Category: Dissemination / Implementation

Symposium

Symposium 65 - Mechanism-Based Approach to Provider Training for Improving Quality and Outcomes of Exposure Therapy

Saturday, November 18
8:30 AM - 10:00 AM
Location: Aqua Salon C & D, Level 3, Aqua Level

Keywords: Change Process / Mechanisms | Community-Based Assessment / Intervention | Psychotherapy Outcome
Presentation Type: Symposium

Understanding treatment mechanism can facilitate effective translation from clinical trial to practice settings in multiple ways, such as through increasing treatment potency and discarding unnecessary treatment elements. Understanding mechanism can also facilitate identification of new targets for provider-level interventions to optimize psychotherapy quality and outcomes.  This symposium will illustrate the process of using a mechanism-based approach to develop a provider training intervention targeting specific provider behaviors in pediatric exposure therapy.  We will briefly introduce the experimental therapeutics model as a conceptual framework for a mechanism-based approach to intervention development and consider its application for patient- and provider-level interventions. Presentations will describe a series of studies as an example of “beginning to end” application of this framework for targeting specific provider behaviors using a treatment mechanism-informed provider intervention.  The first of these presentations describes provider behavior target identification using a behavioral coding system in three large RCTs for pediatric OCD (POTS trials). Results of this study demonstrate that provider behavior functioning to increase or maintain anxiety predicts improved outcome and that anxiety decreasing provider behavior predicts attenuated outcome.  These provider behaviors also facilitate habituation through tolerating fear, a candidate treatment mechanism. These results support provider behavior as a promising mechanism-informed target through which quality and patient outcomes could be improved. The second of these presentations describes intervention development and a test of initial target engagement. Using behavioral coding results from the previous study and an iterative process with community partners, a principle-based and user-friendly training tool (the Exposure Guide) was developed to aid providers in understanding the function of their own behavior during exposures. In a multiple baseline trial, community providers showed improvements in knowledge and exposure beliefs following standard training, but most met benchmarks for observed anxiety increasing and decreasing behaviors only after training with the Exposure Guide. These results provide initial support for principle-based training to impact provider behaviors and for specificity of effects on this provider-level target. The final presentation describes the process of confirming target engagement, using a randomized pilot trial comparing principle-based vs. standard training methods for impacting provider behavior during exposure. Results are expected to confirm that principle-based training results in higher levels of provider anxiety increasing behavior and lower levels of provider anxiety decreasing behavior vs. standard training, and will explore patient-level treatment outcome for each group. Together, these studies illustrate the process of using a mechanism-informed process for identifying and intervening on targeted provider behaviors in order to optimize treatment outcome. 

Learning Objectives:

Joel Sherrill

Deputy Director, Division of Services & Intervention Research
National Institute of Mental Health

Presentation(s):

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Kristen Benito

Warren Alpert Medical School of Brown University

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Bruce F. Chorpita

Professor
UCLA

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Kristen Benito

Warren Alpert Medical School of Brown University

Presentation(s):

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Jennifer Herren

Warren Alpert medical School of Brown University

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Joshua Kemp

Warren Alpert medical School of Brown University

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