Cognitive-Behavioral Couples Therapy for Posttraumatic Stress Disorder

描述(申请人提供)：创伤后应激障碍(PTSD)是一种非常普遍和有害的疾病，经常有慢性病程。与慢性创伤后应激障碍相关的深远和破坏性的人际关系问题可能会维持或加剧其进程。这些问题也可能会干扰成功的治疗提供，并可能被解决，以提高治疗依从性、治疗效果和维持成果。由于这些原因，一些临床医生和研究人员呼吁将重要的其他人纳入创伤后应激障碍的治疗。为了改进慢性创伤后应激障碍及其更广泛的功能障碍的治疗，R34探索性研究基金的总体目标是改进和调整创伤后应激障碍的手册认知-行为夫妇疗法(CBCT)，并针对延迟治疗条件对其进行测试。该项目第一阶段的目标是(1)完善现有的创伤后应激障碍CBCT手册；(2)制定治疗保真度衡量标准；(3)通过治疗一系列10对夫妇中的一人被诊断为慢性创伤后应激障碍，最终确定评估方案。这一阶段将确保治疗有足够的灵活性，以处理一系列受创伤的个人和夫妇，并确保它具有进行对照试验的必要要素。该项目的第二阶段包括对改进的治疗进行随机对照试验，以确定其疗效并估计其他干预参数。样本将由40对社区夫妇组成，其中包括一名被诊断为慢性创伤后应激障碍的人。这些夫妇将被随机安排立即接受治疗，或者被放在等待接受治疗的名单上。初步的假设是，CBCT治疗创伤后应激障碍将比延迟治疗对照更有效地减少临床医生访谈所衡量的整个创伤后应激障碍症状。二次和探索性假设涉及创伤后应激障碍的症状、共病情况、伴侣结局和CBCT中即时与延迟治疗条件的关系功能的改善。计划在三个月时对创伤后应激障碍的即刻CBCT进行无控制的随访评估，并在延迟治疗组中复制初步结果。这一系列研究的长期目标是通过一项R01赠款资助的研究，与最先进的个人创伤后应激障碍治疗进行比较，进行CBCT治疗创伤后应激障碍的第三阶段试验。创伤后应激障碍(PTSD)非常普遍，给个人、他们的亲人和社会带来了巨大的代价。目前的项目旨在开发一种治疗创伤后应激障碍的夫妇疗法，以减少个别创伤后应激障碍症状，并改善幸存者的亲密关系功能和亲密伴侣的福祉。希望这种治疗最终将减少这一重大和日益严重的公共卫生问题的流行率和负担。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) is a highly prevalent and pernicious disorder, with a frequently chronic course. There are far-reaching and devastating interpersonal relationship problems associated with chronic PTSD than can maintain or aggravate its course. These problems can also interfere with successful treatment delivery, and may be addressed to improve treatment compliance, efficacy of treatment, and maintenance of gains. A number of clinicians and researchers have called for the inclusion of significant others in PTSD treatment because of these reasons. In an effort to improve upon the treatment of chronic PTSD and its broader functional impairments, the overall goal of this R34 Exploratory Research Grant is to refine and adapt a manualized Cognitive-Behavioral Couples Therapy (CBCT) for PTSD, and to test it against a delayed treatment condition. Phase 1 of the project aims to (1) refine the existing CBCT for PTSD manual; (2) develop a treatment fidelity measure; and (3) finalize the assessment protocol by treating a series of 10 couples in which one member of the couple is diagnosed with chronic PTSD. This phase would ensure that the treatment is sufficiently flexible to address a range of traumatized individuals and couples, and that it has the necessary elements for conducting a controlled trial. Phase 2 of the project consists of a randomized controlled trial of the refined therapy to determine its efficacy and estimate other intervention parameters. The sample will consist of 40 community couples including one person diagnosed with chronic PTSD. The couples will be randomized to receive the therapy immediately or be placed on a waiting list to receive the treatment. The primary hypothesis is that CBCT for PTSD will be more efficacious than the delayed treatment control in reducing overall PTSD symptoms, as measured by clinician interview, across treatment. Secondary and exploratory hypotheses relate to improved self-reported PTSD symptoms, co-morbid conditions, partner outcomes, and relationship functioning in the CBCT for PTSD immediately versus delayed treatment condition. An uncontrolled follow-up assessment of the immediate CBCT for PTSD condition at three months, and a replication of the primary results in the delayed treatment group are planned. The longer-term goal of this line of research is to conduct a Stage III trial of CBCT for PTSD compared to state-of-the-art individual PTSD treatment through an R01 grant-funded study. Posttraumatic Stress Disorder (PTSD) is highly prevalent, and comes at great cost to individuals, their loved ones, and society. The current project aims to develop a couples treatment for PTSD that would decrease individual PTSD symptoms, as well as improve the survivor's intimate relationship functioning and the well- being of their intimate partner. It is hoped that this treatment will ultimately decrease the prevalence and burden of this significant and growing public health problem.