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（DVA）的一个优先领域是 为抑郁症/焦虑症提供快速、有效、以恢复为导向的治疗， 代表退伍军人中最常见和最有害的精神疾病。认知 行为疗法（CBT）已被证明在治疗抑郁/焦虑方面具有可靠的疗效 残疾人权利委员会的工作重点是为残疾人及其相关缺陷提供服务，并鼓励他们重新融入社会。然而，在这方面， CBT未得到充分利用，这在很大程度上是由于疾病特异性的复杂性和数量。 治疗（DST）跨疾病，以及广泛的培训，需要将其应用于 不同的诊断以及不同的诊断与不同的合并症。此外该 DST的重点和他们对按疾病隔离患者的要求限制了分组的使用 DVA中的CBT及其对患者获得和重返社会的既定好处。最近， 跨诊断行为疗法（TBT）是在DVA开发的，以解决整体 退伍军人的精神健康和康复，而不限于单一的治疗， 精神病诊断对TBT的初步研究表明，治疗有效地减少了 多个功能领域的障碍，包括健康和饮食，工作和财务 退伍军人的情况，娱乐和社区参与，以及社会和家庭关系 诊断范围很广，包括抑郁症，焦虑症， 创伤后应激障碍和相关的合并症。此外，最近的一项研究表明，技术性贸易壁垒可能 易于传播给DVA提供者并在DVA患者中实施。尽管另外 需要研究技术性贸易壁垒中的跨诊断方法，包括新开发的小组技术性贸易壁垒 （G-TBT），可能会解决目前的许多限制的DST，并导致改善 患有PTSD和/或抑郁症的退伍军人的结果。研究计划的主要目标： 拟议的研究旨在：1）测试G-TBT和组DST（G-DST）在改善 残疾和重返社会，以及减少精神疾病，和2） 比较G-TBT和G-DST的可及性、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PTSD的DVA患者 和/或重度抑郁症。使用的程序：随机对照试验（RCT） 与G-TBT和G-DST的条件将完成。参与RCT将涉及 完成：1）知情同意文件，2）摄入评估，3）随机分配 治疗条件，4）每周90分钟的团体心理治疗，持续12周， 和5）自我报告的生活质量评估，社会重新融入，和精神病 入组时、治疗中期、治疗后和6个月随访时的肾脏病学。预期 对退伍军人医疗保健的影响：根据支持疗效和非 与G-DST相比，G-TBT将是一种极好的治疗选择， DVA在提供易于传播和实施的单个组协议方面 以及有效地解决功能障碍，社会 重新融入社会和精神病康复，并改善退伍军人的机会， 各种抑郁症/焦虑症和相关合并症。

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.