Engagement and Alliance in CBT for Depressed Adolescents

描述(由申请人提供)：治疗效果的一个主要威胁是由于过早退出、零星参加和边缘参与而稀释了治疗强度。鉴于儿童诊所的高自然减员率和零星就诊情况，这一问题是一个重大的公共卫生问题。因此，没有充分接触积极治疗成分的儿童和青少年不太可能从经验支持的治疗中受益。我们认为，治疗联盟和促进联盟形成的治疗师行为对于减少辍学、促进定期出席和最大限度地积极参与会议至关重要。因此，经验支持的治疗应该与有助于联盟形成的基于经验的介入干预相补充，并在CBT治疗青少年抑郁症的公开试验中评估参与干预和联盟对治疗完成、定期参加、积极参与和治疗结果的贡献。该提案涉及两项研究。第一项涉及制定和评估治疗师介入干预、治疗联盟和从CBT针对抑郁和自杀青少年的已完成对照试验的录音中参与治疗的观察措施。第二项研究涉及在一项经验性支持的青少年抑郁症治疗认知行为疗法的公开试验中，评估参与干预、联盟、参与、治疗继续/参加以及结果之间的关联。将评估治疗过程的显式中介模型。确定有效参与干预措施，将其纳入青春期抑郁症的机械化治疗，特别是可能纳入一系列青春期障碍的手册。预计以经验为基础的治疗参与指南对于将经验性支持的治疗从研究转移到临床环境是必不可少的。

DESCRIPTION (provided by applicant): A major threat to treatment efficacy is the dilution of treatment strength through early drop out, sporadic attendance, and marginal participation. This problem represents a significant public health concern given the high rates of attrition and sporadic attendance in child clinic settings. As a result, children and adolescents who do not receive adequate exposure to active treatment components are unlikely to benefit from empirically supported treatments. We propose that the therapeutic alliance and therapist behaviors that facilitate alliance formation are critical for reducing drop out, promoting regular attendance, and maximizing active participation in sessions. Thus, empirically supported treatments should be complemented with empirically based engagement interventions that contribute to alliance formation, and to evaluate the contribution of engagement interventions and alliance to treatment completion, regular attendance, active participation, and treatment outcome in an open trial of CBT for adolescent depression. The proposal involves two studies. The first involves the development and evaluation of observational measures of therapist engagement interventions, therapy alliance, and treatment participation from audio recordings of completed, controlled trial of CBT for depressed and suicidal adolescents. The second study involves the evaluation of associations among engagement interventions, alliance, participation, treatment continuation/attendance, and outcome in an open trial of an empirically supported treatment, cognitive-behavioral therapy, for adolescent depression. An explicit mediational model of therapy process will be evaluated. The identification of effective engagement interventions into manualized treatments for adolescent depression, specifically, and potentially into manuals for a range of adolescent disorders. It is expected that empirically based guidelines for treatment engagement will be essential for the transportation of empirically supported treatments from research to clinical settings.