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

项目描述（由申请人提供）：该项目的目标是进行第二阶段临床试验，以研究婚姻检查（MC）的有效性和安全性，这是一种针对有婚姻恶化和离婚风险的治疗回避夫妇的预防性干预措施。除了婚姻恶化和离婚所固有的痛苦外，这些过程还与严重抑郁症、药物滥用、家庭暴力、身体疾病、医疗依从性较差以及儿童身心健康状况较差的风险增加有关。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。处于这种危险阶段的夫妇不太可能寻求治疗，因为他们还没有痛苦到足以看到需要，或者因为治疗的障碍太大。这类夫妇也不寻求婚前干预，因为他们是正式婚姻。然而，正是在高危阶段，夫妇可能从早期干预中受益最多。对处于这一危险阶段的夫妇进行干预，填补了预防计划提供的痛苦接种和夫妇治疗提供的强化治疗之间的空白。目前还没有经验建立的方案，在关系恶化的过程中进行早期干预。MC是第一个这样的计划。第一个目标是确定MC作为识别和提供早期干预的手段的有效性，避免治疗的夫妇有婚姻恶化和离婚的风险。其目的是证明有婚姻恶化风险的避免治疗的夫妇将被吸引参加MC。第二个目标是确定MC作为一种手段，从可能阻碍有效的婚姻健康行为，特别是缺乏亲密，合作和动机改变的婚姻痛苦的症状提供即时救济的功效。第三个目标是确定MC作为激励适当寻求帮助的手段的有效性。第四个目标是确定婚姻互助会作为预防婚姻恶化/离婚及其后遗症的一种手段的效力。MC应促进夫妻努力改善婚姻健康，这反过来又应阻止和扭转关系恶化，否则他们会经历，以及减轻婚姻痛苦对伴侣的精神，身体和儿童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.