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Web-Based Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders, 1 R43 MH086951-01
Anxiety disorders are a major public health concern, having a profound impact on functioning, causing significant disability, loss of productivity and suffering. The need for evidence-based mental health treatments for these disorders, i.e., 'treatment based on the best available science or research evidence’, has been stressed from scientific, ethical, and marketing perspectives. Effective treatments such as cognitive behavior therapy (CBT) exist for anxiety disorders, but few clinicians are trained in these methods. New technologies provide the opportunity to both facilitate accessibility to this specialized training and to improve the quality of this training. The goals of this project is to develop an on- line therapist training tutorial covering the core principles and techniques for CBT treatment of anxiety disorders. Live remote training on applied skills through videoconferencing will be included. Improvement in trainees’ conceptual knowledge will be evaluated pre and post tutorial, and improvement in trainees’ clinical skills in applying the CBT concepts will be evaluated by blind ratings of clinical adherence and competence before and after videoconference training.
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Computer Assisted CBT for OCD: A Comprehensive Stepped-Care Approach, R43 MH090612
The goal of this project is to develop and evaluate the efficacy and feasibility of a web-based CBT intervention for OCD that combines computerized self-help with therapist and non-therapist coaching. This hybrid model of computerized self-help with coaching for encouragement and motivation is a unique addition to standard web-based self-help therapy alone. Using a 3-arm study design, we will test web treatment alone (n=35) vs. web treatment with non-therapist coach (n=35) and web treatment with coaching done by a CBT therapist (n=35). This will provide data on the relative efficacy of each component and inform on how well lay coaching does vs. coaching by a CBT therapist. The long term goal is to provide a cost-effective and empirically validated intervention that is widely accessible and results in reductions in clinical symptomatology, dysfunction and disability.
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Computerized Screening in Adolescents with Substance or Psychiatric Disorders, 5R43MH094092
Comorbid substance abuse and psychiatric disorders in adolescents is a major public health issue. Failure to identify the comorbidity is common, and results in significantly worse treatment outcomes for both disorders, and increased patient suffering and societal burden. A web-based screening tool will help facilitate detection and treatment of comorbidity, resulting in more effective treatment outcomes for patients. The current study will develop an on-line, computerized screening tool to identify comorbid psychiatric disorders in adolescents with substance use or psychiatric disorders. The tool, based on the KSADS, will also contain embedded severity scales to monitor change over time. Fifty adolescents and their parents will take computer and clinician versions of the interview in counterbalanced order; ancillary scales will evaluate construct validity. The study will generate data on reliability, validity, feasibility, clinical utility, user satisfaction, and equivalence to clinician administered diagnosis.
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Automated Interactive Text Messaging to Assess Adolescent Depression, 2R44MH086152
Major depression is a disabling condition that often begins in adolescence. New technologies, such as text-messaging and e-learning, are often adopted earliest by younger members of our society. Innovative methods are needed to take advantage of on-line, multi-media training opportunities and to assist clinicians in incorporating automated interactive text-messaging assessments into therapeutic interventions. The goal in the current project is to develop a computer automated system utilizing both text messaging and on-line training to a) provide an accessible and affordable platform to teach clinicians wishing to learn CBT for use with depressed adolescents, b) an on-line, tablet-based CBT template to structure treatment for use during sessions to teach patients CBT principles to patients and develop individualized homework assignments and c) an interactive automated text messaging system to both enhance treatment compliance between sessions through automated reminders and to monitor treatment progress through the use of text messages to record results of patient’s practice.
Development and Validation of an Autism Case Confirmation Approach, National Children’s Study (formative research project #8) NICHD/NIH/HHS, NIEHS/NIH/HHS, CDC/HHS
Most Autism Spectrum Disorders can be reliably identified by age three, but the average age of diagnosis is considerably later. Recent CDC data indicate that community diagnoses still under-estimate ASD prevalence by >20%. Passive surveillance of community diagnosis is therefore problematic as an case identification strategy. The goal of this project is to assess the criterion validity of three new autism spectrum disorder (ASD) case confirmation instruments. The three instruments (the Screening Tool for Autism in Toddlers and Young Children (STAT), Autism Screening Interview (ASI), and the Video Guided Parent Report (VGPR)) are designed to be administered by staff without special training and experience related to neuorodevelopmental disabilities and are less time-consuming to administer than current gold-standard tools. Criterion validity (sensitivity and specificity) will be evaluated against the Autism Diagnostic Observation Scale (ADOS) and the Autism Diagnostic Interview-Revised. The Center for Telepsychology will program the training materials for the three instruments, and program the VGPR, an on-line scale that asks parents questions about their children after watching two videos (one of a child with autism spectrum disorder and one of a child without this disorder).
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Parenting Your Young Child with Autism: A Web-Based Tutorial for Improving Everyday Skills and Behavior” R43 MH086936
Autism is a neurodevelopmental disorder characterized by deficits in social reciprocity, verbal and nonverbal communication, and behavior. Early detection and intervention has been shown to improve long-term outcomes, including language functioning, cognitive/developmental skills, and social and adaptive behavior. However few clinicians are trained in these interventions. This study will utilize a web-based tutorial to empower parents to administer these interventions directly to their children during their daily interactions. Web access makes this training more widely accessible. The program has the dual goals of improving interactions and parenting effectiveness while at the same time improving the core deficits and long term outcomes in the child. If effective, it also has the potential to reduce caregiver stress, and from a public health perspective, reduce the considerable lifetime cost and service system demands associated with providing autism care to individuals with autism and their families.
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Multicenter trial to evaluate home-based assessment method for Alzheimer’s Disease prevention in people over 75 years old, U01AG010483-166386
The Alzheimer's Disease Cooperative Study
(ADCS) was formed in 1991 as a cooperative agreement between the National Institute on Aging (NIA) and the University of California San Diego. The ADCS conducts clinical studies and develops new assessment instruments to evaluate treatments for both cognitive and behavioral symptoms. At present, patients in clinical studies must visit a clinic to meet with a health care professional to monitor treatment progress. Such visits are time-consuming for the patients and treatment providers, and may prevent people who are less mobile from participating in clinical studies. Assessing patients at their homes might provide an easier and better way to evaluate and document patient changes over time. The Home Based Assessment (HBA
) study is evaluating three methods for using technology to gather clinical information from patients while at home. These methods include (1) mailing in questionnaires and being interviewed by a person on the telephone, (2) using interactive voice response (IVR) technology to automate a telephone system to ask questions and record responses, and (3) installing internet-based computer kiosks that uses touch screens and automatic speech recognition to record answers. 600 participants have been recruited into this 4-year longitudinal study (200 to use each method). This study will determine how practical each method is to use and whether these methods can detect a change in cognitive and functional capabilities over time. The Center for Telepsychology (formerly Center for Psychological Consultation) has developed and is delivering the automated IVR instrument, utilizing both voice recognition and key-pad response.
Speech-Based Biomarkers of CNS Dysfunction Associated with Early Alzheimer’s, 1R441AG044218-01
More efficient methods to screen and monitor elderly patients in clinical practice and research are needed, but visits to clinical offices are expensive and many older patient are restricted by mobility or transportation access. The Alzheimer’s Disease Cooperative Study (ADCS) is evaluating several technology platforms for remotely monitoring patient status at home. A speech-enabled, computer-automated telephone system using interactive voice response (IVR) technology, developed by Dr. Mundt’s research team, is one component. The IVR assessments record speech samples that allow for analysis of the acoustic characteristics of the speech patterns. Recent studies have demonstrated that analysis of vocal acoustic characteristics in speech can provide reliable, physiologically-based biomarkers of CNS functioning associated with major depression. Symptomatic similarities between clinical depression and early Alzheimer’s disease have been noted for many years, but the extent of overlap and temporal sequencing of emergent symptoms remains unresolved. Objective, physiologically-based biomarkers of CNS dysfunction may provide new insights for diagnosing and managing Alzheimer’s patients. The current study will support the development and validation of potential screening measures that could be used for differential diagnosis in clinical practice, as well as provide a foundation for innovative assessment and management approaches for older persons with multiple chronic conditions. Non-identifiable clinical outcomes measures and medical diagnoses obtained from HBA investigative sites across the nation will be compared with audio files of speech samples recorded by the IVR system developed by Dr. Mundt. The clinical and diagnostic information available through the ADCS database will be used to develop and validate multivariate statistical models to improve diagnostic screening, noninvasive monitoring of disease progression, and/or differential diagnoses between conditions.
Partnership for Implementation of Evidence-Based Practices in Rural Primary Care, R24 MH085104-01
Evidence-Based Quality Improvement methods foster participatory research partnerships with rural Community Health Center (CHC) patients and providers to use evidence-based treatment practices. The goals of this partnership are to implement evidence-based practices for bipolar disorder and alcohol use disorders in rural primary care clinics. Scientifically, our aim is to identify and address barriers to implementing evidence-based practices in rural CHCs. This study is exploring the use of Interactive Voice Response (IVR) technology to collect and manage patient outcomes in two demonstration projects. Dr. James Mundt, PhD (Center for Telepsychology) is developing the IVR system to support sustainable evidence-based quality improvement in the CHCs. A feasibility study has evaluated IVR technology regarding response rates and patient acceptance. Patients treated at rural CHCs have near universal access to cell phones, but not to the internet. IVR technology may be the most sustainable approach to automated data collection, and has the potential to substantially increase the capacity for monitoring clinical outcomes associated with new Quality Improvement initiatives.
COMPLETED NIMH Funded Research Studies by Drs. Kobak and Mundt
Computerized Screening of Dual Diagnosed Adolescents. NIDA. N43DA-9-5541
- Positive and Negative Syndrome Scale (PANSS) Rater Training Using Internet and Videoconference. 1R43MH074173
- Reliability Training in Autism Assessment Using New Technologies, Phase I & II, NIMH Contract No. N43MH32080
- Development of a Standardized Hamilton Depression Rating Scale (HAMD) Inter-Rater Reliability Training Program Using Internet-Based Technologies. Phase I & II. NIMH Contract N43MH12049
- Personalizing Automated Interactivity between Treatment Providers and Clients, R43 MH 091995-01
- Facilitation of patient education, treatment and referral via IVR and longitudinal monitoring of cognitive functioning. 2 R44 AG16538-02
- Prediction of Alcohol Treatment Drop-out via IVR, 1 R43 AA012878-01 NIAAA.
- Alcohol Relapse Prevention via Prospective IVR Follow-up, 1 R43 AA012366-1NIAAA.
- Development of a Convenient, Automated Objective Measure of Depression Using Vocal Acoustics Analysis, R44MH068950-04