Category: Dissemination / Implementation

Symposium

Target Identification: Video Coding of Provider Behavior in Clinical Trials of Exposure for youth With OCD

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

Keywords: Change Process / Mechanisms | Exposure | OCD (Obsessive Compulsive Disorder)
Presentation Type: Symposium

We will describe the conceptual model for intervening on specific provider behaviors to improve patient outcomes in exposure therapy. This talk will focus on the process of target identification by studying the behaviors of clinical trial providers. We examined video data from N = 459 videotaped exposures across N = 113 participants with pediatric OCD receiving exposure therapy in one of the POTS Trials. We used the Exposure Process Coding System (EPCS), a microanalytic, time-stamped coding system designed to code provider behaviors for their function on anxiety level during exposures (increases, decreases, or maintains). The EPCS also measures the occurrence of habituation through tolerating fear, a supported mechanism of change in exposure therapy. Results show that EPCS-measured habituation predicts treatment outcome: Higher estimated count of habituations across treatment significantly predicts improved outcome on all measures, including symptom severity change, CGI, and responder status. EPCS-measured provider behavior predicts EPCS-measured habituation: Together, provider behaviors predict 39% of the variance in habituation; addition of anxiety increasing, anxiety decreasing, and neutral items to the model each resulted in significant R-squared change. EPCS-measured provider behavior predicts treatment outcome: Together, provider behaviors predict 19% of the variance in treatment response. Addition of anxiety decreasing and neutral items to the model each resulted in significant R-squared change. Importantly, results show that there is considerable variation in habituation and in provider behavior, even among highly adherent clinical trial providers within a highly efficacious treatment arm. Moreover, provider behaviors predict both habituation and outcome within this treatment arm. These results underscore the potential for targeting provider behavior to improve quality in exposure-based treatments, particularly for community settings where provider behaviors are almost certainly more variable than among trial providers.

Kristen Benito

Warren Alpert Medical School of Brown University

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