Increasing the Effectiveness of CBT for Anxiety in Veterans by Involving Family Members.

背景 创伤后应激障碍(PTSD)和焦虑症，如恐慌症、全身性和 社交焦虑在各个时代的退伍军人中都非常普遍，并对功能产生负面影响 和生活质量。回避是焦虑的一个显著特征，也是维持 无序。虽然认知行为疗法(CBT)是有效的，但相当大比例的 退伍军人在治疗后表现出很小的改善。这通常是由于治疗不当造成的。 坚持，例如避免使用CBT教授的技能，这些技能需要面对痛苦 记忆和令人恐惧的情况。回避行为也可能延伸到照顾者和家庭 退伍军人成员，他们可能会从事住宿行为(即改变自己的住宿行为 行为)，以帮助减轻亲人经历的痛苦。因此，住宿 家庭成员会削弱CBT的有效性，并与更大的 焦虑症患者的症状严重程度和功能损害。 目标 这项研究将检验与新的 对因焦虑症接受CBT的退伍军人家属的干预。 附属家庭-CBT(AF-CBT)为家庭成员提供关于焦虑和 传授可用于促进处于 完成焦虑症的治疗。研究的目的是：(1)通过以下方式适应和提炼AF-CBT 将从退伍军人和家属的反馈中获得信息的迭代过程；(2) 检查AF-CBT的可行性和可接受性/满意度；(3)评估其有效性和 适用于退伍军人和家庭的家庭住宿焦虑量表的信度研究 成员；以及(4)检验家庭住宿行为和 退伍军人的适应与焦虑。 方法 拟议的研究共涉及47名退伍军人和家庭成员二联体(V/F二元体)和 将分两个阶段进行。在第一阶段，将招募12个V/F二人组，家庭成员 将接受AF-CBT，而这位老将因焦虑而接受iCBT。干预措施将是 在三个单独的队列中提供(每个队列中大约有4个V/F二联体)。在1- 月评估，从定性面试中获得的信息将被用来完善 在每个队列的迭代过程中进行干预。在第二阶段，将招募35 V/F二元体 并在相同的治疗和评估后实施最终版本的房颤-CBT 格式化。定性访谈将集中在每个V/F DYAD在AF-CBT上的经验 干预措施以及干预措施的特定组成部分是否有助于退伍军人的 恢复过程。

Background Posttraumatic stress disorder (PTSD) and anxiety disorders such as panic, generalized and social anxiety are highly prevalent among Veterans of all eras and negatively impact functioning and quality of life. Avoidance is a hallmark feature of anxiety and functions to maintain the disorder. Although cognitive behavior therapy (CBT) is effective, a significant proportion of Veterans show minimal improvement following treatment. This is often due to poor treatment adherence such as avoidance of using skills taught in CBT that require confronting distressing memories and feared situations. Avoidance behavior also can extend to caregivers and family members of Veterans, who may engage in accommodation behaviors (i.e., changing their own behaviors) to help alleviate distress experienced by their loved ones. As such, accommodation by family members undermines the effectiveness of CBT and is associated with greater symptom severity and functional impairment in persons with anxiety. Objectives This study will examine the feasibility, acceptability, and satisfaction associated with a new intervention for family members of Veterans undergoing CBT for anxiety-based disorders. Adjunctive Family-CBT (AF-CBT) provides family members psychoeducation on anxiety and teaches skills that can be used to facilitate the recovery of Veterans who are in the process of completing treatment for anxiety. Aims of the study are to: (1) adapt and refine AF-CBT through an iterative process that will be informed by feedback from Veterans and family members; (2) examine the feasibility and acceptability/satisfaction of AF-CBT; (3) assess the validity and reliability of the Family Accommodation Scale-Anxiety adapted for Veterans and family members; and (4) examine the associations between family accommodation behavior and readjustment and anxiety in Veterans. Methods The proposed study involves a total of 47 Veterans and family member dyads (V/F dyad) and will be conducted in two phases. In phase 1, 12 V/F dyads will be recruited, and family members will receive AF-CBT while the Veteran undergoes iCBT for anxiety. The intervention will be delivered in three separate cohorts (approximately 4 V/F dyad in each cohort). During the 1- month assessment, information obtained from qualitative interviews will be used to refine the intervention in an iterative process with each cohort. In phase 2, 35 V/F dyads will be recruited and administered the finalized version of AF-CBT following the same treatment and assessment format. Qualitative interviews will focus on each V/F dyad’s experience with the AF-CBT intervention and whether specific components of the intervention facilitated the Veteran’s recovery process.