Abstract
A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes—alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes—emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen’s h = 0.74–1.44). Secondary outcomes were also significantly stronger for CCT (Cohen’s h = 0.27–1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14–0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14–0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16–0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients’ satisfaction ratings and counselors’ reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.
摘要
本研究对加拿大的两个省级门诊诊所进行了一项非盲法随机试验，测试了系统一致性伴侣疗法(CCT)与基于个体的常规治疗(TAU)在九个临床结果上的有效性: (1)主要结果–酒精使用和赌博、精神症状和伴侣适应; (2) 次要结果– 情绪调节、药物使用、抑郁、创伤后应激障碍(PTSD)和生活压力。本研究对46例数据进行基线、治疗后(5个月)和随访(8个月)的纵向分析。酒精使用障碍(95%)和赌博障碍(5%)属于严重范围，共同成瘾为27%。精神疾病共病率为100%，共同成瘾夫妇为18%。在组内，有症状的CCT患者和伴侣在所有主要结果上都有改善(效应量= 0.07-0.26)，与大效应量的方差分析结果(效应量= 0.14-0.29) 趋同。所有次要结果在CCT中均有显著改善，且效应量较大(效应量= 0.14-0.50)。TAU在酒精使用、其他物质使用和生活压力方面有显著组内改善，效应量较大(效应量= 0.16-0.40)。在组间比较中，CCT对主要结果具有中到大的效应量(Cohen’s h效应量= 0.74-1.44)。CCT的次要结果也明显更强(Cohen h效应量= 0.27-1.53)。主要来访者和其伴侣与CCT进行了同等的改进。研究结果与来访者满意度评分和咨询师报告进行了三角分析。临床和统计学上均检测到CCT的显着组内效应，组间差异有利于CCT。需要未来的试验来验证这些有希望的发现。