# Addressing Mental Health Comorbidities: Integrated CBT to Improve Functioning in Veterans with Co-Occurring Anxiety and Substance Use

> **NIH VA IK2** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2022 · —

## Abstract

Background and significance: Co-occurring hazardous drinking and mental health disorders, particularly
anxiety disorders, is an especially problematic combination experienced by deployed Veterans. Although VA is
a leader in delivering evidence-based mental health treatment, gaps remain in our understanding of how to
best promote psychosocial recovery for Veterans with co-occurring anxiety and hazardous drinking. Veterans
who have been deployed are at particular risk for experiencing problems in functioning and reintegration
related to mental health disorders and alcohol use. Co-occurring anxiety, posttraumatic stress disorder
(PTSD), and hazardous drinking heavily impact psychosocial functioning (including occupational and
relationship functioning) and quality of life. Cognitive behavior therapy (CBT) is an evidence-based
psychotherapy (EBP) for anxiety disorders and hazardous drinking that can promote improvements in
functioning and quality of life. However, many Veterans do not receive CBT for anxiety disorders and/or SUD.
A significant challenge in treating an anxiety disorder or SUD with CBT is that providers most often treat each
disorder separately, often in separate clinics. This results in an inefficient treatment process that leads to poor
outcomes. The Unified Protocol (UP) is a transdiagnostic CBT protocol that effectively treats symptoms of
multiple emotional disorders simultaneously. Adapting the UP to meet the needs of deployed Veterans with co-
occurring anxiety, PTSD, and hazardous drinking has the potential to more efficiently and effectively improve
functioning and reduce symptoms. Given the impact of anxiety, PTSD, and hazardous drinking among
returning Veterans, the research goals of this RR&D CDA-2 proposal support the adaptation of the UP for use
among deployed Veterans with hazardous drinking and examination of its feasibility, acceptability, and
preliminary efficacy. Research Plan: Aim 1: Adapt the UP for treatment of anxiety disorders/PTSD and
hazardous drinking among deployed Veterans (UP-A). This will be achieved using established iterative
intervention development strategies, including incorporating stakeholder feedback in the development of the
intervention. Feedback from stakeholders will include qualitative interviews key stakeholders (clinicians,
Veterans). Aim 2: Evaluate deployed Veterans’ experience using UP-A through a non-randomized pilot trial (N
= 10) and qualitative interviews with Veterans and revising the intervention based on findings to ensure
Veteran-centricity, Veteran satisfaction, feasibility, and acceptability. Veterans will be recruited from VA
treatment settings and provided UP-A by study clinicians. Veterans will complete measures of functioning and
symptoms before and after receiving the intervention. Aim 3: Explore the feasibility, acceptability, and
preliminary effect of UP-A on functioning outcomes, anxiety and PTSD symptoms, and alcohol use through a
pilot randomized controlled trial. Deplo...

## Key facts

- **NIH application ID:** 10508510
- **Project number:** 5IK2RX003520-02
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Anthony Ecker
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10508510

## Citation

> US National Institutes of Health, RePORTER application 10508510, Addressing Mental Health Comorbidities: Integrated CBT to Improve Functioning in Veterans with Co-Occurring Anxiety and Substance Use (5IK2RX003520-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10508510. Licensed CC0.

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