Computer-Based Training in DBT Validation Strategies

描述（由申请人提供）：循证疗法的传播仍然是NIDA的高度优先事项。一些障碍限制了循证疗法在常规临床环境中的可及性。物质使用障碍（SUD）与边缘型人格障碍（BPD）并存，构成了严重而复杂的公共卫生问题。物质滥用者的辩证行为疗法（DBT-SUD）是一种综合性的心理社会治疗，对BPD物质依赖者有效。 在第一阶段，我们开发和评估了一个创新的基于计算机的培训（CBT）原型，突出了DBT-SUD验证策略的药物治疗提供者使用原型开发的迭代过程。验证策略是DBT-SUD中使用的核心治疗策略之一。我们在一项随机对照试验（RCT）中测试了原型的有效性，该试验将DBT-SUD CBT（n = 12）与来自常规药物治疗环境的治疗提供者样本中的对照CBT（n = 12）进行了比较。结果表明，DBT-SUD CBT是有效的知识增益，回忆过程中的策略，提高自我效能感治疗药物成瘾的BPD患者，并在随后的几周内使用的技能在治疗环境中。我们建议在第二阶段大幅度扩大这一课程的内容及其评价。我们将再次使用迭代开发过程，依赖于广泛的最终用户测试以及科学顾问和DBT-SUD专家小组的反馈。完成后，我们将开始一项随机对照试验（n = 120），将CBT（n = 40）与其他“标准”培训方法进行比较，特别是教师主导的培训（n = 40）和文本（n = 40）。除了第一阶段评估的结果变量外，我们还将包括一项基于绩效的测试，评估第二阶段技能的临床应用。在临床应用测试中，受试者将参与角色扮演，他们将扮演DBT-SUD治疗师，研究助理将扮演虚构的“客户”。这些角色扮演将被录像和编码，以便遵守。

DESCRIPTION (provided by applicant): Dissemination of evidence-based therapies remains a high priority at NIDA. A number of barriers limit accessibility to evidence-based therapies in routine clinical settings. Substance use disorders (SUDs) co-occurring with borderline personality disorder (BPD) pose serious and complex public health problems. Dialectical Behavior Therapy for Substance Abusers (DBT-SUD) is a comprehensive psychosocial treatment, efficacious for substance-dependent individuals with BPD. In Phase I, we developed and evaluated an innovative computer-based training (CBT) prototype highlighting DBT-SUD Validation strategies for drug treatment providers using an iterative process of prototype development. Validation strategies are among the core treatment strategies used in DBT-SUD. We tested the prototype's efficacy in a randomized controlled trial (RCT) comparing the DBT-SUD CBT (n = 12) to a control CBT (n = 12) in a sample of treatment providers from routine drug treatment settings. Results demonstrated that the DBT-SUD CBT was efficacious at producing knowledge gains, recall of course strategies, increased self-efficacy in treating drug-addicted BPD patients, and use of skills in therapeutic settings in subsequent weeks. We propose to significantly expand this course content and its evaluation in Phase II. We will again use an iterative process of development, relying on extensive end-user testing and feedback from a panel of scientific advisors and DBT-SUD experts. Upon completion, we will begin a RCT (n = 120) to compare the CBT (n = 40) to other 'standard' training methods, specifically instructor-led training (n = 40) and text (n = 40). In addition to the outcome variables assessed in Phase I, we will include a performance-based test assessing clinical application of skills for Phase II. In the clinical application test, subjects will take part in a role-play scenario where they will act as DBT-SUD therapist, and a research assistant will act as a fictional 'client'. These role-plays will be video-taped and coded for adherence.