Web Based Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders

说明(由申请人提供)：从科学、伦理和营销角度强调了以证据为基础的心理健康治疗的必要性，即“基于现有最佳科学或研究证据的治疗”1。虽然经验证据支持认知行为疗法(CBT)对焦虑症4-8的疗效和有效性，但对接受过这些方法培训的临床医生的需求远远超过供应。例如，尽管有经验数据支持这些方法对焦虑症的疗效，但只有11%的焦虑症患者接受了行为疗法作为治疗，只有16%的患者接受了认知疗法9。相比之下，接受动态疗法的患者中有40%接受了动态疗法，后者对焦虑症的疗效缺乏经验支持。造成这种情况的一个主要原因是缺乏训练有素的认知行为治疗师10.新技术提供了机会，既便于心理健康专业人员获得这一专门培训，又提高了这一培训的质量。最近的研究发现，使用这些新的基于网络的技术来培训临床医生是非常有效的，可以显著提高技能，并且比传统的培训计划具有显著的优势11，12。这些工具可以整合到应用学术实践中，并通过继续教育被现场的临床医生利用。该项目的长期目标是通过开发一套能够广泛传播这一培训的基于网络的培训工具，增加接受过焦虑症认知行为治疗培训的心理健康专业人员的数量。在第一阶段，我们开发了一个原型在线教程，涵盖了一些核心的CBT原则和社交焦虑障碍模块。我们还测试了通过视频会议进行远程实况培训的可行性。用户对在线教程和视频会议培训的满意度都非常高。学员对CBT概念的认识在辅导前和辅导后均有显著提高。没有关于教程或视频会议培训的技术困难的报告。在第二阶段，我们将扩展教程原型，以包括CBT原理和技术的全面回顾，并将模块扩展到包括焦虑症(即强迫症、恐慌症、广泛性焦虑症、创伤后应激障碍和社交焦虑症)的全部范围。我们还将评估现场远程培训在提高临床技能方面的效果。将招募来自不同教育和专业背景的5名临床医生。学员的概念性知识的改善将在辅导前后进行评估，学员在应用CBT概念方面的临床技能的改善将通过视频会议培训前后的临床依从性和能力的盲目评分来评估。还将评估用户对在线教程和视频会议培训的满意度。 公共卫生相关性：焦虑症是一个重大的公共卫生问题，对功能有深远的影响，导致严重残疾、生产力损失和痛苦。 这些疾病有有效的治疗方法，但很少有临床医生接受过这些方法的培训。该项目试图通过使用基于网络的工具来帮助获得这一培训，从而增加现有治疗师的数量，以帮助满足这一未得到满足的需求，从而弥补这一缺陷。

DESCRIPTION (provided by APPLICANT): The need for evidence-based mental health treatments i.e., 'treatment based on the best available science or research evidence' 1, has been stressed from scientific, ethical, and marketing perspectives3. While empirical evidence supports both the efficacy and effectiveness of cognitive behavior therapy (CBT) for anxiety disorders4-8, the demand for clinicians trained in these approaches far exceeds the supply. For example, in spite of empirical data supporting the efficacy of these approaches for anxiety disorders, only 11 percent of treated anxiety disorder patients received behavior therapy as their treatment, and only 16 percent of treated patients received cognitive therapy 9. This compares with 40 percent of treated patients receiving dynamic therapy, which has less empirical support for its efficacy in anxiety disorders. A major reason for this is the lack of trained cognitive behavior therapists 10. New technologies provide the opportunity to both facilitate accessibility to this specialized training by mental health professionals and to improve the quality of this training. Recent research has found that training clinicians using these new web-based technologies is highly effective, can significantly improve skills, and has significant advantages over traditional training programs11,12. These tools could be integrated into an applied academic practicum, as well as utilized by clinicians in the field through continuing education. The long term goal of this project is to increase the number of available mental health professionals trained in cognitive behavior therapy for anxiety disorders by developing a set of web-based training tools enabling the widespread dissemination of this training. In Phase I we developed a prototype on- line tutorial covering some core CBT principles and a Social Anxiety Disorder module. We also tested the feasibility of live remote training through videoconferencing. User satisfaction with both the on-line tutorial and the videoconference training was extremely high. Trainees' knowledge of CBT concepts improved significantly pre-to-post tutorial. No technical difficulties were reported with either the tutorial or the videoconference training. In Phase II we will expand the tutorial prototype to include a comprehensive review of CBT principles and techniques and expand modules to include the full spectrum of anxiety disorders (i.e., Obsessive Compulsive Disorder, Panic Disorder, Generalized Anxiety Disorder, Posttraumatic Stress Disorder and Social Anxiety Disorder). We will also evaluate the efficacy of live remote training in improving clinical skills. A cohort of 5 clinicians from diverse educational and professional backgrounds will be recruited. Improvement in trainees' conceptual knowledge will be evaluated pre and post tutorial, and improvement in trainees' clinical skills in applying the CBT concepts will be evaluated by blind ratings of clinicl adherence and competence before and after videoconference training. User satisfaction with both the on-line tutorial and the videoconference training will also be evaluated. PUBLIC HEALTH RELEVANCE: Anxiety disorders are a major public health concern, having a profound impact on functioning, causing significant disability, loss of productivity and suffering. Effective treatments exist for these disorders, but few clinicians are trained in these methods. This project attempts to remedy this shortcoming by using web-based tools to facilitate access to this training, thus increasing the number of available therapists in order to help meet this unmet need.