Engagement and Alliance in CBT for Depressed Adolescents

描述（由申请人提供）：治疗效果的主要威胁是由于早期退出，零星参加和边缘参与而稀释了治疗强度。鉴于儿童诊所的高流失率和零星就诊情况，这一问题引起了重大的公共卫生关切。因此，没有充分接触到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。我们建议，治疗联盟和治疗师的行为，促进联盟的形成是减少退出，促进定期出席，并最大限度地积极参与会议的关键。因此，在一项针对青少年抑郁症的CBT公开试验中，经验支持的治疗应辅以有助于联盟形成的基于经验的参与干预，并评估参与干预和联盟对治疗完成、定期出勤、积极参与和治疗结果的贡献。该提案涉及两项研究。第一个涉及到治疗师参与干预、治疗联盟和治疗参与的观察性措施的发展和评估，这些观察性措施来自于完成的、针对抑郁和自杀青少年的CBT对照试验的录音。第二项研究涉及评估参与干预、联盟、参与、治疗持续/出席和结果之间的关联，这是一项公开试验的经验支持的治疗方法，认知行为疗法，用于青少年抑郁症。治疗过程的显式中介模型将被评估。确定有效的参与干预青少年抑郁症的手动治疗，特别是，潜在地进入一系列青少年障碍的手册。预计以经验为基础的治疗参与指南对于将经验支持的治疗从研究转移到临床环境至关重要。

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.