Addressing Mental Health Comorbidities: Integrated CBT to Improve Functioning in Veterans with Co-Occurring Anxiety and Substance Use

解决心理健康合并症：综合认知行为治疗可改善同时存在焦虑和药物滥用的退伍军人的功能

• 批准号: 10704571
• 负责人: Anthony Ecker
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704571
• 关键词: Address; Aftercare; Alcohol abuse; Alcohol consumption; Anxiety; Anxiety Disorders; Award; Caring; Cladribine; Clinic; Clinical Trials; Cognitive Therapy; Communities; Complex; Consultations; Data; Development; Diagnostic; Disease; Effectiveness; Emotional disorder; Ensure; Family; Feedback; Feeling suicidal; Funding; Goals; Health; Health Personnel; Heavy Drinking; Individual; Intervention; Interview; Lead; Life; Logistics; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Military Personnel; Occupational; Odds Ratio; Outcome; Post-Traumatic Stress Disorders; Process; Protocols documentation; Provider; Psychotherapy; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation Outcome; Research; Research Personnel; Risk; Role; Schedule; Site; Symptoms; Testing; Training; Travel; Treatment Protocols; Veterans; acceptability and feasibility; alcohol related problem; alcohol use disorder; anxiety symptoms; binge drinking; career; combat zone; community reintegration; comorbidity; cost; drinking; dual diagnosis; evidence base; experience; functional improvement; hazardous drinking; high risk; improved; intervention refinement; military veteran; pilot trial; problem solving therapy; psychiatric comorbidity; psychologic; psychosocial; recruit; reduce symptoms; reduced substance use; rehabilitation research; satisfaction; service member; skills; substance use; symposium; symptom treatment; therapy development; treatment of anxiety disorders

Background and significance: Co-occurring hazardous drinking and mental health disorders, particularly anxiety disorders, is an especially problematic combination experienced by deployed Veterans. Although VA is a leader in delivering evidence-based mental health treatment, gaps remain in our understanding of how to best promote psychosocial recovery for Veterans with co-occurring anxiety and hazardous drinking. Veterans who have been deployed are at particular risk for experiencing problems in functioning and reintegration related to mental health disorders and alcohol use. Co-occurring anxiety, posttraumatic stress disorder (PTSD), and hazardous drinking heavily impact psychosocial functioning (including occupational and relationship functioning) and quality of life. Cognitive behavior therapy (CBT) is an evidence-based psychotherapy (EBP) for anxiety disorders and hazardous drinking that can promote improvements in functioning and quality of life. However, many Veterans do not receive CBT for anxiety disorders and/or SUD. A significant challenge in treating an anxiety disorder or SUD with CBT is that providers most often treat each disorder separately, often in separate clinics. This results in an inefficient treatment process that leads to poor outcomes. The Unified Protocol (UP) is a transdiagnostic CBT protocol that effectively treats symptoms of multiple emotional disorders simultaneously. Adapting the UP to meet the needs of deployed Veterans with co- occurring anxiety, PTSD, and hazardous drinking has the potential to more efficiently and effectively improve functioning and reduce symptoms. Given the impact of anxiety, PTSD, and hazardous drinking among returning Veterans, the research goals of this RR&D CDA-2 proposal support the adaptation of the UP for use among deployed Veterans with hazardous drinking and examination of its feasibility, acceptability, and preliminary efficacy. Research Plan: Aim 1: Adapt the UP for treatment of anxiety disorders/PTSD and hazardous drinking among deployed Veterans (UP-A). This will be achieved using established iterative intervention development strategies, including incorporating stakeholder feedback in the development of the intervention. Feedback from stakeholders will include qualitative interviews key stakeholders (clinicians, Veterans). Aim 2: Evaluate deployed Veterans’ experience using UP-A through a non-randomized pilot trial (N = 10) and qualitative interviews with Veterans and revising the intervention based on findings to ensure Veteran-centricity, Veteran satisfaction, feasibility, and acceptability. Veterans will be recruited from VA treatment settings and provided UP-A by study clinicians. Veterans will complete measures of functioning and symptoms before and after receiving the intervention. Aim 3: Explore the feasibility, acceptability, and preliminary effect of UP-A on functioning outcomes, anxiety and PTSD symptoms, and alcohol use through a pilot randomized controlled trial. Deployed Veterans (N=40) will be randomized to receive UP-A or a problem solving therapy control. Outcomes will be collected at baseline, post-treatment, and three months post- treatment. Veterans will also complete qualitative interviews to obtain feedback on feasibility and acceptability. Career Plan: Dr. Ecker will receive training in conducting rehabilitation research among high-need Veteran populations (e.g., post-deployment health), clinical trial research, and training related to becoming an independently-funded VA researcher. These training objectives will be achieved through a multifaceted strategy that includes research with mentors, formal coursework, trainings/seminars/conferences, and consultation with the mentor team. Training will support the immediate goals of successfully conducting the proposed research and the long-term career goal of conducting research to improve functioning in Veterans with complex mental health care needs.

背景和意义：危险饮酒和精神健康障碍，特别是 焦虑症，是一个特别有问题的组合所经历的部署退伍军人。虽然， 作为提供循证心理健康治疗的领导者，我们对如何 最好的促进心理社会康复退伍军人与共同发生的焦虑和危险的饮酒。退伍军人 已经部署的妇女特别有可能在运作和重返社会方面遇到问题 与精神疾病和酗酒有关。同时出现的焦虑症，创伤后应激障碍 （PTSD）和危险饮酒严重影响心理社会功能（包括职业和 关系运作）和生活质量。认知行为疗法（CBT）是一种基于证据的 心理治疗（EBP）的焦虑症和危险饮酒，可以促进改善 功能和生活质量。然而，许多退伍军人不接受CBT焦虑症和/或SUD。 用CBT治疗焦虑症或SUD的一个重大挑战是，提供者通常会治疗每一种焦虑症或SUD。 通常在不同的诊所进行。这导致低效的处理过程，导致不良的 结果。统一协议（UP）是一种跨诊断CBT协议，可有效治疗 同时患有多种情绪障碍调整UP以满足部署的退伍军人的需求， 发生的焦虑，创伤后应激障碍，和危险的饮酒有可能更有效地改善 功能和减轻症状。考虑到焦虑、创伤后应激障碍和危险饮酒的影响， 为了满足退伍军人的需要，RR&D CDA-2建议书的研究目标支持对UP进行修改，以便使用 在部署的退伍军人与危险饮酒和检查其可行性，可接受性， 初步疗效。研究计划：目标1：调整UP用于治疗焦虑症/PTSD， 在退伍军人中饮酒（UP-A）。这将通过使用已建立的迭代 制定干预措施战略，包括在制定 干预利益相关者的反馈将包括定性访谈关键利益相关者（临床医生， 退伍军人）。目的2：通过一项非随机初步试验（N）评估部署的退伍军人使用UP-A的经验 = 10）和与退伍军人的定性访谈，并根据调查结果修改干预措施，以确保 退伍军人中心，退伍军人满意度，可行性和可接受性。退伍军人将从VA招募 治疗设置，并由研究临床医生提供UP-A。退伍军人将完成功能的措施， 在接受干预前后的症状。目标3：探索可行性、可接受性和 UP-A对功能结果、焦虑和PTSD症状以及酒精使用的初步影响， pilot随机对照试验部署的退伍军人（N=40）将随机接受UP-A或问题 解决治疗控制。将在基线、治疗后和治疗后3个月收集结局。 治疗退伍军人还将完成定性访谈，以获得关于可行性和可接受性的反馈。 职业规划：Ecker博士将接受在高需求退伍军人中进行康复研究的培训 群体（例如，部署后的健康），临床试验研究，以及与成为 独立资助的退伍军人事务部研究员这些培训目标将通过多方面的 战略，包括与导师的研究，正式课程，培训/研讨会/会议，以及 与导师团队协商。培训将支持成功开展 拟议的研究和长期的职业目标进行研究，以改善退伍军人的功能 有着复杂的心理健康需求

项目成果

Feasibility of Group-Based Implementation Facilitation for Video Telemental Health.

• DOI: 10.1007/s41347-022-00295-x
• 发表时间: 2023-01-11
• 期刊: Journal of technology in behavioral science

The role of depression and anxiety symptom severity in remotely delivered mental health care.

抑郁和焦虑症状严重程度在远程心理保健中的作用。

• DOI: 10.1037/ser0000775
• 发表时间: 2024
• 期刊: Psychological services
• 影响因子: 2.3
• 作者: Ecker,AnthonyH;Amspoker,AmberB;Johnston,Winter;Walder,Annette;Lindsay,JanA;Hogan,JuliannaB
• 通讯作者: Hogan,JuliannaB