# Increasing the Effectiveness of CBT for Anxiety in Veterans by Involving Family Members.

> **NIH VA I21** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2022 · —

## Abstract

Background
Posttraumatic stress disorder (PTSD) and anxiety disorders such as panic, generalized and
social anxiety are highly prevalent among Veterans of all eras and negatively impact functioning
and quality of life. Avoidance is a hallmark feature of anxiety and functions to maintain the
disorder. Although cognitive behavior therapy (CBT) is effective, a significant proportion of
Veterans show minimal improvement following treatment. This is often due to poor treatment
adherence such as avoidance of using skills taught in CBT that require confronting distressing
memories and feared situations. Avoidance behavior also can extend to caregivers and family
members of Veterans, who may engage in accommodation behaviors (i.e., changing their own
behaviors) to help alleviate distress experienced by their loved ones. As such, accommodation
by family members undermines the effectiveness of CBT and is associated with greater
symptom severity and functional impairment in persons with anxiety.
Objectives
This study will examine the feasibility, acceptability, and satisfaction associated with a new
intervention for family members of Veterans undergoing CBT for anxiety-based disorders.
Adjunctive Family-CBT (AF-CBT) provides family members psychoeducation on anxiety and
teaches skills that can be used to facilitate the recovery of Veterans who are in the process of
completing treatment for anxiety. Aims of the study are to: (1) adapt and refine AF-CBT through
an iterative process that will be informed by feedback from Veterans and family members; (2)
examine the feasibility and acceptability/satisfaction of AF-CBT; (3) assess the validity and
reliability of the Family Accommodation Scale-Anxiety adapted for Veterans and family
members; and (4) examine the associations between family accommodation behavior and
readjustment and anxiety in Veterans.
Methods
The proposed study involves a total of 47 Veterans and family member dyads (V/F dyad) and
will be conducted in two phases. In phase 1, 12 V/F dyads will be recruited, and family members
will receive AF-CBT while the Veteran undergoes iCBT for anxiety. The intervention will be
delivered in three separate cohorts (approximately 4 V/F dyad in each cohort). During the 1-
month assessment, information obtained from qualitative interviews will be used to refine the
intervention in an iterative process with each cohort. In phase 2, 35 V/F dyads will be recruited
and administered the finalized version of AF-CBT following the same treatment and assessment
format. Qualitative interviews will focus on each V/F dyad’s experience with the AF-CBT
intervention and whether specific components of the intervention facilitated the Veteran’s
recovery process.

## Key facts

- **NIH application ID:** 10477667
- **Project number:** 1I21RX003863-01A1
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Ellen Teng
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-07-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10477667

## Citation

> US National Institutes of Health, RePORTER application 10477667, Increasing the Effectiveness of CBT for Anxiety in Veterans by Involving Family Members. (1I21RX003863-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10477667. Licensed CC0.

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