根據(jù)文章的背景資料：“有充分的記錄顯示，PTSD與親密關(guān)系問題——包括關(guān)系窘迫和侵犯——之間是有聯(lián)系的，而研究證明某一方存在PTSD癥狀與另一方的照顧者負(fù)擔(dān)和心理困擾有關(guān),。”
加拿大多倫多瑞爾森大學(xué)的Candice M. Monson, Ph.D.及其同事開展了一項研究對PTSD采取一種旨在檢驗認(rèn)知-行為結(jié)合療法（CBCT）對PTSD的功效,，該療法是為了治療PTSD及其癥狀并增進配偶間親密關(guān)系爾設(shè)計的,。這一在2008-2012年間開展的隨機對照試驗包括了異性及同性配偶（n = 40 名配偶; n = 80 名個人）,；根據(jù)臨床醫(yī)生執(zhí)行的PTSD量表，這些配偶中有一方符合PTSD的標(biāo)準(zhǔn),。評估者在研究開始時,、治療中（中位數(shù)[中點]為基線狀態(tài)之后8周）及治療后（中位數(shù)為基線狀態(tài)后16周）收集了有關(guān)PTSD癥狀、并發(fā)疾病及關(guān)系滿意度等數(shù)據(jù),。一個沒有對照的為期3個月的隨訪也得以完成,。配偶被隨機分配立刻參加15次的按照PTSD規(guī)程進行的認(rèn)知-行為結(jié)合治療(n = 20) 或被列在治療的等待名單上（n = 20）。
研究人員發(fā)現(xiàn),，與等待名單上者相比,，參加配偶治療者的PTSD癥狀的嚴(yán)重性和病人的親密關(guān)系滿意度得到了更為顯著的改善。同時,，與等待治療名單上者相比,，變化比率（其計算為：將從治療前至治療后的接受CBCT者的情況改變除以同期的在等待名單上的人的情況改變）表明，接受CBCT者從治療前至治療后的PTSD癥狀的嚴(yán)重性下降了幾乎3倍多,，而病人報告的關(guān)系滿意度增加了4倍多,。
相對于等待名單上的人，接受CBCT者的抑郁癥,、一般性焦慮及憤怒表達癥狀等繼發(fā)性后果也得到了更多的改善,。
文章的作者寫道：“這一隨機對照的試驗提供了配偶療法可有效治療PTSD和伴發(fā)癥狀，以及改善親密關(guān)系滿意度的證據(jù),。這些改善出現(xiàn)在一個配偶樣本中,，在該樣本中的患者在有關(guān)性、經(jīng)歷的創(chuàng)傷類型及性取向上都不相同,。對PTSD及伴發(fā)癥狀治療效果大小的估計與那些接受PTSD個別心理治療者相比,，其效果相當(dāng)或更好。此外,，病人報告的關(guān)系滿意度的改善與先前嘗試配偶療法的關(guān)系窘迫配偶的改善情況一致或更好,，且比那些旨在增進非關(guān)系窘迫配偶關(guān)系運作的干預(yù)治療的改善情況更強,。”（生物谷Bioon.com)
doi:10.1001/jama.2012.9307
PMC:
PMID:
Effect of Cognitive-Behavioral Couple Therapy for PTSD
Candice M. Monson, Steffany J. Fredman, Alexandra Macdonald, Nicole D. Pukay-Martin, Patricia A. Resick, Paula P. Schnurr
Context 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.
Objective 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.
Intervention 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).
Main Outcome Measures 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.
Results 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.
Conclusion 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.
