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

研究计划的相关性：退伍军人事务部（DVA）的一个优先领域是 为抑郁症/焦虑症提供快速、有效、以恢复为导向的治疗， 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）已被证明在治疗抑郁/焦虑方面具有可靠的疗效 疾病及其相关损害。然而，CBT在很大程度上由于 疾病特异性治疗（DST）方案的复杂性和数量， 以及将它们应用于不同诊断和不同 诊断合并症的组合。最近，跨诊断行为疗法（TBT） 是作为一种跨诊断干预措施，以解决每一个抑郁/焦虑 疾病及其合并症的退伍军人在一个单一的治疗方案。初步研究 技术性贸易壁垒，包括一个由企业社会责任和发展基金资助的职业发展奖（CDA），表明 治疗有效地减少精神障碍和相关的损害， 退伍军人的诊断范围很广。初步调查结果也支持了 DVA供应商传播和实施技术性贸易壁垒。虽然更多的研究 需要更大的样本和更好的对照组， 技术性贸易壁垒可以解决上述争端解决条约目前的许多局限性。主要目标 研究计划：拟议的研究旨在测试技术性贸易壁垒和技术性贸易壁垒在以下方面的非劣效性： 改善精神病学和相关损伤。据推测，TBT将 结果精神病学和相关损伤的非劣效性改善 与DST对照组相比。第二个目的是比较可行性和 TBT和DST的可接受性。受试者人群：拟定研究的受试者 将包括216名患有创伤后应激障碍（PTSD），严重抑郁症 (MDD)和/或惊恐障碍和广场恐怖症（PD/AG）。一般入选标准包括：1）a PTSD、MDD或PD/AG的诊断;以及2）愿意并有能力提供 知情同意参与研究。使用的程序：随机对照 将完成具有TBT和DST条件的RCT。参与RCT将涉及 完成：1）知情同意文件，2）摄入评估，3）随机分配 治疗条件，4）每周45 - 60分钟的心理治疗预约，持续12周，以及 5)自我报告的精神病学评估和摄入时的损害， 治疗、治疗后和6个月随访。还将研究工艺变量。 对退伍军人医疗保健的预期影响：根据支持疗效的调查 和非劣效性相比，DST，TBT将是一个很好的治疗选择， DVA提供了一个易于传播和实施的单一协议 提供者以及有效地解决精神病学和相关 患有各种抑郁症/焦虑症和相关合并症的退伍军人的损伤。

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.