Effects of Mindfulness-Based Cognitive-Behavioral Conjoint Therapy on PTSD and Re

描述(由申请人提供)： 5%至15%的退伍军人从伊拉克和阿富汗的部署归来时患有创伤后应激障碍，这些症状对他们生活的许多方面都有不利影响，包括亲密关系。尽管研究结果一直表明，亲密关系障碍的程度与退伍军人创伤后应激障碍症状的严重程度相关，但很少有夫妇干预措施被开发和系统评估。认知行为联合治疗PTSD(CBCT For PTSD)是一种治疗PTSD和关系功能障碍的干预措施，已显示出良好的初步结果。然而，针对创伤后应激障碍的CBCT缺乏训练元意识的具体干预措施，例如那些教授基于正念的压力减轻(MBSR)的干预措施。正念练习有一个新的证据基础，可以在几个重要方面改善创伤后应激障碍和人际关系功能。首先，练习正念会促进放松反应，而放松反应会对抗过度觉醒，并导致对困难和挑战采取更冷静的方法。其次，回避和麻木是通过有意识地允许一个人的经历保持现状，同时暂停判断来抵消的，这与增加同情心和同理心有关。最后，正念支持一种与所有生活经验相处的方式，而不是提供仅用于应对特定困难的技巧，这使个人能够获得他们已经拥有的内在力量。正如许多身体状况需要不止一种康复方法一样，CBCT治疗创伤后应激障碍和正念干预之间可能存在协同作用。正念技能可以帮助个人容忍对其经历的痛苦情绪反应，这反过来可能会增强他们对相关感觉和想法的意识。随着元意识的增强，那些可能维持创伤后应激障碍症状和关系障碍的信念变得更容易接受认知重组。因此，建议拨款的目的是研究创伤后应激障碍基于正念的认知-行为联合治疗(MB-CBCT)对从持久自由和伊拉克自由行动(OEF-OIF)返回的退伍军人的创伤后应激障碍症状和亲密关系功能的影响。拟议的项目包括两个阶段。在第一阶段，正念干预将被整合到创伤后应激障碍认知行为联合治疗手册中。针对创伤后应激障碍的综合干预措施MB-CBCT将提供给10名OIF-OEF退伍军人及其亲密伴侣，以制定和测试培训和监测治疗师的程序。在第二阶段，将对40对OEF-OIF退伍军人夫妇进行随机对照试验，比较MB-CBCT治疗创伤后应激障碍与传授沟通技能的对照条件。我们假设MB-CBCT治疗创伤后应激障碍将在以下方面带来更大的改善：1)退伍军人的创伤后应激障碍症状；2)退伍军人和伴侣的关系功能；以及3)焦虑和抑郁症状。创伤后应激障碍在退伍军人的疾病负担中占很大比例。该项目的长期目标是进行MB-CBCT的全功率随机对照临床试验，以确定其有效性并最终完成治疗手册。 公共卫生相关性： 项目说明和与退伍军人健康的相关性创伤后应激障碍在退伍军人的疾病负担中占很大比例。在最近一项对2001至2005年间在退伍军人事务部卫生保健机构就诊的持久与伊拉克自由行动(OEF-OIF)退伍军人的研究中，创伤后应激障碍是最常见的与兵役相关的心理健康诊断，占接受心理健康诊断的退伍军人的一半以上，占研究中所有OEF-OIF退伍军人的13%(Seal KH等人，2007年)。尽管研究已经证明了创伤后应激障碍和人际关系功能之间的关系，但很少有夫妻干预措施被开发和测试。拟议研究的结果将为政策制定者和临床医生提供科学合理的信息，例如综合正念和认知行为治疗夫妇干预可以预期的临床和康复益处(减少创伤后应激障碍症状和改善关系功能)。拟议的研究还将产生可输出到其他环境中的程序，以便进行复制和进一步改进。

DESCRIPTION (provided by applicant): Between 5 and 15 percent of veterans return from deployment in Iraq and Afghanistan with PTSD and the symptoms adversely affect many aspects of their lives, including intimate relationships. Although research findings consistently suggest that the degree of intimate relationship dysfunction correlates with the severity of veteran's PTSD symptoms, few couples interventions have been developed and systematically evaluated. Cognitive Behavioral Conjoint Therapy for PTSD (CBCT for PTSD) is an intervention developed to treat both PTSD and relationship dysfunction that has shown promising preliminary results. However, CBCT for PTSD lacks specific interventions that train meta-awareness, such as those taught in mindfulness-based stress reduction (MBSR). Mindfulness practices have an emerging evidence base for improving both PTSD and relationship functioning in several important ways. First, practicing mindfulness promotes the relaxation response which counters hyperarousal and results in a calmer approach to difficulties and challenges. Second, avoidance and numbing are countered by mindfully allowing one's experience to be as it is while suspending judgment, which is associated with increased compassion and empathy. Lastly, mindfulness supports a way of being with all life experiences rather than providing techniques just for coping with specific difficulties, which enables individuals to access inner strengths that are already available to them. Just as many physical conditions require more than one rehabilitation approach, there may be a synergy between CBCT for PTSD and mindfulness interventions. Mindfulness skills may assist individuals in tolerating painful emotional reactions to their experiences which may in turn enhance their awareness of associated feelings and thoughts. With enhanced meta-awareness the beliefs that may maintain PTSD symptoms and relationship dysfunction become more amenable to cognitive restructuring. Therefore, the goal of the proposed grant is to examine the effects of a Mindfulness-Based Cognitive-Behavioral Conjoint Therapy for PTSD (MB-CBCT for PTSD) on PTSD symptoms and intimate relationship functioning of veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF-OIF). The proposed project involves two phases. In Phase 1, mindfulness interventions will be integrated within the Cognitive Behavioral Conjoint Therapy for PTSD treatment manual. The integrated intervention, MB-CBCT for PTSD, will be delivered to 10 OIF- OEF veterans and their intimate partners in order to develop and test procedures to train and monitor therapists. During Phase 2, a randomized controlled trial with 40 OEF-OIF veteran couples will be conducted comparing the MB-CBCT for PTSD with a control condition that teaches communication skills. We hypothesize that MB-CBCT for PTSD will lead to greater improvement in: 1) veterans' PTSD symptoms; 2) veterans' and partners' relationship functioning; and 3) anxiety and depression symptoms. PTSD constitutes a substantial proportion of the burden of illness among veterans. The longer term goals of this project are to conduct a fully-powered randomized controlled clinical trial of MB-CBCT to determine its effectiveness and to finalize the treatment manual. PUBLIC HEALTH RELEVANCE: Project Narrative and Relevance to Veterans' Health PTSD constitutes a substantial proportion of the burden of illness among veterans. In a recent study of Operation Enduring and Iraqi Freedom (OEF-OIF) veterans seen at VA health care facilities between 2001 and 2005, PTSD was the most commonly diagnosed military service-related mental health diagnosis, accounting for more than half of the veterans receiving a mental health diagnosis and 13 percent of all OEF-OIF veterans in the study (Seal KH, et al., 2007). Although research has documented a relationship between PTSD and relationship functioning, few couples interventions have been developed and tested. Results of the proposed study will yield scientifically sound information for policy makers and clinicians, such as the kinds of clinical and rehabilitation benefits (reduced PTSD symptoms and improved relationship functioning) that can be expected from an integrated mindfulness and cognitive behavior therapy couples intervention. The proposed study will also produce procedures that may be exported to other settings, allowing for replication and further refinement.