A Comparison of the Efficacy of Transdiagnostic Behavior Therapy and Disorder-specific Therapy in Veterans with PTSD, Anxiety, and Depression

跨诊断行为疗法和疾病特异性疗法对患有 PTSD、焦虑和抑郁的退伍军人的疗效比较

• 批准号: 10425235
• 负责人: Daniel F. Gros
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425235
• 关键词: Address; Aftercare; Agoraphobia; Anxiety; Anxiety Disorders; Appointment; Area; Behavior Disorders; Behavior Therapy; Behavioral; Client satisfaction; Clinical; Cognitive; Cognitive Therapy; Competence; Consent; Diagnosis; Diagnostic; Disease; Dissemination and Implementation; Documentation; Equipment and supply inventories; Financial Hardship; Funding; Goals; Healthcare; Impairment; Individual; Informed Consent; Intake; Intervention; Investigation; K-Series Research Career Programs; Major Depressive Disorder; Measures; Mental Depression; Mental disorders; Outcome; Panic Disorder; Participant; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Procedures; Process; Protocols documentation; Provider; Psychiatric Diagnosis; Psychotherapy; Questionnaires; Randomized; Randomized Controlled Trials; Recovery; Relapse; Research; Sampling; Severities; Symptoms; Testing; Time; Training; Treatment Protocols; United States Department of Veterans Affairs; Unnecessary Procedures; Veterans; acceptability and feasibility; anxiety symptoms; associated symptom; comorbidity; comparison group; cost; cost effective; depressive symptoms; design; effective therapy; efficacious treatment; efficacy evaluation; follow-up; improved; inclusion criteria; innovation; psychiatric comorbidity; satisfaction; symptomatology; trait; treatment comparison; treatment effect; trial comparing; trial design; willingness

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. However, CBT is underutilized due in large part to the complexity and number of disorder-specific treatments (DSTs) protocols across disorders, as well as extensive training needed to apply them to different diagnoses and different combinations of diagnostic comorbidities. Recently, Transdiagnostic Behavior Therapy (TBT) was developed as a transdiagnostic intervention to address each of the depressive/anxiety disorders and their comorbidities in Veterans within a single treatment protocol. Initial studies of TBT, including a funded CSR&D Career Development Award (CDA), demonstrate that the treatment is efficacious in reducing psychiatric symptomatology and related impairments in Veterans presenting with a wide range of diagnoses. Preliminary findings also support the ease of dissemination and implementation of TBT by DVA providers. Although additional study is needed with larger samples and improved comparison groups, the transdiagnostic approach in TBT may address many of the current limitations of the DSTs discussed above. Primary Aims in Research Plan: The proposed study aims to test the non-inferiority of TBT and DSTs in improving psychiatric symptomatology and related impairments. It is hypothesized that TBT will result non-inferior improvements in psychiatric symptomatology and related impairments compared to the DST comparison groups. A secondary aim is to compare the feasibility and acceptability of TBT and DSTs. Participant population: The participants of the proposed study will include 216 Veterans with posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and/or panic disorder and agoraphobia (PD/AG). General inclusion criteria involve: 1) a diagnosis of a PTSD, MDD, or PD/AG; and 2) a willingness and competence to provide informed consent for research participation. Procedures to be used: A randomized controlled trial (RCT) with TBT and 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 45-60-minute appointments of psychotherapy for 12 weeks, and 5) self-report assessments of psychiatric symptomatology and impairment at intake, mid- treatment, post-treatment, and 6-month follow-up. Process variables also will be investigated. Anticipated Impacts on Veterans Health Care: Upon investigation with supported efficacy and non-inferiority as compared to DSTs, TBT will represent an excellent treatment option within the DVA in terms of providing a single protocol that is easy to disseminate to and implement by providers as well as being efficacious in addressing psychiatric symptomatology and related impairments in Veterans with various depressive/anxiety disorders and related comorbidities.

研究计划的相关性：退伍军人事务部（DVA）的一个优先领域是 为了为抑郁/焦虑症提供快速，有效，面向恢复的治疗， 代表退伍军人中最常见和最损害的精神疾病。认知的 行为疗法（CBT）在治疗抑郁/焦虑方面表现出可靠的功效 疾病及其相关障碍。但是，CBT在很大程度上不足 跨疾病的复杂性和特异性治疗（DSTS）方案的复杂性和数量 以及需要大量培训将它们应用于不同的诊断和不同的培训 诊断合并症的组合。最近，经诊断行为疗法（TBT） 是作为经诊断干预措施开发的，以解决每种抑郁/焦虑 单个治疗方案中的退伍军人中的疾病及其合并症。最初的研究 TBT，包括资助的CSR＆D职业发展奖（CDA），表明 治疗可有效减少精神病症状学和相关障碍 退伍军人表现出广泛的诊断。初步发现也支持轻松 DVA提供商对TBT的传播和实施。虽然其他研究是 需要较大的样本和改进的比较组，在 TBT可能会解决上述DST的许多当前局限性。主要目的 在研究计划中：拟议的研究旨在测试TBT和DST的不介绍性 改善精神症状学和相关障碍。假设TBT将 导致精神症状和相关障碍的非内部改善 与DST比较组相比。第二个目的是比较可行性和 TBT和DST的可接受性。参与者人数：拟议研究的参与者 将包括216名患有创伤后应激障碍（PTSD）的退伍军人，重度抑郁症 （MDD）和/或恐慌症和恐惧症（PD/AG）。一般纳入标准涉及：1） 诊断为PTSD，MDD或PD/AG； 2）愿意和能力提供 知情同意研究参与。要使用的过程：随机控制 具有TBT和DSTS条件的试验（RCT）将完成。参与RCT将涉及 完成：1）同意文件，2）进气评估，3）随机分配到 治疗条件，4）每周45-60分钟的心理治疗任命12周， 5）对摄入量的精神症状和损害的自我报告评估， 治疗，治疗后和6个月的随访。过程变量也将进行研究。 对退伍军人卫生保健的预期影响：在有支持的疗效调查后 与DST相比，TBT将代表一个出色的治疗选择 DVA在提供易于传播和实施的单个协议方面 提供者以及有效解决精神病症状和相关性 患有各种抑郁/焦虑症和相关合并症的退伍军人的损害。