A Comparison of Group Transdiagnostic Behavior Therapy (G-TBT) to Disorder-Specific Group Psychotherapies in the Recovery of Veterans with PTSD, Major Depression, and Related Conditions

研究计划的相关性：退伍军人事务部 (DVA) 的一个优先领域是 为抑郁/焦虑症提供快速、有效、以康复为导向的治疗方法， 代表退伍军人中最常见和最有害的精神疾病。认知 行为疗法（CBT）在治疗抑郁/焦虑方面已被证明具有可靠的功效 疾病及其相关损伤，并鼓励重新融入社会。然而， CBT 未得到充分利用，很大程度上是由于特定疾病的复杂性和数量 跨疾病的治疗（DST），以及将其应用于治疗所需的广泛培训 不同的诊断以及具有不同合并症的不同诊断。此外， DST 的重点及其按疾病隔离患者的要求限制了分组的使用 DVA 中的 CBT 及其对患者就诊和重新融入社会的既定益处。最近， 跨诊断行为疗法 (TBT) 是在 DVA 中开发的，旨在解决整体问题 退伍军人的精神健康和康复，不限于单一治疗 精神科诊断。 TBT 的初步研究表明该治疗可有效减少 多个功能领域的损害，包括健康和饮食、工作和财务 退伍军人的处境、娱乐和社区参与以及社会和家庭关系 提出多种诊断，包括抑郁症、焦虑症、 创伤后应激障碍（PTSD）和相关合并症。此外，最近的一项研究表明，TBT 可以 易于传播给 DVA 提供者并在 DVA 患者中实施。虽然额外的 需要研究 TBT 的跨诊断方法，包括新开发的 Group TBT （G-TBT），可能会解决 DST 当前的许多局限性，并导致改进 患有创伤后应激障碍和/或抑郁症的退伍军人的结果。研究计划的主要目标： 拟议研究的目的是：1）测试 G-TBT 和组 DST（G-DST）在改进方面的等效性 损害和重新融入社会以及减少精神症状，2) 比较 G-TBT 和 G-DST 的可及性、可行性和可接受性。参加者 人群：拟议研究的参与者将包括 208 名患有 PTSD 的 DVA 患者 和/或重度抑郁症。使用的程序：随机对照试验（RCT） G-TBT 和 G-DST 条件将完成。参与 RCT 将涉及 完成：1) 同意文件，2) 摄入评估，3) 随机分配 治疗条件，4）每周90分钟的团体心理治疗预约，持续12周， 5) 对生活质量、重新融入社会和精神状况的自我报告评估 摄入时、治疗中期、治疗后和 6 个月随访时的症状。预期的 对退伍军人医疗保健的影响：经调查，具有支持的功效和非 与 G-DST 相比，G-TBT 将是一种极好的治疗选择 DVA 提供易于传播和实施的单组协议 由提供者提供，并能有效解决功能障碍、社交障碍 重返社会和精神病学症状，并改善了患有以下疾病的退伍军人的获取机会 各种抑郁/焦虑症和相关合并症。

Relevance of Research Plan: One priority area for the Department of Veterans Affairs (DVA) is to provide quick, effective, recovery-oriented treatments for depressive/anxiety disorders, representing the most common and impairing psychiatric disorders in Veterans. Cognitive behavioral therapy (CBT) has demonstrated reliable efficacy in treating depressive/anxiety disorders and their related impairments as well as encouraging social reintegration. However, CBT is underutilized due in large part to the complexity and number of disorder-specific treatments (DSTs) across disorders, as well as extensive training needed to apply them to different diagnoses as well as different diagnoses with different comorbidities. In addition, the focus of DSTs and their requirement to segregate patients by disorder limit the use of group CBT in the DVA and its established benefits to patient access and social reintegration. Recently, Transdiagnostic Behavior Therapy (TBT) was developed in the DVA to address overall psychiatric well-being and rehabilitation in Veterans, without limiting treatment to a single psychiatric diagnosis. Initial studies of TBT show the treatment is effective in reducing impairment across multiple domains of functioning, including health and diet, work and financial situation, recreation and community involvement, and social and family relationships in Veterans presenting with a wide range of diagnoses, including depressive disorders, anxiety disorders, PTSD, and related comorbidities. In addition, a recent study demonstrated that TBT could be easily disseminated to DVA providers and implemented with DVA patients. Although additional study is needed, the transdiagnostic approach in TBT, including a newly developed Group TBT (G-TBT), may address many of the current limitations of the DSTs and lead to improved outcomes for Veterans with PTSD and/or depression. Primary Aims in Research Plan: The proposed study aims to: 1) test equivalence of G-TBT and Group DSTs (G-DSTs) in improving impairment and social reintegration as well as reducing psychiatric symptomatology, and 2) compare the access, feasibility, and acceptability of G-TBT and G-DSTs. Participant population: The participants of the proposed study will include 208 DVA patients with PTSD and/or major depressive disorder. Procedures to be used: A randomized controlled trial (RCT) with G-TBT and G-DSTs conditions will be completed. Participation in the RCT will involve completion of: 1) consent documentation, 2) intake assessment, 3) random assignment to treatment condition, 4) weekly 90-minute appointments of group psychotherapy for 12 weeks, and 5) self-report assessments of quality life, social reintegration, and psychiatric symptomatology at intake, mid-treatment, post-treatment, and 6-month follow-up. Anticipated Impacts on Veterans Health Care: Upon investigation with supported efficacy and non- inferiority as compared to G-DSTs, G-TBT will represent an excellent treatment option within the DVA in terms of providing a single group protocol that is easy to disseminate to and implement by providers as well as being efficacious in addressing functional impairment, social reintegration, and psychiatric symptomatology and with improved access for Veterans with various depressive/anxiety disorders and related comorbidities.