Optimizing Fidelity to Family-Based Treatment for Adolescent Anorexia Nervosa

描述(由申请人提供)：本申请响应RFA-MH-12-050“优化经验性行为治疗精神障碍的保真度”。迫切需要传播有效的精神障碍心理社会治疗方法，因为循证方法和一般临床实践之间存在巨大差距。造成这一差距的一个因素是治疗师对临床环境中的手动治疗的忠诚度较低。神经性厌食症(AN)是一种严重的疾病，与严重的精神和医学发病率、死亡率和高昂的治疗费用有关。对青少年AN可用的唯一循证治疗是基于家庭的治疗(FBT)。然而，导致临床成功的FBT的关键组成部分(例如，促进父母联盟、外部化、使用家庭聚餐以及关于AN危及生命的性质的心理教育)的作用尚未根据结果进行评估。此外，重要的是制定更有效的培训战略，以促进采用循证治疗。尽管治疗师可能会接受使用FBT的培训，但所需的关键干预措施、评估这些干预措施的最可靠方法、确定保真度的有效战略、保真度与结果的关系以及如何最好地在FBT中有效地培训治疗师，都是尚未回答的问题。为了解决这些知识差距，我们在两阶段设计中提出了以下目标。在第一阶段(R21)：1)完善现有的FBT保真度评估工具并检查其心理测量学特性；2)检查FBT保真度及其组成部分与患者结局的关系；3)探索FBT保真度的预测因素；4)为FBT制定有针对性的培训(FT)和监督计划。在第二阶段(R33)，我们计划1)通过进行FT与标准培训(ST)的小型试点RCT，评估在FBT中进行两种类型培训的比较研究的可行性；并探索每组治疗师治疗的患者的比较结果。为了实现阶段1(R21)的目标，我们将使用FBT对从先前研究中选择的磁带中的归档数据进行编码和分析。在第二阶段(R33)，我们计划通过随机选择30名治疗师(15名治疗师，每个治疗师嵌套3名受试者)来比较FT和ST，让他们接受两种培训计划中的任何一种。主要成果将是进行有足够动力的比较研究的可行性(例如，征聘、自然减员、评估小组、资源成本)。 公共卫生相关性：这项研究将使用青少年神经性厌食症家庭治疗的存档治疗过程的数据库来确定忠诚度对治疗和结果的作用。此外，它还将开发一种新的更有效的方法来培训青少年神经性厌食症的家庭治疗师，并研究是否可以进行一项试验，将这种新的培训与标准的、更密集的培训进行比较。

DESCRIPTION (provided by applicant): This application responds to RFA-MH-12-050 "Optimizing Fidelity of Empirically-Supported Behavioral Treatments for Mental Disorders." There is a critical need to disseminate effective psychosocial treatments for mental disorders as there is a significant gap between evidenced-based approaches and common clinical practice. One factor that contributes to this gap is low therapist fidelity to manualized treatments in clinial settings. Anorexia Nervosa (AN) is a serious disorder associated with significant psychiatric and medical morbidity, mortality, and high treatment costs. The only evidence based treatment available for adolescent AN is Family-Based Treatment (FBT). However, the role of key components of FBT that lead to clinical success (e.g., promoting parental alliance, externalization, use of a family meal, and psycho-education about the life-threatening nature of AN), have not been evaluated in relation to outcome. Moreover, it is important that more efficient training strategies be developed to promote adoption of evidence based treatments. Although therapists can likely be trained to use FBT, the key interventions needed, the most reliable methods for assessing these interventions, efficient strategies for identifying fidelity, he relationship of fidelity to outcome, and how best to train therapists efficiently in FBT are all unanswered questions. To address these gaps in knowledge, we propose the following aims in a 2-Phase design. In Phase 1 (R21): 1) To refine an existing fidelity assessment instrument for FBT and examine its psychometric properties; 2) To examine the relationship of FBT fidelity and its components to patient outcome; 3) To explore predictors of fidelity in FBT; 4) To develop a Focused Training (FT) and supervision program for FBT. During Phase 2 (R33) we plan to 1) To assess the feasibility of conducting a comparison study of two types of training in FBT by conducting a small pilot RCT of FT versus Standard Training (ST); and, explore the comparative outcomes of the patients treated by therapists in each group. To accomplish the aims of Phase 1 (R21) we will code and analyze archival data from tapes selected from previous studies using FBT. During Phase 2 (R33) we plan to compare FT to ST by randomizing 30 therapists (15 therapists with 3 subjects nested in each therapist) to receive either one of the two training programs. The primary outcome will be feasibility (e.g., recruitment, attrition, assessment battery, resource costs) to conduct a sufficiently powered comparative study. PUBLIC HEALTH RELEVANCE: This study will use a data base of archived therapy sessions of family therapy for adolescent anorexia nervosa to determine the role of fidelity to treatment and outcome. In addition, it will develop a novel more efficient way to train therapists in family therapy for adolescent anorexia nervosa and examine if it is feasible to conduct a trial comparing this novel training to standard, more intensive training.