Safety Aid Reduction Treatment for Rural Veterans

This is an intervention pilot project examining the acceptability, feasibility, and utility
of a group-based transdiagnostic treatment delivered to rural Veterans. Approximately 5.2
million Veterans reside in rural communities across the United States, making it difficult
for them to access quality medical and mental health (MH) care. The Department of Veterans
Affairs (VA) established Community Based Outpatient Clinics (CBOCs) to improve access to
healthcare for rural Veterans; however, these clinics often lack MH specialists including
psychiatrists and psychologists, limiting the breadth of specialty services available. As
such, MH care is often delivered by primary care providers or MH clinicians who (a) lack
familiarity with evidence-based interventions and (b) lack the time needed to implement such
intensive therapies. Group-based cognitive behavioral protocols that target a number of
different diagnoses are likely to be more attractive in these settings and therefore more
readily disseminated. Such protocols, often referred to as transdiagnostic treatments, are
based on the theory that emotional disorders share common features and therefore respond to
common therapeutic procedures. One such treatment, termed Safety Aid Reduction Treatment
(START), has received increasing empirical support. This group-based transdiagnostic
treatment is designed to address cognitive and behavioral strategies, otherwise known as
safety aids, that are common across a number of psychiatric conditions (e.g., anxiety
disorders, trauma- and stressor-related disorders, obsessive-compulsive and related
disorders, and depressive disorders) and used to reduce anxiety. START has been found to
effectively reduce psychopathology in community-based clinical samples and more recently
among Veterans at the Southeast Louisiana Veterans Health Care System (SLVHCS). However, the
utility of this treatment has yet to be examined in rural settings. Thus, the primary aim of
the current proposal is to test the acceptability and feasibility of a group-based
transdiagnostic treatment, termed START, delivered to rural Veterans at CBOCs. Because this
is a pilot project, we will not emphasize symptom reduction, as we will likely be
underpowered to detect treatment effects. Nevertheless, a secondary aim of the project is to
examine the utility of START by gathering data on symptom change, which will be used as pilot
data for a subsequent grant proposal. For this pilot project, Veterans (N = 24) will be
recruited from two of the five Southeast Louisiana Veterans Health Care System (SLVHCS)
CBOCs. The anticipated results of the proposed study include: 1) START will be both
acceptable and feasible to Veterans and mental health care providers, alike and 2) START will
lead to meaningful reductions in symptoms of anxiety and depression. Findings from the
current study will help to advance our understanding of the amelioration of anxiety and
depressive disorders among Veterans.

Inclusion Criteria:

- 18 years of age and older

- Veterans must be diagnosed with an emotional disorder (e.g., anxiety disorder,
obsessive-compulsive and related disorder, trauma-and stressor-related disorder,
depressive disorder).

- And be primarily served at a CBOC location.

Exclusion Criteria:

- < 18 years of age

- Currently dependent upon substances and in need of detoxification

- Evidence of active psychosis

- Acutely suicidal or homicidal

- Uncontrolled bipolar disorder (e.g., not stable on medications)