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退伍军人中普遍存在，并对功能产生负面影响 和生活质量。回避是焦虑的一个标志性特征，它的功能是维持焦虑。 disorder.虽然认知行为疗法（CBT）是有效的，但很大一部分 退伍军人在治疗后表现出最小的改善。这往往是由于治疗不善 坚持，例如避免使用CBT中教授的需要面对痛苦的技能 记忆和恐惧的情况。回避行为也可以延伸到照顾者和家庭 退伍军人，谁可以从事住宿行为（即，改变自己的 行为），以帮助减轻他们所爱的人所经历的痛苦。因此，住宿 由家庭成员破坏CBT的有效性，并与更大的 焦虑症患者症状严重程度和功能障碍。 目标 这项研究将探讨可行性，可接受性和满意度与新的 对因焦虑性疾病接受CBT的退伍军人家庭成员进行干预。 辅助家庭-CBT（AF-CBT）为家庭成员提供焦虑和焦虑的心理教育， 教授技能，可用于促进退伍军人谁是在恢复的过程中， 完成焦虑症的治疗本研究的目的是：（1）通过以下方式调整和完善AF-CBT 一个迭代的过程，将由退伍军人和家庭成员的反馈信息;（2） 检查AF-CBT的可行性和可接受性/满意度;（3）评估有效性， 适用于退伍军人及其家属的家庭适应焦虑量表的信度 成员;（4）研究家庭住宿行为与 退伍军人的重新适应和焦虑。 方法 这项拟议的研究共涉及47名退伍军人和家庭成员二人组（V/F二人组）， 将分两个阶段进行。在第1阶段，将招募12个V/F二联体， 将接受AF-CBT，而退伍军人接受iCBT治疗焦虑。干预将是 在三个单独的队列中输送（每个队列中约4 V/F二联体）。在1- 月评估，从定性访谈中获得的信息将用于完善 在迭代过程中对每个队列进行干预。在第2阶段，将招募35个V/F二联体 并在相同的治疗和评估后给予AF-CBT的最终版本 格式.定性访谈将侧重于每个V/F二元体的经验与AF-CBT 干预以及干预的具体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.