Cognitive-Behavioral Couples Therapy for Posttraumatic Stress Disorder

描述（由申请人提供）：创伤后应激障碍（PTSD）是一种非常普遍和有害的疾病，通常具有慢性病程。与慢性创伤后应激障碍相关的人际关系问题影响深远，可能会维持或加剧其病程。这些问题也会影响治疗的成功实施，可以通过改善治疗依从性、治疗效果和维持治疗效果来解决。由于这些原因，许多临床医生和研究人员呼吁在创伤后应激障碍治疗中纳入重要的他人。为了改善慢性创伤后应激障碍及其更广泛的功能障碍的治疗，本R34探索性研究基金的总体目标是改进和适应创伤后应激障碍的人工认知行为配对疗法（CBCT），并对其进行延迟治疗条件的测试。该项目的第一阶段旨在：(1)完善现有的创伤后应激障碍CBCT手册；(2)制定治疗保真度度量；(3)通过治疗10对夫妇，其中一方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具有足够的灵活性，以解决一系列受到创伤的个人和夫妇，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一项改进疗法的随机对照试验，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，其中一人被诊断患有慢性创伤后应激障碍。这些夫妇将被随机分配，要么立即接受治疗，要么被列入等待治疗的名单。主要假设是，在整个治疗过程中，通过临床医生访谈测量，CBCT治疗PTSD在减少整体PTSD症状方面比延迟治疗控制更有效。次要的和探索性的假设涉及改善自我报告的PTSD症状、共病条件、伴侣结果和关系功能在CBCT中对PTSD立即与延迟治疗条件。计划在三个月时对PTSD的即时CBCT进行无控制的随访评估，并复制延迟治疗组的主要结果。这项研究的长期目标是通过一项R01基金资助的研究，进行CBCT治疗PTSD的第三阶段试验，并将其与最先进的个体PTSD治疗进行比较。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夫妻治疗创伤后应激障碍的方法，以减少个体的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幸福。希望这种治疗将最终减少这一重大和日益严重的公共卫生问题的患病率和负担。

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.