Web Based Therapist Training on Complicated Grief Therapy

摘要 目前的估计表明，新冠肺炎的死亡率将继续上升，而且 至少，将导致数万人死亡。可悲的是，这些死亡的情况将 可能会增加长期悲伤障碍(PGD)的比率，远远超过估计的7% 失去亲人的总人数。DSM5现在加入了ICD-11的行列，提出了类似的 诊断标准和使用名称延长的悲伤障碍来指定一个综合征 以持久的、无处不在的和损害的悲伤为特征的。突然的意外死亡，需要 对于物理距离、病毒的高传染性、广泛的失业和 这些死亡发生的持续的高压力环境是 新冠肺炎的死亡增加了患PGD的风险。我们开发了一种短期的， 手工化复杂悲伤治疗(CGT)，发现它是有效的 三项由NIMH赞助的大型随机对照试验。在父母的资助中，我们制定了一个 CGT在线治疗师培训，以帮助传播CGT培训，这是一项现在非常需要的技能 和一个没有被广泛拥有的人。在这份行政副刊中，我们计划增加两个主要的 应对COVID疫情的母公司研究的特点：1)患者的发展- 面对治疗师辅助的基于网络的CGT形式，专门为应对CoVID而开发- 相关悲痛和2)开发三个辅助性治疗师培训单元：a) 在为Covid相关损失提供CGT时的特殊注意事项，b)如何管理CGT 远程通过视频会议和c)如何将面向患者的CGT形式集成到 临床医生指导治疗。一种使用两种自导治疗活动的混合模型 增加了治疗师指南，已在英国成功演示，并已 被采纳为治疗抑郁症的最佳实践。这样的模式将会增强1) 治疗的效果，因为研究表明，患者对 治疗的概念，治疗结果越好，以及2)将能够减少 临床医生会诊次数，既可降低患者成本，又可腾出临床医生时间进行更多治疗 患者为了满足这场危机所带来的压倒性需求。

ABSTRACT Current estimates suggest that death rates from Covid-19 will continue to rise and, at the very least, will lead to tens of thousands of deaths. Sadly, the circumstances of these deaths will likely increase the rates of prolonged grief disorder (PGD) well over the estimated 7% of the overall bereaved population. The DSM5 has now joined the ICD-11 in proposing similar diagnostic criteria and in using the name Prolonged Grief Disorder to designate a syndrome characterized by persistent, pervasive and impairing grief. Sudden unexpected death, the need for physical distancing, the high contagiousness of the virus, the widespread unemployment and the ongoing highly stressful context in which these deaths occur are unique characteristics of covid-19 deaths that increase the risk of developing PGD. We developed a short-term, manualized Complicated Grief Treatment (CGT) for this condition and found it efficacious in three large NIMH sponsored randomized controlled trials. In the parent grant, we develop an on-line therapist training in CGT to help disseminate CGT training, a skill now greatly in demand and one not widely possessed. In this administrative supplement we plan add two major features to our parent study in response to the COVID epidemic: 1) development of a patient- facing therapist-assisted web-based form of CGT developed specifically to deal with COVID- related grieving and 2) development of three supplementary therapist training modules: a) special considerations when delivering CGT for covid-related loss, b) how to administer CGT remotely via videoconference and c) how to integrate the patient-facing form of CGT into clinician-guided treatment. A hybrid model using both self-guided therapeutic activities augmented with a therapist guide has been successfully demonstrated in the UK, and has been adopted as best practice for the treatment of depression. Such a model will both 1) enhance the efficacy of treatment, as studies have shown that the more a patient understands the concepts of treatment, the better the treatment outcomes, and 2) will enable the reduction in the number of clinician sessions, both reducing patient costs and freeing clinician time to treat more patients in order to meet the overwhelming demand due to this crisis.