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

研究计划的相关性：社交焦虑症(SAD)在近10%的 退伍军人，与社交、情绪、心理健康和一般健康受损有关 而且自杀意念的风险增加了三倍以上。退伍军人与 SAD还证明有大量的精神共病，特别是创伤后应激障碍 精神障碍(PTSD)，伴有SAD-PTSD的退伍军人表现明显恶化 与患有创伤后应激障碍的退伍军人相比，生活质量和终生自杀企图的风险增加 没有SAD合并症。然而，尽管循证心理疗法取得了进展， 患有SAD的退伍军人被低估了，并报告说在VA治疗环境中参与度很低， 部分原因是诊断性共病、社会损伤和回避。除了注意到 传播和实施的好处，跨诊断的最新发展 心理疗法，更具体地说，跨诊断行为疗法(TBT)可能会提供 为患有SAD的退伍军人提供福利。TBT旨在解决整体精神健康问题，并 康复，不局限于单一的精神诊断，通过重新参与 由于以下原因通常会避免的重大活动、关系和社区参与 精神病症状学。到目前为止，对技术性贸易壁垒的研究表明，这种治疗是有效的 在减少跨多个功能领域(例如，健康、工作和社交)的损害方面 和家庭关系)在退伍军人中表现出广泛的诊断和 合并症。尽管SAD患者TBT的初步研究结果令人振奋， TBT在患有SAD的退伍军人和患有SAD-PTSD的退伍军人中尚未得到系统的研究 共病，代表了一个很好的候选人来解决这些社交和情感上的问题 使退伍军人伤残，促进退伍军人康复。主要目标是 研究计划：拟议的研究旨在：1)比较技术性贸易壁垒和特定障碍 心理治疗(DST)在改善损伤和重新融入社会以及减少 精神症状学，以及2)比较技术性贸易壁垒的可及性、可行性和可接受性 和DST。参与者人数：拟议研究的参与者将包括264名退伍军人 伴有SAD和PTSD症状的患者。要使用的程序：A TBT和DST条件下的随机对照试验(RCT) 对于SAD)将完成。参与区域现金转移将涉及完成：1)同意 记录，2)摄入量评估，3)随机分配治疗条件，4)每周 为期12周的60分钟心理治疗预约，以及自我报告评估 高质量生活、重新融入社会和精神症状学在吸食、治疗中期、治疗后 治疗后随访6个月。对退伍军人保健的预期影响： 与DST相比，TBT将代表一种极好的 退伍军人事务部内的治疗选项，提供易于传播的单一方案 并由提供商实施，以及在解决功能障碍方面有效， 重新融入社会和精神症状学，以及改善退伍军人的机会 患有SAD和其他情绪障碍以及相关的合并症。

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.