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

基于正念的认知行为联合疗法对 PTSD 和 Re 的影响

• 批准号: 8856292
• 负责人: Louanne W. Davis
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8856292
• 关键词: Accounting; Address; Affect; Afghanistan; Anxiety; Awareness; Behavioral; Belief; Clinical; Cognitive; Cognitive Therapy; Communication; Compassion; Conflict (Psychology); Couples; Diagnosis; Educational Intervention; Educational process of instructing; Effectiveness; Empathy; Feeling; Freedom; Functional disorder; Goals; Grant; Health; Health care facility; Individual; Intervention; Interview; Iraq; Judgment; Lead; Learning; Life Experience; Manuals; Mental Health; Military Personnel; Monitor; Pain; Patient Self-Report; Phase; Policy Maker; Post-Traumatic Stress Disorders; Procedures; Process; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Rehabilitation therapy; Relaxation; Reporting; Research; Role; Services; Severities; Symptoms; Techniques; Testing; Thinking; Training; Translating; Trauma; Veterans; base; burden of illness; coping; depressive symptoms; emotional reaction; evidence base; experience; functional outcomes; improved; intimate behavior; mindfulness; mindfulness-based stress reduction; operation; physical conditioning; primary outcome; psychoeducation; response; secondary outcome; skills; sound; therapy design

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.

描述（由申请人提供）： 5% 到 15% 的退伍军人从伊拉克和阿富汗部署返回后患有创伤后应激障碍 (PTSD)，这些症状对他们生活的许多方面产生了不利影响，包括亲密关系。尽管研究结果一致表明，亲密关系功能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，但很少有夫妻干预措施被开发出来并进行系统评估。 PTSD 认知行为联合疗法（CBCT for PTSD）是一种为治疗 PTSD 和关系功能障碍而开发的干预措施，已显示出有希望的初步结果。然而，针对 PTSD 的 CBCT 缺乏训练元意识的具体干预措施，例如基于正念减压 (MBSR) 的干预措施。正念练习有一个新兴的证据基础，可以通过几个重要的方式改善创伤后应激障碍和人际关系功能。首先，练习正念可以促进放松反应，从而对抗过度兴奋，并以更平静的方式应对困难和挑战。其次，通过有意识地让自己的经历保持原样，同时暂停判断，可以抵消回避和麻木，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历相处的方式，而不是仅仅提供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，针对 PTSD 的 CBCT 与正念干预之间可能存在协同作用。正念技能可以帮助个人忍受对其经历的痛苦情绪反应，从而增强他们对相关感受和想法的认识。随着元意识的增强，可能维持创伤后应激障碍症状和关系功能障碍的信念变得更容易进行认知重组。因此，拟议拨款的目标是研究基于正念的 PTSD 认知行为联合疗法 (MB-CBCT for PTSD) 对从持久自由行动和伊拉克自由行动 (OEF-OIF) 返回的退伍军人的 PTSD 症状和亲密关系功能的影响。拟议项目分为两个阶段。在第一阶段，正念干预将被纳入创伤后应激障碍认知行为联合疗法治疗手册中。针对 PTSD 的 MB-CBCT 综合干预措施将向 10 名 OIF-OEF 退伍军人及其亲密伴侣提供，以开发和测试培训和监测治疗师的程序。在第二阶段，将对 40 名 OEF-OIF 退伍军人夫妇进行一项随机对照试验，将针对 PTSD 的 MB-CBCT 与教授沟通技巧的控制条件进行比较。我们假设针对 PTSD 的 MB-CBCT 将在以下方面带来更大的改善：1）退伍军人的 PTSD 症状； 2）退伍军人和合作伙伴的关系正常运转； 3）焦虑和抑郁症状。创伤后应激障碍（PTSD）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开展一项全能的 MB-CBCT 随机对照临床试验，以确定其有效性并最终确定治疗手册。