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

研究计划的相关性：退伍军人事务部的一个优先领域是 为抑郁症/焦虑症提供快速、有效、面向康复的治疗， 代表了退伍军人中最常见和最严重的精神障碍。认知 行为疗法(CBT)在治疗抑郁/焦虑方面显示出可靠的疗效。 此外，儿童基金会还将继续关注精神障碍及其相关的损害，并鼓励重新融入社会。然而， CBT未得到充分利用，在很大程度上是由于特定于障碍的复杂性和数量 跨障碍的治疗(DST)，以及将其应用于 不同的诊断以及不同的诊断有不同的合并症。此外， DST的重点及其按障碍隔离的要求限制了群体的使用 DVA中的CBT及其对患者探视和重新融入社会的既定好处。最近， 跨诊断行为疗法(TBT)是在DVA中开发的，旨在全面解决 退伍军人的精神健康和康复，不限于单一治疗 精神病学诊断。对技术性贸易壁垒的初步研究表明，这种治疗在减少 多个功能领域的损害，包括健康和饮食、工作和财务 退伍军人的处境、娱乐和社区参与以及社会和家庭关系 出现了广泛的诊断，包括抑郁障碍，焦虑症， 创伤后应激障碍，以及相关的并发症。此外，最近的一项研究表明，技术性贸易壁垒可能会 易于传播到DVA提供者，并在DVA患者中实施。尽管增加了 需要研究，技术性贸易壁垒的跨诊断方法，包括新开发的团体技术性贸易壁垒 (G-TBT)，可能会解决目前DST的许多局限性，并导致改进 患有创伤后应激障碍和/或抑郁症的退伍军人的结局。研究计划的主要目标： 本研究的目的是：1)检验G-TBT和团体DSTs(G-DSTs)在改进方面的等价性 损害和重新融入社会以及减少精神症状，以及2) 比较G-TBT和G-DST的接入性、可行性和可接受性。参与者 人群：拟议研究的参与者将包括208名患有创伤后应激障碍的DVA患者 和/或严重的抑郁障碍。使用的程序：随机对照试验(RCT) 有了G-TBT和G-DSTS，条件就完成了。参与区域合作伙伴关系将包括 完成：1)同意文件，2)摄入量评估，3)随机分配到 治疗条件，4)每周90分钟的集体心理治疗，为期12周， 以及5)对生活质量、重新融入社会和精神疾病的自我报告评估 服药时、治疗中期、治疗后和6个月随访时的症状学。预期的 对退伍军人卫生保健的影响：基于支持疗效和非有效性的调查 与G-DST相比，G-TBT将是一种极好的治疗选择 在提供易于传播和实施的单一组协议方面的DVA 由提供者提供，并有效地解决功能障碍、社会 重返社会和精神症状学，以及改善退伍军人与 各种抑郁/焦虑障碍和相关的共病。

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.