Improving Access to Services with an Intensive Weekend Treatment for Panic

描述（由申请人提供）： 对退伍军人医疗保健的预期影响：本研究探索了一种创新的方法，为最近返回的患有恐慌症并居住在农村社区的退伍军人提供认知行为治疗。这项研究的潜在影响很高，作为一个简短而密集的周末干预焦虑克服了许多寻求帮助的障碍，在传统的心理社会治疗方法，目前在大多数VA设置。项目背景：恐慌症是该国最令人衰弱和代价最高的焦虑症之一，并伴有许多令人痛苦的身体和心理症状。恐慌的后果包括药物和物质滥用/依赖，社会和情感功能障碍，职业问题和增加的社会退缩。研究表明，许多从伊拉克和阿富汗返回的美国军事人员由于时间和财政限制、无法获得即时护理（特别是那些生活在农村地区的人）以及与精神疾病相关的耻辱感而不寻求治疗。不幸的是，焦虑症的标准心理社会治疗需要多次预约，而且通常发生在大多数人上学或上班的一周内，这进一步导致服务利用不足。项目目标：目前的项目建议审查在三个农村门诊部对患有恐慌症的返回服务人员实施强化治疗的可行性。具体目标是（1）与利益相关者进行焦点小组讨论，以确定与在每个诊所提供治疗相关的潜在障碍;（2）根据获得的信息调整治疗，以增强其在现有计划结构中的适应性;（3）通过在三个地点中的每个地点提供一个周末来试点调整后的治疗。项目方法：三个焦点小组将与管理人员，提供者和病人在三个社区为基础的门诊诊所，服务于生活在农村地区的退伍军人。访谈的重点是收集关于在其设施提供为期两天的强化治疗的可行性的信息，这些信息将用于调整现有的治疗方案。简短的循证干预包括两个6小时的治疗日，将在每个研究中心的一个周末提供。预计三个研究中心的总样本量为15名退伍军人。样本将包括目前诊断为惊恐障碍的持久自由行动/伊拉克自由行动（OEF/OIF）退伍军人。本研究将排除物质依赖、精神病、双相情感障碍和重度抑郁症患者。评估将在治疗前后一周通过电话进行，并包括3个月的随访。将使用配对样本t检验计算和分析主要结局变量（包括惊恐发作的频率和严重程度）的效应量。还将评估治疗满意度和生活质量。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: This study explores an innovative method of delivering cognitive-behavioral treatment for recently returning Veterans who have panic disorder and live in rural communities. The potential impact of this study high, as a brief and intensive weekend intervention for anxiety overcomes many help-seeking barriers inherent in conventional psychosocial treatment approaches currently offered in most VA settings. Project Background: Panic disorder ranks among one of the most debilitating and costly anxiety disorders in the country and is accompanied by a host of distressing physical and psychological symptoms. Consequences of panic include medication and substance abuse/dependence, social and emotional dysfunction, vocational problems, and increased social withdrawal. Research indicates that many U.S. military personnel returning from Iraq and Afghanistan do not seek treatment because of time and financial constraints, inability to access immediate care (particularly those living in rural areas), and stigma associated with mental illness. Unfortunately, standard psychosocial treatments for anxiety disorders require multiple appointments and usually occur during the week when most people are in school or at work, which further contributes to the underutilization of services. Project Objectives: The current project proposes to examine the feasibility of implementing an intensive treatment for returning service members with panic disorder in three rural outpatient clinics. The specific aims are to (1) conduct focus groups with stakeholders to identify potential barriers associated with offering the treatment at each clinic; (2) Adapt the treatment to enhance its fit within existing program structures based on information obtained; and (3) pilot the adapted treatment by offering it over a single weekend at each of the three sites. Project Methods: Three focus groups will be conducted with administrators, providers, and patients at three community based outpatient clinics that serve Veterans living in rural areas. The interviews will focus on gathering information regarding the feasibility of offering an intensive two-day treatment at their facilities, which will be used to adapt the existing treatment protocol. The brief evidence-based intervention consists of two, 6-hour days of treatment and will be offered over a single weekend at each site. The total sample expected across the three sites will be 15 Veterans. The sample will consist of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with a current diagnosis of panic disorder. Persons with substance dependence, psychosis, bipolar disorder and severe depression will be excluded from the study. Assessments will be conducted over the telephone one-week before and after treatment, and include a 3-month follow-up. Effect sizes for the primary outcome variables consisting of frequency and severity of panic attacks will be calculated and analyzed using paired samples t-tests. Treatment satisfaction and quality of life will also be evaluated.