Increasing the Effectiveness of CBT for Anxiety in Veterans by Involving Family Members.

通过让家人参与来提高认知行为治疗对退伍军人焦虑的有效性。

• 批准号: 10477667
• 负责人: Ellen Teng
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10477667
• 关键词: Address; Aftercare; Anxiety; Anxiety Disorders; Behavior; Behavior Therapy; Benchmarking; Caregivers; Caring; Client satisfaction; Cognitive Therapy; Disease; Distress; Effectiveness; Equipment and supply inventories; Evaluation; Family; Family member; Feasibility Studies; Feedback; Fright; Goals; Individual; Intervention; Interview; Measures; Memory; Methods; Panic; Participant; Patient Self-Report; Patients; Persons; Phase; Post-Traumatic Stress Disorders; Prevalence; Process; Protocols documentation; Quality of life; Questionnaires; Recovery; Severities; Structure; Symptoms; System; Testing; Therapeutic; Therapeutic Intervention; Validity and Reliability; Veterans; acceptability and feasibility; anxiety treatment; avoidance behavior; base; brief intervention; cohort; community reintegration; experience; follow up assessment; follow-up; formative assessment; functional disability; generalized anxiety; group intervention; improved; loved ones; military veteran; novel; phase 2 study; prevent; psychoeducation; recruit; retention rate; satisfaction; skills; social anxiety; suicide rate; telehealth; therapy development; treatment adherence; treatment of anxiety disorders

Background Posttraumatic stress disorder (PTSD) and anxiety disorders such as panic, generalized and social anxiety are highly prevalent among Veterans of all eras and negatively impact functioning and quality of life. Avoidance is a hallmark feature of anxiety and functions to maintain the disorder. Although cognitive behavior therapy (CBT) is effective, a significant proportion of Veterans show minimal improvement following treatment. This is often due to poor treatment adherence such as avoidance of using skills taught in CBT that require confronting distressing memories and feared situations. Avoidance behavior also can extend to caregivers and family members of Veterans, who may engage in accommodation behaviors (i.e., changing their own behaviors) to help alleviate distress experienced by their loved ones. As such, accommodation by family members undermines the effectiveness of CBT and is associated with greater symptom severity and functional impairment in persons with anxiety. Objectives This study will examine the feasibility, acceptability, and satisfaction associated with a new intervention for family members of Veterans undergoing CBT for anxiety-based disorders. Adjunctive Family-CBT (AF-CBT) provides family members psychoeducation on anxiety and teaches skills that can be used to facilitate the recovery of Veterans who are in the process of completing treatment for anxiety. Aims of the study are to: (1) adapt and refine AF-CBT through an iterative process that will be informed by feedback from Veterans and family members; (2) examine the feasibility and acceptability/satisfaction of AF-CBT; (3) assess the validity and reliability of the Family Accommodation Scale-Anxiety adapted for Veterans and family members; and (4) examine the associations between family accommodation behavior and readjustment and anxiety in Veterans. Methods The proposed study involves a total of 47 Veterans and family member dyads (V/F dyad) and will be conducted in two phases. In phase 1, 12 V/F dyads will be recruited, and family members will receive AF-CBT while the Veteran undergoes iCBT for anxiety. The intervention will be delivered in three separate cohorts (approximately 4 V/F dyad in each cohort). During the 1- month assessment, information obtained from qualitative interviews will be used to refine the intervention in an iterative process with each cohort. In phase 2, 35 V/F dyads will be recruited and administered the finalized version of AF-CBT following the same treatment and assessment format. Qualitative interviews will focus on each V/F dyad’s experience with the AF-CBT intervention and whether specific components of the intervention facilitated the Veteran’s recovery process.

背景 创伤后应激障碍 (PTSD) 和焦虑症，如惊恐、全身性和 社交焦虑在各个时代的退伍军人中都非常普遍，并对功能产生负面影响 和生活质量。回避是焦虑的一个标志性特征，也是维持焦虑的功能。 紊乱。尽管认知行为疗法（CBT）是有效的，但很大一部分 退伍军人在治疗后表现出最小的改善。这往往是由于治疗不当造成的 坚持，例如避免使用 CBT 中教授的需要面对痛苦的技能 记忆和恐惧的情况。回避行为也可以延伸到照顾者和家人 退伍军人成员，他们可能会做出迁就行为（即改变自己的 行为）以帮助减轻亲人所经历的痛苦。如此一来，住宿 家庭成员的行为会破坏 CBT 的有效性，并与更大的风险相关 焦虑症患者的症状严重程度和功能障碍。 目标 本研究将检验与新的项目相关的可行性、可接受性和满意度 对因焦虑障碍而接受 CBT 的退伍军人家属进行干预。 辅助家庭 CBT (AF-CBT) 为家庭成员提供有关焦虑和焦虑的心理教育 教授可用于促进退伍军人康复的技能 完成焦虑症的治疗。研究的目的是：（1）通过以下方式调整和完善 AF-CBT： 一个迭代过程，将根据退伍军人和家庭成员的反馈提供信息； (2) 审查 AF-CBT 的可行性和可接受性/满意度； (3) 评估有效性和 适用于退伍军人和家庭的家庭住宿量表焦虑的可靠性 会员； (4) 检查家庭住宿行为与 退伍军人的重新调整和焦虑。 方法 拟议的研究总共涉及 47 名退伍军人和家庭成员二人组 (V/F 双人组) 将分两个阶段进行。第一阶段将招募12名V/F二人组，以及家庭成员 将接受 AF-CBT，而退伍军人则因焦虑而接受 iCBT。干预措施将是 分三个单独的组进行（每个组中大约有 4 个 V/F 二元组）。期间 1- 月评估，从定性访谈中获得的信息将用于完善 对每个队列的迭代过程进行干预。第二阶段将招募 35 名 V/F 双人组 并在相同的治疗和评估后实施 AF-CBT 的最终版本 格式。定性访谈将重点关注每个 V/F 双人组的 AF-CBT 体验 干预以及干预的具体组成部分是否促进了退伍军人的 恢复过程。