Indicated Treatment and Prevention of Marital Deterioration in At-Risk Couples

项目描述（由申请人提供）：项目目的是开展一项II期临床试验，研究婚姻检查（MC）的有效性和安全性，这是一项针对有婚姻恶化和离婚风险的逃避治疗夫妇的指示性预防性干预措施。除了婚姻恶化和离婚所固有的痛苦之外，这些过程还与严重抑郁症、药物滥用、家庭暴力、身体疾病、较差的医疗依从性以及较差的儿童身心健康的风险增加有关。严重痛苦并最终解除婚姻的夫妇首先要经历一个危险阶段，在这个阶段，他们经历了婚姻恶化的早期症状，但尚未遭受不可逆转的损害。处于这一危险阶段的夫妇不太可能寻求治疗，因为他们还没有变得足够痛苦，看不到治疗的必要性，或者因为治疗的障碍太大。这类夫妇也不寻求婚前干预，因为他们是固定婚姻。然而，正是在有风险的阶段，夫妻可能从早期干预中获益最多。对处于危险阶段的夫妇进行干预，填补了预防项目提供的痛苦接种和夫妻治疗提供的强化治疗之间的空白。目前还没有在关系恶化过程的早期进行干预的经验建立的方案。MC是第一个这样的项目。第一个目标是确定MC作为一种识别和早期干预有婚姻恶化和离婚风险的逃避治疗夫妇的手段的有效性。目的是证明有婚姻恶化风险的逃避治疗的夫妇会被吸引参加婚姻管理。第二个目标是确定婚姻管理作为一种手段的功效，可以立即缓解婚姻痛苦的症状，这些症状可能阻碍有效的婚姻健康行为，特别是缺乏亲密、合作和改变的动机。第三个目标是确定MC作为激励适当寻求帮助的手段的功效。第四个目标是确定管委会在防止婚姻恶化/离婚及其后遗症方面的效用。婚姻管理委员会应促进夫妻改善婚姻健康的努力，这反过来应阻止和扭转他们可能经历的关系恶化，并减轻婚姻痛苦对伴侣精神、身体和子女健康的已知负面影响。

DESCRIPTION (provided by applicant): The project objective is to conduct a Phase II clinical trial to study the efficacy and safety of the Marriage Checkup (MC), an indicated preventive intervention for treatment-avoidant couples at-risk of marital deterioration and divorce. In addition to the suffering inherent in marital deterioration and divorce, these processes have been associated with increased risk of major depression, substance abuse, domestic violence, physical illness, poorer medical treatment adherence, and poorer child mental and physical health. Couples that become severely distressed and eventually dissolve their marriages first pass through an at-risk stage in which they experience early symptoms of marital deterioration but have not yet suffered irreversible damage. Couples in this at-risk stage are unlikely to seek treatment because they have not yet become distressed enough to see the need or because the barriers to therapy are too great. Such couples also do not seek premarital interventions because they are in established marriages. However, it is during the at-risk stage that couples may benefit most from early intervention. Intervening with couples in this at-risk stage fills a niche between the distress inoculation provided by prevention programs and the intensive treatment provided by couple therapy. There are currently no empirically established programs for intervening early in the process of relationship deterioration. The MC is the first such program. The first objective is to determine the efficacy of the MC as a means of identifying and providing early intervention with treatment-avoidant couples at-risk for marital deterioration and divorce. The objective is to demonstrate that treatment-avoidant couples at-risk of marital deterioration will be attracted to participate in the MC. The second objective is to determine the efficacy of the MC as a means of providing immediate relief from the symptoms of marital distress that may hinder effective marital health behaviors, specifically lack of intimacy, collaboration, and motivation to change. The third objective is to determine the efficacy of the MC as a means of motivating appropriate help seeking. The fourth objective is to determine the efficacy of the MC as a means of preventing marital deterioration/divorce and their sequelae. The MC should facilitate couples' efforts to improve their marital health, which in turn should arrest and reverse relationship deterioration that they would otherwise experience, as well as alleviate the known negative effects of marital distress on partners' mental, physical, and children's' health.