A Comparison of Group Transdiagnostic Behavior Therapy (G-TBT) to Disorder-Specific Group Psychotherapies in the Recovery of Veterans with PTSD, Major Depression, and Related Conditions

团体跨诊断行为疗法 (G-TBT) 与特定障碍团体心理疗法在患有 PTSD、重度抑郁症和相关病症的退伍军人康复中的比较

基本信息

批准号：
10844353
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
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-10-01 至 2024-03-31
项目状态：
已结题

项目摘要

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 as well as encouraging social reintegration. However, CBT is underutilized due in large part to the complexity and number of disorder-specific treatments (DSTs) across disorders, as well as extensive training needed to apply them to different diagnoses as well as different diagnoses with different comorbidities. In addition, the focus of DSTs and their requirement to segregate patients by disorder limit the use of group CBT in the DVA and its established benefits to patient access and social reintegration. Recently, Transdiagnostic Behavior Therapy (TBT) was developed in the DVA to address overall psychiatric well-being and rehabilitation in Veterans, without limiting treatment to a single psychiatric diagnosis. Initial studies of TBT show the treatment is effective in reducing impairment across multiple domains of functioning, including health and diet, work and financial situation, recreation and community involvement, and social and family relationships in Veterans presenting with a wide range of diagnoses, including depressive disorders, anxiety disorders, PTSD, and related comorbidities. In addition, a recent study demonstrated that TBT could be easily disseminated to DVA providers and implemented with DVA patients. Although additional study is needed, the transdiagnostic approach in TBT, including a newly developed Group TBT (G-TBT), may address many of the current limitations of the DSTs and lead to improved outcomes for Veterans with PTSD and/or depression. Primary Aims in Research Plan: The proposed study aims to: 1) test equivalence of G-TBT and Group DSTs (G-DSTs) in improving impairment and social reintegration as well as reducing psychiatric symptomatology, and 2) compare the access, feasibility, and acceptability of G-TBT and G-DSTs. Participant population: The participants of the proposed study will include 208 DVA patients with PTSD and/or major depressive disorder. Procedures to be used: A randomized controlled trial (RCT) with G-TBT and G-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 90-minute appointments of group psychotherapy for 12 weeks, and 5) self-report assessments of quality life, social reintegration, and psychiatric symptomatology at intake, mid-treatment, post-treatment, and 6-month follow-up. Anticipated Impacts on Veterans Health Care: Upon investigation with supported efficacy and non- inferiority as compared to G-DSTs, G-TBT will represent an excellent treatment option within the DVA in terms of providing a single group protocol that is easy to disseminate to and implement by providers as well as being efficacious in addressing functional impairment, social reintegration, and psychiatric symptomatology and with improved access for 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以及鼓励社会重返社会。然而， CBT在很大程度上归因于疾病特异性的复杂性和数量很大跨疾病的治疗（DST），以及需要将其应用于不同的诊断以及不同合并症的不同诊断。另外， DST的重点及其要求通过无序分割患者的要求限制了组的使用 DVA中的CBT及其对患者访问和社交重返社会的既定好处。最近，在DVA中开发了转诊行为疗法（TBT），以解决总体退伍军人的精神福祉和康复，而无需将治疗限制为单一精神诊断。 TBT的初步研究表明该治疗可有效减少跨多个功能领域的损害，包括健康和饮食，工作和财务情况，娱乐和社区参与以及退伍军人的社会和家庭关系表现出广泛的诊断，包括抑郁症，焦虑症， PTSD和相关合并症。此外，最近的一项研究表明TBT可能是很容易将DVA提供商传播并与DVA患者实施。虽然附加需要研究，即TBT中的转诊方法，包括新开发的组TBT （G-TBT）可能解决DST的许多当前局限性，并导致改进具有PTSD和/或抑郁症的退伍军人的结果。研究计划的主要目标：拟议的研究的目的是：1）在改善G-TBT和组DSTS（G-DST）的测试等效性障碍和社交重返社会以及减轻精神病症状学，2）比较G-TBT和G-DST的访问，可行性和可接受性。参与者人口：拟议研究的参与者将包括208名DVA患者和/或主要的抑郁症。要使用的程序：随机对照试验（RCT）使用G-TBT和G-DSTS条件将完成。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90分钟的组心理治疗任命12周， 5）自我报告评估质量生活，社交重返社会和精神病学摄入量，中期治疗，治疗和6个月的随访中的症状学。预期对退伍军人卫生保健的影响：在调查后，具有支持的功效和非 - 与G-DST相比，劣等性，G-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组协议方面提供者以及有效解决功能障碍，社会重返社会和精神病症状学，并改善了退伍军人各种抑郁/焦虑症和相关合并症。