed DBT Field Coach will substantially aid in the generalization of DBT skills in the clients' natural environment when they most need assistance. The focus of Phase I will be limited to developing and testing the DBT Field Coach with one DBT skill from the emotion regulation module - Opposite Action (OA). This Phase 1 project is divided into two parts: 1) an initial formative evaluation, characterized by an iterative process of developing the prototype using extensive feedback from target end-users and 2) a summative evaluation involving a randomized controlled feasibility trial (n=30) to evaluate the program's efficacy at increasing frequency and effectiveness of OA skill use, self-efficacy in applying the skill, and retention of content knowledge. Participants will consist of DBT-naove individuals with BPD and SUD recruited from treatment programs in New York City and will be randomized to either the DBT Field Coach condition or to a treatment-as-usual text-based handouts condition. All participants will initially learn OA via an efficacious instructional video designed by treatment developer, Marsha Linehan, for patients with BPD, including those with SUD and will be encouraged to practice the skill. After two weeks, participants will be reassessed in a post-training follow-up. In the event of a successful Phase I test of feasibility, we will substantially expand the DBT Field Coach and its evaluation in Phase II, to include the other DBT skills from all four modules (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness) as well as unique tools designed to promote effective skills use. Furthermore, we will expand the features available in the DBT Field Coach. If effective, mobile technology offering in-vivo skills coaching may be a powerful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior. When used as a treatment adjunct for clients in DBT programs, a DBT Field Coach mobile technology device may also (1) expedite and/or improve clinical outcomes by offering BPD-SUD clients "on-demand" skills coaching and (2) reduce therapist burn-out by reducing after-hours phone coaching calls. PUBLIC HEALTH RELEVANCE: Dialectical Behavior Therapy (DBT) is an efficacious, comprehensive psychosocial treatment for individuals with Borderline Personality Disorder (BPD) and Substance Use Disorder (SUD). The primary goal of this project is to develop and test the feasibility of a DBT Field Coach, a program for a mobile technology device ("smart phone") designed specifically to enhance generalization of DBT skills among clients with BPD and SUD. The DBT Field Coach, by offering in-vivo skills coaching, may be a powerful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior.

描述（由申请人提供）：物质使用障碍（SUD）与边缘型人格障碍（BPD）共同发生，造成严重和复杂的公共卫生问题。物质滥用者的辩证行为疗法（DBT）是对患有BPD的物质依赖个体的有效的社会心理治疗（Linehan，1993 a，B; Lynch等人，2007年）。这是向NIDA提交的第一阶段小企业创新研究（SBIR; R43/44）资助申请，以支持开发一种创新产品：DBT现场教练，这是一种安装在智能手机上的移动的技术程序，旨在提高BPD和SUD患者DBT技能的有效推广（Linehan，1993 b）。目前的应用程序代表了主要研究者的小企业关注，行为技术研究公司，一家在开发心理社会治疗创新培训项目方面有着令人印象深刻的历史的公司，以及社会研究新学院。拟议的DBT现场教练将大大有助于在客户最需要帮助的时候，在客户的自然环境中推广DBT技能。第一阶段的重点将限于开发和测试DBT现场教练与一个DBT技能从情绪调节模块-相反的行动（OA）。第一阶段项目分为两个部分：1）初始形成性评价，其特征在于使用目标最终用户的广泛反馈开发原型的迭代过程，以及2）总结性评价，包括随机对照可行性试验（n=30），以评价该计划在增加OA技能使用频率和有效性方面的有效性，应用技能的自我效能，和内容知识的保留。参与者将包括从纽约市的治疗项目中招募的患有BPD和SUD的DBT-naove个体，并将被随机分配到DBT现场教练条件或常规治疗文本讲义条件。所有参与者最初将通过治疗开发人员Marsha Linehan为BPD患者（包括SUD患者）设计的有效教学视频学习OA，并鼓励他们练习该技能。两周后，将在培训后的后续行动中对参与者进行重新评估。如果第一阶段的可行性测试成功，我们将在第二阶段大幅扩展DBT现场教练及其评估，包括所有四个模块的其他DBT技能（正念，情绪调节，痛苦承受力和人际效能）以及旨在促进有效技能使用的独特工具。此外，我们将扩展DBT Field Coach中可用的功能。如果有效的话，提供体内技能辅导的移动的技术可能是一个强大的工具，可以通过直接教授和辅导替代的适应性应对行为来减少使用物质和从事其他适应不良行为的冲动。当在DBT项目中用作客户的治疗辅助时，DBT现场教练移动的技术设备还可以（1）通过向BPD-SUD客户提供“按需”技能辅导来加快和/或改善临床结果，以及（2）通过减少下班后的电话辅导呼叫来减少治疗师的倦怠。公共卫生相关性：辩证行为疗法（Dialectical Behavior Therapy，DBT）是一种针对边缘型人格障碍（BPD）和物质使用障碍（SUD）患者的有效、全面的心理社会治疗方法。本项目的主要目标是开发和测试DBT现场教练的可行性，这是一种专门设计用于BPD和SUD客户的移动的技术设备（“智能手机”）的程序，旨在提高DBT技能的普及。DBT现场教练，通过提供体内技能辅导，可能是一个强大的工具，减少冲动使用物质和从事其他适应不良的行为，直接教学和辅导替代，适应性应对行为。