Improving Veteran Functioning with Intensive Transdiagnostic CBT for Anxiety

通过针对焦虑的强化跨诊断 CBT 改善退伍军人的功能

• 批准号: 10554233
• 负责人: Ellen Teng
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10554233
• 关键词: Address; Anxiety; Anxiety Disorders; Behavior Therapy; Clinical; Clinical Trials; Cognitive Therapy; Data; Disease; Dropout; Effectiveness; Environmental Risk Factor; Equilibrium; Evaluation; Family; Family member; Generalized Anxiety Disorder; Geographic Locations; Health; Heterogeneity; Hour; Impairment; Interview; Life; Longevity; Measures; Mental Depression; Mental Health; Mental Health Services; Methods; Occupational; Outcome; Panic; Panic Disorder; Participant; Patients; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Process; Productivity; Protocols documentation; Psychotherapy; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Reporting; SF-12; Schools; Self Care; Severities; Social Anxiety Disorder; Social Functioning; Symptoms; Therapeutic Intervention; Time; Trauma; Veterans; War; Work; base; clinical care; community involvement; community reintegration; comorbidity; compare effectiveness; data format; demographics; depressive symptoms; effectiveness testing; emotional functioning; evidence base; experience; flexibility; follow-up; improved; improved functioning; innovation; military service; novel; operation; overtreatment; post-traumatic stress; primary outcome; psychiatric comorbidity; recruit; secondary outcome; service member; skills; social; social anxiety; standard care; symptomatic improvement; treatment arm; treatment as usual; treatment effect; treatment of anxiety disorders

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.

背景 在所有战争时代的退伍军人中，焦虑和创伤频谱障碍非常普遍， 在社会和职业功能以及生活质量差的情况下造成重大损害 整个生命周期。创伤后应激障碍，恐慌，社交焦虑和普遍的焦虑 疾病与健康，生活质量，人际交往和 职业功能。许多具有心理健康问题的退伍军人遇到困难的报告 在社会功能，生产力，社区参与和自我保健方面。虽然认知 用于基于焦虑疾病的行为疗法（CBT）是非常有效的常规CBT 格式需要3到4个月才能完成，这通常是退伍军人的障碍 需要大量时间离开工作，学校和其他重要的生活活动。因此， 相对较少的退伍军人接受并完成治疗。初步数据支持可行性， 有效性以及强化周末治疗形式的可接受性并显示 功能和临床结果的改善。 目标 当前的项目建议评估一个简短但密集的经诊断CBT 同时靶向有或没有同时发生抑郁症的多种焦虑症。这 将通过评估一种直接的创新治疗方法来完成 解决与标准心理治疗相关的障碍。主要目标是 （1）确定一个周末交付的密集CBT协议（ICBT）是否可以改善 与标准CBT相比，社区重新融合，生活质量和情感功能 （SCBT）和照常治疗（tau）； （2）检查心理疗法参与的率 ICBT与SCBT相比； （3）通过定性获得更深入的理解 与退伍军人及其家人的访谈，有关ICBT和环境因素的访谈 影响重新融合和生活质量的过程。 方法 拟议的研究是一项带有3个治疗臂的随机对照试验。经诊断 将以标准的压缩周末格式（ICBT）比较组CBT协议 涉及每周3个月的课程（SCBT）的小组交付格式。照常治疗 （TAU）将包括（TAU）以比较结果。有一个或多个焦虑的退伍军人 基于或有或没有同时发生的抑郁症的疾病将随机分为 三个治疗臂。在此期间，将要求退伍军人参加总共四项评估 研究包括基线评估，1个月，3个月和6个月的随访。定性 将对完成ICBT和家人的退伍军人进行访谈。