一项针对创伤后应激障碍循证心理治疗实施后研讨会咨询策略的随机对照拆解试验，以提高其效果和忠实度。
A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic Stress Disorder.
机构信息
Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston University, 150 South Huntington Ave (116B3), Boston, MA 02130, USA.
出版信息
Implement Sci. 2013 Aug 1;8:82. doi: 10.1186/1748-5908-8-82.
BACKGROUND
Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies.
METHODS
The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians' adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings.
DISCUSSION
Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT01861769.
背景
创伤后应激障碍（PTSD）是一种严重的心理健康状况，给个人和社会带来了巨大的成本。在退伍军人中，PTSD 的终身患病率估计高达 20%。许多研究表明，短期认知行为心理疗法，如认知加工疗法（CPT），可显著改善 PTSD 症状。尽管有已知的益处，但只有少数临床医生提供这些疗法。将这一研究知识转化为临床环境仍然是改善 PTSD 退伍军人健康的最大障碍之一。仅仅参加一个研讨会不足以促进充分的知识转移和持续的技能提高；然而，相对较少的研究旨在确定有效的培训后支持策略。
方法
本研究调查了接受研讨会后支持（持续六个月）的临床医生是否会比未接受正式研讨会后支持的临床医生更准确地提供 CPT（即心理治疗的依从性和能力），并改善患者的治疗效果。研究条件为：技术增强型小组远程咨询；标准小组远程咨询；以及没有咨询的保真度评估。主要结果是通过音频记录对临床医生提供 CPT 的依从性和能力进行独立评估。次要结果是观察患者在治疗期间和治疗后症状的变化，作为临床医生保真度的函数。对临床医生进行咨询后的访谈将有助于确定获得心理治疗技能的促进因素和障碍。研究结果将为如何最好地将循证心理治疗（如 CPT）实施和转移到临床环境以获得与研究环境中观察到的结果相媲美的结果提供信息。
讨论
研究结果将加深我们对研讨会后需要多少和何种类型的支持以帮助临床医生熟练掌握新方案的理解。将讨论对临床医生学习和患者结果的几个影响因素。将制定基于证据的临床咨询模型，最终目标是为政策提供信息并影响临床咨询的最佳实践。
试验注册
ClinicalTrials.gov：NCT01861769。
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