Effectiveness of a unified transdiagnostic treatment in routine clinical care

描述（由申请人提供）：就个人和医疗保健系统的成本而言，焦虑和情绪诊断是慢性和破坏性的，并且比任何其他类型的疾病更普遍。当这些疾病同时出现时，重大的公共卫生影响和社会成本就会加剧。尽管治疗方案之间存在较高的合并症发生率和潜在的机制相似性，针对这些疾病的基于单一疾病证据的心理治疗方案传统上被推荐按顺序治疗情绪障碍。此外，当临床医生面对复杂的病例报告时，他们往往没有准备好进行治疗，并偏离循证方法，这可能会增加精神卫生系统的负担。情绪障碍跨诊断治疗统一方案（UP）是一项创新的跨诊断方案，有希望成功治疗情绪障碍，包括独立和共病表现，包括未另行指定（NOS）障碍的分类。迄今为止，只有UP的疗效试验，这限制了普遍性，并且没有解决更大的公共卫生影响和常规临床护理环境中精神和医学合并症的有效性。为了解决这一关键限制，申请人提出了试点可行性，可接受性和

DESCRIPTION (provided by applicant): Anxiety and mood diagnoses are chronic and devastating with respect to costs to the individual and the healthcare system, and are more prevalent than any other class of disorders. When these disorders present concurrently, the significant public health implications and societal costs are intensified. Despite high rates of comorbidity and underlying mechanistic similarities between treatment protocols, single disorder evidence- based psychotherapy protocols for these disorders have traditionally been recommended to treat emotional disorders sequentially. Moreover, when clinicians are presented with complex case presentations, they are often unprepared to treat them and move away from evidence-based approaches, potentially increasing the burden on the mental health system. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an innovative transdiagnostic protocol with promising evidence for successful treatment of emotional disorders, both for standalone and comorbid presentations, including the classification of not otherwise specified (NOS) disorders. To date, there have only been efficacy trials of the UP, which limit generalizability and do not address the larger public health impact and effectiveness in routine clinical care settings with both psychiatric and medical comorbidity. To address this critical limitation, the applicant proposes a pilot feasibility, acceptability, and tolerability study of the UP in patients with diverse psychiatric and medical comorbidity to manualized supportive therapy within a hospital. The deployment focused model (DFM) will inform design and statistical analyses. An additional aim includes determining the feasibility, acceptability, perceived fit and satisfaction of the UP in clinic settings through surveying and interviewing stakeholders in the system that are implementing the UP through the study. Consultation with stakeholders can minimize the time required to collect and assess fit within the larger system and, therefore, minimizes the time lag between science and practice in routine care settings. This study addresses an important public health concern by examining the effectiveness of the UP in a new population as a strategy for treatment of common and debilitating mental disorders in routine care settings. Furthermore, the proposed research aims will complement a comprehensive training plan to prepare the applicant to become an independent investigator with expertise in implementation science and effectiveness research. Results from the study will provide important information about whether or not this efficacious treatment can be effective, efficient, and ready for implementation in routine care settings in which psychiatric and medical comorbidity are common. This study will also serve as a model of deploying efficacious treatments into generalist clinics.