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：退伍军人事务部的一个优先领域是 为抑郁症/焦虑症提供快速、有效、面向康复的治疗， 代表了退伍军人中最常见和最严重的精神障碍。认知 行为疗法(CBT)在治疗抑郁/焦虑方面显示出可靠的疗效。 精神障碍及其相关的损害。然而，CBT没有得到充分利用，很大程度上是因为 跨障碍的障碍特异性治疗(DST)方案的复杂性和数量，如 以及将它们应用于不同的诊断和不同的 诊断合并症的组合。最近，跨诊断行为疗法(TBT) 作为一种跨诊断干预措施被开发出来，以解决每一种抑郁/焦虑 退伍军人在单一治疗方案中的疾病及其共病。关于…的初步研究 TBT，包括一个资助的CSR&D职业发展奖(CDA)，表明 治疗在减少精神症状和相关损害方面有效 退伍军人提出了广泛的诊断。初步发现也支持这一宽松政策 关于DVA提供商传播和实施TBT的情况。尽管其他研究是 需要更大的样本和改进的对照组，跨诊断方法 技术性贸易壁垒可以解决上述DST目前的许多局限性。主要目标 在研究计划中：拟议的研究旨在测试TBT和DSTs在 改善精神症状和相关损害。据推测，技术性贸易壁垒将 结果在精神症状和相关损害方面的非劣势改善 与DST对照组进行比较。第二个目标是比较可行性和 TBT和DSTs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)、严重抑郁障碍的退伍军人 (MDD)和/或惊恐障碍和广场恐怖症(PD/AG)。一般纳入标准包括：1)a) 诊断为创伤后应激障碍、MDD或PD/AG；以及2)愿意和有能力提供 参与研究的知情同意。使用的程序：随机对照 将完成具有TBT和DSTS条件的试验(RCT)。参与区域合作伙伴关系将包括 完成：1)同意文件，2)摄入量评估，3)随机分配到 治疗条件，4)每周45-60分钟的心理治疗，为期12周，以及 5)自我报告精神症状和精神损害的评估，年中 治疗、治疗后及6个月随访。还将对工艺变量进行调查。 对退伍军人医疗保健的预期影响：基于支持疗效的调查 与DST相比，TBT将是一种极好的治疗选择 DVA在提供易于传播和实施的单一协议方面 以及有效地解决精神症状和相关问题 患有各种抑郁/焦虑障碍和相关共病的退伍军人的损害。

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.