Building evidence-based treatments from the ground up: treatment development through research-clinician participatory research

It is well established that youth anxiety and depression are highly comorbid, and that co-morbidity is linked to worse outcomes and greater impairment. Though numerous evidence based treatments (EBTs) exist for these disorders, treatment developers have historically neglected to fully consider the realities of community-based practice, thereby hindering widespread implementation of EBTs. This project seeks to bridge the gap between research and practice by incorporating community clinicians early in the development process. Community clinicians were recruited to use a novel, behaviorally-based, transdiagnostic protocol with a youth client. Four participants implemented Individual Behavioral Activation Treatment (IBAT) protocol, which incorporates Behavioral Activation and in vivo exposure to treat anxiety, depression, and anger in youth. Prior to treatment, clinicians completed questionnaires regarding therapist variables, biases in case conceptualization, and attitudes towards different treatment strategies. During treatment, clinicians provided qualitative and quantitative feedback on the acceptability and feasibility of the protocol after every four sessions. Following treatment completion, participants gave input regarding specific treatment strategies, overall attitude towards the protocol, and suggestions for future iterations. Given the low usage rates of exposure exercises in community practice, questionnaires included items specifically designed to assess attitudes towards, barriers to, and facilitators of the use exposure. Results demonstrated that clinicians found the protocol to be acceptable, feasible to implement, and appropriate in addressing clients’ needs. The protocol’s detailed structure, organizational guidelines, and worksheets facilitated treatment. Despite overall acceptance, clinicians indicated that IBAT as a whole would only be appropriate for a portion (58.5%) of the cases they see focusing on anxiety and depression, possibly due to traditional understandings of treatment tools such that exposures are used exclusively for anxiety and that behavioral activation is used exclusively for behavioral activation. Recommendations included spacing activities over more sessions and adding additional tips or modules to address factors related to the treatment of anxiety and depression, such as building motivation or sleep and eating hygiene. Feedback has been used to generate a list of specific recommendations for future iterations of IBAT.Psy.D.Includes bibliographical referencesby Andrea Temki