Utilizing Mobile Technology for DBT Skills Generalization with BPD-SUD Clients

描述（由申请人提供）：物质使用障碍（SUD）与边缘性人格障碍（BPD）共存，构成严重而复杂的公共卫生问题。物质滥用者辩证行为疗法（DBT）是一种有效的心理治疗方法，适用于物质依赖的BPD患者（Linehan, 1993a, b; Lynch et al., 2007）。这是NIDA的第一阶段小企业创新研究（SBIR; R43/44）拨款申请，用于支持创新产品的开发：DBT现场教练，这是一个安装在智能手机上的移动技术程序，旨在提高BPD和SUD患者DBT技能的有效推广（Linehan, 1993b）。目前的申请代表了首席研究员的小型企业，行为技术研究公司和社会研究新学院之间的合作伙伴关系。行为技术研究公司在开发创新的社会心理治疗培训项目方面有着令人印象深刻的历史。当客户最需要帮助时，建议的DBT现场教练将在客户的自然环境中实质性地帮助他们推广DBT技能。第一阶段的重点将限于开发和测试DBT现场教练的一项DBT技能，该技能来自情绪调节模块——相反行为（OA）。该第一阶段项目分为两个部分：1)初始形成性评估，其特点是利用目标最终用户的广泛反馈开发原型的迭代过程；2)总结性评估，包括随机对照可行性试验（n=30），以评估项目在提高OA技能使用频率和有效性、应用技能的自我效能和内容知识保留方面的有效性。参与者将包括从纽约市的治疗项目中招募的未接受DBT治疗的BPD和SUD患者，他们将被随机分配到DBT现场教练组或常规治疗的基于文本的讲义组。所有参与者首先将通过一段由治疗开发者Marsha Linehan为BPD患者（包括SUD患者）设计的有效教学视频学习OA，并鼓励他们练习这项技能。两周后，参与者将在训练后随访中重新评估。如果第一阶段的可行性测试成功，我们将在第二阶段大幅扩展DBT现场教练及其评估，包括所有四个模块中的其他DBT技能（正念、情绪调节、痛苦容忍和人际关系有效性）以及旨在促进有效技能使用的独特工具。此外，我们将扩展DBT现场教练的功能。如果有效的话，提供活体技能指导的移动技术可能是一种强有力的工具，可以通过直接教授和指导替代的适应性应对行为来减少使用物质的冲动和参与其他适应不良行为。当DBT Field Coach移动技术设备被用作DBT项目中客户的治疗辅助设备时，它还可以(1)通过向BPD-SUD客户提供“按需”技能指导来加快和/或改善临床结果；(2)通过减少下班后的电话指导电话来减少治疗师的倦怠。与公共卫生相关：辩证行为疗法（DBT）是一种针对边缘型人格障碍（BPD）和物质使用障碍（SUD）患者的有效、全面的心理社会治疗方法。该项目的主要目标是开发和测试DBT现场教练的可行性，这是一个专门为BPD和SUD客户设计的移动技术设备（“智能手机”）项目，旨在提高DBT技能的推广。DBT现场教练，通过提供体内技能指导，可能是一个强有力的工具，通过直接教授和指导替代的适应性应对行为，来减少使用物质的冲动和参与其他适应不良行为。

DESCRIPTION (provided by applicant): Substance use disorders (SUD) co-occurring with borderline personality disorder (BPD) pose serious and complex public health problems. Dialectical Behavior Therapy for Substance Abusers (DBT) is an efficacious psychosocial treatment for substance dependent individuals with BPD (Linehan, 1993a, b; Lynch et al., 2007). This is a Phase I Small Business Innovation Research (SBIR; R43/44) grant application to NIDA to support the development of an innovative product: the DBT Field Coach, a mobile technology program installed on a smart phone designed to enhance effective generalization of DBT Skills (Linehan, 1993b) in individuals with BPD and SUD. The current application represents a cooperative partnership between the Principal Investigator's small business concern, Behavioral Tech Research, Inc., a company with an impressive history of developing innovative training programs for psychosocial treatments, and the New School for Social Research. The proposed DBT Field Coach will substantially aid in the generalization of DBT skills in the clients' natural environment when they most need assistance. The focus of Phase I will be limited to developing and testing the DBT Field Coach with one DBT skill from the emotion regulation module - Opposite Action (OA). This Phase 1 project is divided into two parts: 1) an initial formative evaluation, characterized by an iterative process of developing the prototype using extensive feedback from target end-users and 2) a summative evaluation involving a randomized controlled feasibility trial (n=30) to evaluate the program's efficacy at increasing frequency and effectiveness of OA skill use, self-efficacy in applying the skill, and retention of content knowledge. Participants will consist of DBT-naove individuals with BPD and SUD recruited from treatment programs in New York City and will be randomized to either the DBT Field Coach condition or to a treatment-as-usual text-based handouts condition. All participants will initially learn OA via an efficacious instructional video designed by treatment developer, Marsha Linehan, for patients with BPD, including those with SUD and will be encouraged to practice the skill. After two weeks, participants will be reassessed in a post-training follow-up. In the event of a successful Phase I test of feasibility, we will substantially expand the DBT Field Coach and its evaluation in Phase II, to include the other DBT skills from all four modules (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness) as well as unique tools designed to promote effective skills use. Furthermore, we will expand the features available in the DBT Field Coach. If effective, mobile technology offering in-vivo skills coaching may be a powerful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior. When used as a treatment adjunct for clients in DBT programs, a DBT Field Coach mobile technology device may also (1) expedite and/or improve clinical outcomes by offering BPD-SUD clients "on-demand" skills coaching and (2) reduce therapist burn-out by reducing after-hours phone coaching calls. PUBLIC HEALTH RELEVANCE: Dialectical Behavior Therapy (DBT) is an efficacious, comprehensive psychosocial treatment for individuals with Borderline Personality Disorder (BPD) and Substance Use Disorder (SUD). The primary goal of this project is to develop and test the feasibility of a DBT Field Coach, a program for a mobile technology device ("smart phone") designed specifically to enhance generalization of DBT skills among clients with BPD and SUD. The DBT Field Coach, by offering in-vivo skills coaching, may be a powerful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior.