Ryerson University, Department of Psychology, 350 Victoria Ave, Toronto, ON M5B 2K3, Canada.
JAMA. 2012 Aug 15;308(7):700-9. doi: 10.1001/jama.2012.9307.
Posttraumatic stress disorder (PTSD) is a prevalent condition associated with intimate relationship problems, and intimate relationship factors have been shown to affect individual PTSD treatment outcomes.
To compare cognitive-behavioral conjoint therapy for PTSD (a manualized couple therapy delivered to patients with PTSD and their significant others to simultaneously treat PTSD symptoms and enhance relationship satisfaction) with a wait-list condition.
DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of heterosexual and same-sex couples (n = 40 couples; n = 80 individuals) in which one partner met criteria for PTSD according to the Clinician-Administered PTSD Scale, conducted from 2008 to 2012 in a Department of Veterans Affairs outpatient hospital setting in Boston, Massachusetts, and a university-based research center in Toronto, Ontario, Canada. Symptoms of PTSD, comorbid conditions, and relationship satisfaction were collected by blinded assessors at baseline, at mid treatment (median, 8.00 weeks [range, 1.71-20.43 weeks] after baseline), and at posttreatment (median, 15.86 weeks [range, 7.14-38.57 weeks] after baseline). An uncontrolled 3-month follow-up (median, 38.21 weeks [range, 28.43-50.57 weeks] after baseline) was also completed.
Couples were randomly assigned to take part in the 15-session cognitive-behavioral conjoint therapy for PTSD protocol immediately (n = 20) or were placed on a wait list for the therapy (n = 20).
Clinician-rated PTSD symptom severity was the primary outcome and was assessed with the Clinician-Administered PTSD Scale. Intimate relationship satisfaction, assessed with the Dyadic Adjustment Scale, patient- and partner-rated PTSD symptoms, and comorbid symptoms were secondary outcomes.
PTSD symptom severity (score range, 0-136) was significantly more improved in the couple therapy condition than in the wait-list condition (mean change difference, -23.21; 95% CI, -37.87 to -8.55). Similarly, patients' intimate relationship satisfaction (score range, 0-151) was significantly more improved in couple therapy than in the wait-list condition (mean change difference, 9.43; 95% CI, 0.04-18.83). The time × condition interaction effect in the multilevel model predicting PTSD symptoms (t37.5 = -3.09; P = .004) and patient-reported relationship satisfaction (t68.5 = 2.00; P = .049) revealed superiority of the couple therapy compared with the wait list. Treatment effects were maintained at 3-month follow-up.
Among couples in which one partner was diagnosed as having PTSD, a disorder-specific couple therapy, compared with a wait list for the therapy, resulted in decreased PTSD symptom severity and patient comorbid symptom severity and increased patient relationship satisfaction.
clinicaltrials.gov Identifier: NCT00669981.
创伤后应激障碍（PTSD）是一种常见的疾病，与亲密关系问题有关，亲密关系因素已被证明会影响个体 PTSD 治疗的结果。
比较创伤后应激障碍认知行为联合治疗（一种针对 PTSD 患者及其重要他人的手册化夫妻治疗，旨在同时治疗 PTSD 症状和提高关系满意度）与候补治疗。
设计、地点和参与者：2008 年至 2012 年，在马萨诸塞州波士顿退伍军人事务部门诊医院和加拿大安大略省多伦多大学的一个基于研究中心，对符合创伤后应激障碍临床医生管理 PTSD 量表标准的异性恋和同性恋伴侣（n = 40 对；n = 80 人）进行了随机对照试验。创伤后应激障碍的症状、合并症和关系满意度由盲法评估者在基线、治疗中期（中位数 8.00 周[范围 1.71-20.43 周]）和治疗后（中位数 15.86 周[范围 7.14-38.57 周]）进行收集。还完成了不受控制的 3 个月随访（中位数 38.21 周[范围 28.43-50.57 周]）。
夫妻被随机分配立即参加 15 节创伤后应激障碍认知行为联合治疗方案（n = 20）或候补治疗（n = 20）。
临床医生评定的 PTSD 症状严重程度是主要结局，采用临床医生管理 PTSD 量表进行评估。亲密关系满意度采用对偶调整量表评估，患者和伴侣评定的 PTSD 症状和合并症症状为次要结局。
与候补治疗相比，夫妻治疗组 PTSD 症状严重程度（评分范围 0-136）显著改善（平均变化差异-23.21；95%置信区间-37.87 至-8.55）。同样，患者的亲密关系满意度（评分范围 0-151）在夫妻治疗组也显著提高（平均变化差异 9.43；95%置信区间 0.04-18.83）。在多水平模型中，预测 PTSD 症状（t37.5 =-3.09；P =.004）和患者报告的关系满意度（t68.5 =2.00；P =.049）的时间×条件交互效应表明夫妻治疗优于候补治疗。治疗效果在 3 个月随访时仍保持。
在患有 PTSD 的伴侣中，与候补治疗相比，特定于疾病的夫妻治疗可降低 PTSD 症状严重程度和患者合并症症状严重程度，提高患者的关系满意度。
clinicaltrials.gov 标识符：NCT00669981。
