This K23 Mentored Patient-Oriented Career Development Award application is to request support for Dr. Dalrymple's development as an independent investigator specializing in combined treatment trials (psychotherapy plus pharmacotherapy) for patients with complicated presentations of depression. The short- term goal of this award is to develop and evaluate the feasibility and acceptability of a psychosocial intervention to augment pharmacotherapy for patients with comorbid Major Depressive Disorder (MDD) and Social Anxiety Disorder (SAD), as this comorbidity pattern is highly prevalent yet undertreated in routine psychiatric settings. The training goals of this application include: 1) obtain further experience in treating this population by developing an integrated behavioral treatment;2) receive training in the development of psychosocial interventions for MDD;3) obtain training in the pharmacological treatment of MDD and SAD to prepare for future combined treatment trials;4) develop skills in the implementation of treatment research in routine practice settings;5) receive formal training in advanced longitudinal data analytic methods as applied to clinical trials;6) expand grant writing and manuscript preparation skills;and 7) obtain further knowledge of ethical and multicultural issues related to treatment outcome research. These goals will be accomplished through mentorship provided by Drs. Zimmerman and Miller as well as other consultant mentors, completion of coursework, seminars, and clinical experiences, and implementation of the proposed research project. The 5- year research plan will include the development of a psychosocial treatment integrating behavioral and acceptance-based techniques to augment pharmacotherapy for patients with comorbid MDD-SAD, called Depression and Social Anxiety Treatment (DASAT). The goals of this research project are to: 1) develop a treatment manual for DASAT by conducting an initial open trial (n=20);2) conduct a randomized controlled pilot study comparing pharmacotherapy-as-usual (PAU;n=15) to pharmacotherapy-as-usual plus DASAT (PAU+DASAT;n=15), to examine the feasibility and acceptability of the intervention;3) develop a therapist training program;4) develop and test therapist adherence and competence scales;and 5) refine DASAT and study procedures to prepare for a larger clinical trial.
The proposed project will result in substantial public health benefit because it will be developed for and tested in a routine practice setting, where the prevalence of comorbid Major Depressive Disorder and Social Anxiety Disorder is highest and improved treatments for it are needed. In addition, the treatment will target overall functioning and quality of life as well as symptoms, and will be designed to augment pharmacotherapy, further increasing its public health impact.
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