ABSTRACT

Objective

Mindfulness-Oriented Recovery Enhancement (MORE) is a mind-body therapy that unites complementary aspects of mindfulness training, third-wave cognitive behavioral therapy (CBT), and principles from positive psychology into an integrative treatment for addiction and its comorbidities. As interest in MORE has grown among researchers and clinicians, there is an increasing need to provide quality assurance measures to ensure treatment integrity during implementation of MORE. Here, we describe the development and validation of the Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM).

Method

We developed a 17-item scale assessing therapist competence and adherence to the MORE treatment manual, which was then used for fidelity monitoring of 40 MORE treatment sessions across two Stage 2 and two Stage 1 RCT for addictive behaviors (e.g., opioid misuse, obesity) involving a total N = 295.

Results

Internal consistency for the Adherence (α =.89) and Competence subscales (α =.92) was high, and interrater reliability was adequate (Adherence subscale ICC =.77; Competence subscale ICC =.51), with therapists exhibiting good-to-excellent levels of fidelity across all trials. Importantly, linear mixed modeling indicated that higher levels of overall fidelity were associated with greater reductions in opioid misuse across two Stage 2 RCTs (F_1,48.00 = 7.38, p=.009), indicating that the MORE-FM is a valid measure of treatment fidelity that can predict clinical outcomes.

Conclusions

Findings from this study yielded insights for future iterations of the MORE-FM. In sum, the MORE-FM is a valuable tool for assessing and enhancing the integrity of MORE in future research trials and clinical applications.

中文翻译：

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以正念为导向的恢复增强保真度测量 (MORE-FM)：开发和验证评估治疗师依从性和能力的新工具

摘要

客观的

以正念为导向的恢复增强 (MORE) 是一种身心疗法，它将正念训练、第三波认知行为疗法 (CBT) 和积极心理学原则的互补方面结合到成瘾及其合并症的综合治疗中。随着研究人员和临床医生对 MORE 的兴趣日益浓厚，越来越需要提供质量保证措施，以确保在实施 MORE 期间的治疗完整性。在这里，我们描述了面向正念的恢复增强保真度测量 (MORE-FM) 的开发和验证。

方法

我们开发了一个 17 项量表来评估治疗师的能力和对 MORE 治疗手册的依从性，然后将其用于在两个第 2 阶段和两个第 1 阶段 RCT 中对 40 个更多治疗疗程的保真度监测，以发现成瘾行为（例如，阿片类药物滥用、肥胖）涉及总数 N = 295。

结果

依从性 ( α  =.89) 和能力子量表 ( α  =.92)的内部一致性很高，评估者之间的可靠性足够（依从性子量表 ICC =.77；能力子量表 ICC =.51），治疗师表现出良好- 在所有试验中都具有出色的保真度。重要的是，线性混合模型表明，更高水平的整体保真度与两个第 2 阶段 RCT 中阿片类药物滥用的更大减少相关（F _1,48.00  = 7.38，p =.009），表明 MORE-FM 是一个有效的衡量标准可以预测临床结果的治疗保真度。

结论

这项研究的结果为 MORE-FM 的未来迭代提供了见解。总之，MORE-FM 是一个有价值的工具，用于在未来的研究试验和临床应用中评估和增强 MORE 的完整性。