Improving Veteran Functioning with Intensive Transdiagnostic CBT for Anxiety

背景 焦虑和创伤谱系障碍在所有战争时期的退伍军人中非常普遍， 导致社会和职业功能严重受损，生活质量差 在整个生命周期中。创伤后应激障碍、恐慌、社交焦虑和广泛性焦虑 疾病与健康、生活质量、人际关系和 职业功能。许多有心理健康问题的退伍军人报告说， 在社会功能、生产力、社区参与和自我照顾方面。虽然认知 行为疗法（CBT）是一种非常有效的，传统的CBT 格式需要3至4个月才能完成，这往往是退伍军人的障碍，因为它 需要大量的时间远离工作、学校和其他重要的生活活动。因此，在本发明中， 很少有退伍军人接受和完成治疗。初步数据支持可行性， 有效性和可接受性 改善功能和临床结果。 目标 目前的项目建议评估一种简短但密集的跨诊断CBT， 同时针对多种焦虑症，伴或不伴抑郁症。这 将通过评估一种创新的治疗方法来实现， 解决了与标准心理治疗提供相关的障碍。主要目的是 (1)确定在一个周末内交付的密集CBT协议（iCBT）是否可以改善 与标准CBT相比，社区重返、生活质量和情感功能 （sCBT）和常规治疗（TAU）;（2）检查心理治疗参与率， iCBT与sCBT进行比较;（3）通过定性分析， 采访退伍军人及其家庭成员，了解iCBT和环境因素如何可能 影响重返社会进程和生活质量。 方法 拟定研究是一项随机对照试验，有3个治疗组。一种跨诊断 将以压缩周末格式（iCBT）与标准CBT协议进行比较 包括3个月的每周会议（sCBT）的小组交付形式。像往常一样治疗 (TAU)将纳入条件以比较结果。有一种或多种焦虑的退伍军人- 基础疾病（伴或不伴抑郁症）将被随机分配至 三个治疗臂。退伍军人将被要求参加总共四个评估期间， 研究包括基线评价、1个月、3个月和6个月随访。定性 采访将与完成iCBT的退伍军人和家庭成员进行。

Background Anxiety and trauma spectrum disorders are highly prevalent among Veterans from all war eras, causing significant impairment in social and occupational functioning and poor quality of life across the lifespan. Posttraumatic stress disorder, panic, social anxiety, and generalized anxiety disorders are associated with substantial decrements in health, quality of life, interpersonal and vocational functioning. Many Veterans with mental health concerns report experiencing difficulty in social functioning, productivity, community involvement, and self-care. Although cognitive behavioral therapy (CBT) for anxiety-based disorders is highly effective, conventional CBT formats require 3 to 4 months to complete, which is often a barrier for Veterans because it requires substantial time away from work, school, and other important life activities. Thus, relatively few Veterans undergo and complete treatment. Preliminary data support the feasibility, effectiveness, and acceptability of an intensive weekend treatment delivery format and show improvement in functional and clinical outcomes. Objectives The current project proposes to evaluate a brief but intensive transdiagnostic CBT that simultaneously targets multiple anxiety disorders with or without co-occurring depression. This will be accomplished by evaluating an innovative treatment delivery method that directly addresses barriers associated with standard psychotherapy delivery. The main objectives are to (1) determine if an intensive CBT protocol (iCBT) delivered over one weekend can improve community reintegration, quality of life, and emotional functioning compared with standard CBT (sCBT) and treatment as usual (TAU); (2) examine the rates of psychotherapy engagement in iCBT compared with sCBT; and (3) obtain a deeper understanding, through qualitative interviews with Veterans and their family members, of how iCBT and environmental factors may impact the process of reintegration and quality of life. Methods The proposed study is a randomized controlled trial with 3 treatment arms. A transdiagnostic group CBT protocol will be compared in a compressed weekend format (iCBT) with a standard group delivery format involving 3 months of weekly sessions (sCBT). A treatment as usual (TAU) condition will be included to compare outcomes. Veterans with one or more anxiety- based disorder(s) (with or without co-occurring depression) will be randomized to one of the three treatment arms. Veterans will be asked to attend a total of four assessments during the study including a baseline evaluation, 1-month, 3-month, and 6-month follow-ups. Qualitative interviews will be conducted with Veterans who completed iCBT and family members.