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

一项随机临床试验，比较跨诊断行为疗法与特定障碍心理疗法在患有社交焦虑症和共病 PTSD 症状的退伍军人康复中的作用

• 批准号: 10746930
• 负责人: Daniel F. Gros
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2027-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746930
• 关键词: Address; Aftercare; Appointment; Behavior Disorders; Behavior Therapy; Client satisfaction; Clinical; Cognitive Therapy; Consent Forms; Development; Diagnosis; Diagnostic; Disease; Dissemination and Implementation; Distress; Emotional; Emotional disorder; Family Relationship; Feeling suicidal; Goals; Health; Healthcare; Impairment; Improve Access; Intake; Investigation; Major Depressive Disorder; Measures; Mental Depression; Mental Health; Outcome; Panic Disorder; Participant; Patient Self-Report; Patients; Penetration; Personal Satisfaction; Population; Post-Traumatic Stress Disorders; Procedures; Process; Protocols documentation; Provider; Psyche structure; Psychiatric Diagnosis; Psychotherapy; Quality of Life Assessment; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Reporting; Research; Research Support; Social Anxiety Disorder; Social Functioning; Suicide attempt; Symptoms; Training; Veterans; Well in self; Work; acceptability and feasibility; alternative treatment; community involvement; comorbidity; comparative efficacy; design; efficacy evaluation; emotional functioning; evidence base; follow-up; functional disability; improved; lifetime risk; primary care setting; psychiatric comorbidity; psychiatric symptom; psychologic; randomized, clinical trials; satisfaction; social; social anxiety; social relationships; suicidal risk; symptomatology; trial comparing; trial design

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.

研究计划的相关性：近10％的社交焦虑症（SAD） 退伍军人，与社会，情感，心理健康和一般健康相关 功能，自杀念头的风险增加了三倍以上。退伍军人 SAD还证明了大量精神病合并症，尤其是在创伤后压力的情况下 障碍（PTSD），与合并症的退伍军人表现出明显更糟 与PTSD的退伍军人相比 没有悲伤的合并症。但是，尽管基于证据的心理治疗方面取得了进步，但 SAD的退伍军人被识别得很少，报告在VA治疗环境中的参与度不佳， 部分原因是合并症，社会障碍和避免。除了 传播和实施的好处，转诊的最新发展 心理疗法和经诊断行为疗法（TBT）更具体地提供 悲伤的退伍军人的好处。 TBT旨在解决整体精神病健康和 康复，没有将治疗限制为单一的精神诊断，通过重新接触 重要的活动，关系和社区参与通常是由于 精神症状学。迄今为止，TBT的研究表明该治疗是有效的 减少功能多个领域的损害（例如，健康，工作和社会 和家庭关系）在退伍军人中表现出广泛的诊断和 合并症。尽管在SAD患者中对TBT的初步发现很有希望，但 TBT尚未在患有SAD和SAD-PTSD的退伍军人的退伍军人中进行系统的研究 合并症，代表一个在社交和情感上解决这些问题的绝佳候选人 在VA中禁用条件并促进退伍军人的恢复。主要目标 研究计划：拟议的研究旨在：1）比较TBT和特定于疾病的研究 心理治疗（DST）在改善障碍和社会重返社会以及减少 精神病症状和2）比较TBT的访问，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 VA 合并性SAD和PTSD症状的患者。要使用的过程： 具有TBT和DST条件的随机对照试验（RCT）（认知行为疗法 为了悲伤）将完成。参与RCT将涉及以下完成：1）同意 文件，2）摄入评估，3）随机分配治疗条件，4）每周 60分钟的心理治疗任命12周，5）自我报告评估 摄入量，中等治疗，后，质量生活，社会重返社会和精神病学症状学 治疗和6个月的随访。对退伍军人卫生保健的预期影响： 与DST相比，具有支持疗效的调查，TBT将代表一个极好的 在提供易于传播的单一协议方面，VA内的治疗选项 提供和实施提供商以及有效解决功能障碍的有效性， 社交重返社会和精神病症状学，并改善了退伍军人的机会 具有悲伤和其他情绪障碍和相关合并症。