A Comparison of the Efficacy of Transdiagnostic Behavior Therapy and Disorder-specific Therapy in Veterans with PTSD, Anxiety, and Depression

跨诊断行为疗法和疾病特异性疗法对患有 PTSD、焦虑和抑郁的退伍军人的疗效比较

• 批准号: 10657498
• 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
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10657498
• 关键词: Address; Aftercare; Agoraphobia; Anxiety; Anxiety Disorders; Appointment; Area; Behavior Disorders; Behavior Therapy; Behavioral; Client satisfaction; Clinical; Cognitive; Cognitive Therapy; Competence; Consent Forms; Diagnosis; Diagnostic; Disease; Dissemination and Implementation; Equipment and supply inventories; Financial Hardship; Funding; Goals; Healthcare; Impairment; Individual; Informed Consent; Intake; Intervention; Investigation; K-Series Research Career Programs; Major Depressive Disorder; Measures; Mental Depression; Mental disorders; Outcome; Panic Disorder; Participant; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Procedures; Process; Protocols documentation; Provider; Psychiatric Diagnosis; Psychotherapy; Questionnaires; Randomized; Randomized, Controlled Trials; Recovery; Relapse; Research; Sampling; Severities; Symptoms; Testing; Time; Training; Treatment Protocols; United States Department of Veterans Affairs; Unnecessary Procedures; Veterans; acceptability and feasibility; anxiety symptoms; associated symptom; comorbidity; comparison group; cost; cost effective; depressive symptoms; design; diagnostic strategy; effective therapy; efficacious treatment; efficacy evaluation; follow-up; improved; inclusion criteria; innovation; psychiatric comorbidity; satisfaction; symptomatology; trait; treatment comparison; treatment effect; trial comparing; trial design; willingness

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.

研究计划的相关性：退伍军人事务部 (DVA) 的一个优先领域是 为抑郁/焦虑症提供快速、有效、以康复为导向的治疗方法， 代表退伍军人中最常见和最有害的精神疾病。认知的 行为疗法（CBT）在治疗抑郁/焦虑方面已被证明具有可靠的功效 疾病及其相关损伤。然而，CBT 并未得到充分利用，这在很大程度上是由于 跨疾病的疾病特异性治疗 (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情况所需的广泛培训 诊断合并症的组合。最近，跨诊断行为疗法（TBT） 被开发为一种跨诊断干预措施，以解决每一种抑郁/焦虑问题 在单一治疗方案中解决退伍军人的疾病及其合并症。初步研究 TBT，包括资助的 CSR&D 职业发展奖 (CDA)，表明 治疗可有效减少精神症状和相关损伤 退伍军人提出了各种各样的诊断。初步调查结果也支持轻松 DVA 提供商传播和实施 TBT 的情况。虽然额外的研究是 需要更大的样本和改进的比较组，跨诊断方法 TBT 可以解决上述 DST 当前的许多限制。主要目标 研究计划中：拟议的研究旨在测试 TBT 和 DST 的非劣效性 改善精神症状和相关障碍。据推测，TBT 将 导致精神症状和相关损伤的非劣质改善 与 DST 对照组相比。第二个目的是比较可行性和 TBT 和 DST 的可接受性。参与者人群：拟议研究的参与者 将包括 216 名患有创伤后应激障碍 (PTSD)、重度抑郁症的退伍军人 (MDD)，和/或恐慌症和广场恐惧症 (PD/AG)。一般纳入标准包括： 1) a PTSD、MDD 或 PD/AG 的诊断； 2) 提供的意愿和能力 研究参与的知情同意。使用的程序：随机对照 具有TBT和DST条件的试验（RCT）将完成。参与 RCT 将涉及 完成：1) 同意文件，2) 摄入评估，3) 随机分配 治疗条件，4) 每周 45-60 分钟的心理治疗预约，持续 12 周，以及 5）自我报告的精神症状学评估和摄入时的损伤，中期 治疗、治疗后和6个月的随访。还将调查过程变量。 对退伍军人医疗保健的预期影响：经调查并得到支持的功效 与 DST 相比，TBT 具有非劣效性，将代表一种极好的治疗选择 DVA 提供易于传播和实施的单一协议 提供者以及有效解决精神病症状和相关问题 患有各种抑郁/焦虑症和相关合并症的退伍军人的损伤。