Engagement and Alliance in CBT for Depressed Adolescents

描述（由申请人提供）：治疗有效性的主要威胁是通过早期脱落、零星就诊和边际参与稀释治疗强度。 鉴于儿童诊所的高自然减员率和零星就诊率，这一问题是一个重大的公共卫生问题。 因此，没有充分接触活性治疗成分的儿童和青少年不太可能从经验支持的治疗中获益。 我们建议，治疗联盟和治疗师的行为，促进联盟的形成是至关重要的减少辍学，促进定期出席，并最大限度地积极参与会议。 因此，经验支持的治疗应该补充以经验为基础的参与干预，有助于联盟的形成，并评估参与干预和联盟的贡献，治疗完成，定期出勤，积极参与，并在一项开放试验中的CBT治疗青少年抑郁症的治疗结果。 这项建议涉及两项研究。 第一个涉及的治疗师参与干预，治疗联盟和治疗参与的音频记录完成，对照试验的CBT抑郁症和自杀青少年的观察措施的发展和评价。 第二项研究涉及参与干预，联盟，参与，治疗继续/出席，并在一个开放的试验结果的经验支持的治疗，认知行为疗法，青少年抑郁症之间的协会的评估。 一个明确的中介模型的治疗过程将进行评估。 确定有效的参与干预措施，用于青少年抑郁症的手动治疗，特别是，并可能用于一系列青少年疾病的手册。 预计基于经验的治疗参与指南将是必不可少的运输经验支持的治疗从研究到临床环境。

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.