针对谈话治疗服务中的高强度治疗师开展培训工作坊以优化共病性人格障碍个体的抑郁和焦虑结局的非随机可行性研究：研究方案

Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol.

作者信息

Warbrick Laura A, Dunn Barnaby D, Moran Paul A, Campbell John, Kessler David, Marchant Katie, Farr Michelle, Ryan Mary, Parkin Megan, Sharpe Richard, Turner Katrina, Sylianou Mona, Sumner Gemma, Wood Emma

机构信息

Mood Disorders Centre, University of Exeter, Exeter, EX4 4QQ, UK.

College of Medicine and Health, University of Exeter, Exeter, UK.

出版信息

Pilot Feasibility Stud. 2023 Oct 5;9(1):170. doi: 10.1186/s40814-023-01394-z.

DOI:10.1186/s40814-023-01394-z

PMID:37798752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10552316/

Abstract

BACKGROUND

The NHS Talking Therapies for Anxiety and Depression programme ('TTad'; formerly Improving Access to Psychological Therapies 'IAPT') delivers high-intensity cognitive behavioural therapy (CBT) to over 200,000 individuals each year for common mental health problems like depression and anxiety. More than half of these individuals experience comorbid personality difficulties, who show poorer treatment outcomes. TTad therapists report feeling unskilled to work with clients with personality difficulties, and enhancing the training of TTad therapists may lead to improved treatment outcomes for individuals presenting with secondary personality difficulties alongside depression and anxiety.

METHODS

This is a pre-post non-randomised mixed-method feasibility study, exploring the feasibility and acceptability of a 1-day training workshop for high-intensity (HI) CBT therapists. The workshop is focused on understanding and assessing personality difficulties and adapting HICBT treatments for anxiety and depression to accommodate client needs. The feasibility and acceptability of the workshop and the evaluation procedures will be investigated. It will be examined to what extent the workshop provision leads to improvements in therapist skills and confidence and explored to what extent the training has the potential to enhance clinical outcomes for this client group.

DISCUSSION

This feasibility study will provide data on the acceptability and feasibility of delivering brief therapist training to adapt usual HICBT to optimise care for individuals with secondary personality difficulties seeking treatment in TTad services for a primary problem of depression and/or anxiety. The study will also evaluate proof of concept that such an approach has the potential to improve clinical outcomes for those with secondary personality difficulties and report any possible harms identified. The study will inform the design of a future randomised controlled trial designed to test the effectiveness and cost-effectiveness of the training.

TRIAL REGISTRATION

ISRCTN81104604 . Submitted on 6th June 2022. Registration date: 3rd January 2023.

摘要

背景

英国国家医疗服务体系（NHS）的焦虑与抑郁谈话治疗项目（“TTad”；前身为改善心理治疗可及性项目“IAPT”）每年为超过20万人提供高强度认知行为疗法（CBT），治疗抑郁症和焦虑症等常见心理健康问题。这些人中超过一半同时存在人格障碍，其治疗效果较差。TTad治疗师表示，他们觉得自己没有足够的技能来治疗存在人格障碍的患者，加强对TTad治疗师的培训可能会改善那些除了患有抑郁症和焦虑症还存在继发性人格障碍的患者的治疗效果。

方法

这是一项前后对照的非随机混合方法可行性研究，旨在探索为高强度（HI）CBT治疗师举办为期1天的培训工作坊的可行性和可接受性。该工作坊聚焦于理解和评估人格障碍，并调整针对焦虑症和抑郁症的HI CBT治疗方法以满足患者需求。将调查该工作坊及其评估程序的可行性和可接受性。将考察工作坊的举办在多大程度上能提高治疗师的技能和信心，并探究培训在多大程度上有潜力改善该患者群体的临床治疗效果。

讨论

这项可行性研究将提供数据，说明为使常规HI CBT适应于优化对在TTad服务机构中因原发性抑郁症和/或焦虑症问题而寻求治疗的继发性人格障碍患者的护理而开展简短治疗师培训的可接受性和可行性。该研究还将评估这样一种方法是否有可能改善继发性人格障碍患者的临床治疗效果的概念验证，并报告发现的任何可能危害。该研究将为未来一项旨在测试该培训的有效性和成本效益的随机对照试验的设计提供信息。