A Randomized Clinical Trial Comparing Transdiagnostic Behavior Therapy to Disorder-Specific Psychotherapy in the Recovery of Veterans with Social Anxiety Disorder and Comorbid PTSD Symptomatology

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Relevance of Research Plan: Social Anxiety Disorder (SAD) is found in nearly 10% of Veterans and is associated with impaired social, emotional, mental health, and general health functioning and with more than a three-fold increase in risk for suicidal ideation. Veterans with SAD also evidence substantial psychiatric comorbidity, especially with posttraumatic stress disorder (PTSD), with Veterans with comorbid SAD-PTSD demonstrating significantly worse quality of life and increased risk for lifetime suicide attempts compared to Veterans with PTSD without SAD comorbidity. However, despite advances in evidence-based psychotherapies, Veterans with SAD are under-identified and report poor engagement in VA treatment settings, due in part to diagnostic comorbidity and social impairments and avoidance. In addition to noted benefits in dissemination and implementation, recent developments in transdiagnostic psychotherapies, and Transdiagnostic Behavior Therapy (TBT) more specifically, may provide benefits for Veterans with SAD. TBT is designed to address overall psychiatric well-being and rehabilitation, without limiting treatment to a single psychiatric diagnosis, via reengagement in significant activities, relationships, and community involvement that are typically avoided due to psychiatric symptomatology. To date, studies of TBT have shown the treatment to be effective in reducing impairment across multiple domains of functioning (e.g., health, work, and social and family relationships) in Veterans presenting with a wide range of diagnoses and comorbidities. Although preliminary findings for TBT in patients with SAD have been promising, TBT has yet to be systematically studied in Veterans with SAD and in Veterans with SAD-PTSD comorbidity, representing an excellent candidate to address these socially and emotionally disabling conditions in the VA and promote improved recovery in Veterans. Primary Aims in Research Plan: The proposed study aims to: 1) compare TBT and disorder-specific psychotherapy (DST) in improving impairment and social reintegration as well as reducing psychiatric symptomatology, and 2) compare the access, feasibility, and acceptability of TBT and DST. Participant population: The participants of the proposed study will include 264 VA patients with comorbid SAD and PTSD symptomatology. Procedures to be used: A randomized controlled trial (RCT) with TBT and DST condition (Cognitive Behavioral Therapy for SAD) 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 60-minute appointments of 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 compared to DSTs, TBT will represent an excellent treatment option within the VA in terms of providing a single 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 SAD and other emotional disorders and related comorbidities.