Tesi sul tema "Trauma-focused cognitive behavioural therapy"

This review aims to examine literature on psychological interventions in the adult acute inpatient settings, with a particular focus on Cognitive Behavioural Therapy (CBT) groups. It outlines the challenges in creating a therapeutic environment on acute psychiatric wards and presents CBT groups developed and introduced in various services across the UK. It is clear that standard interventions, as available in outpatient settings, cannot be applied in the acute units. CBT groups on the wards prove to be popular among clients and staff. They are also seen as meaningful by clinical psychologists. However, popularity is not considered as the same as clinical effectiveness, and so there is a need for more research in this area.

Reliving is an integral part of trauma-focused CBT, a recommended treatment for PTSD with a convincing evidence base supporting its use. However, the literature suggests that clinicians are reluctant to use reliving in therapy. Very few studies have explored clients' experiences of undergoing CBT for PTSD, and it seems none have specifically at reliving. The aim of this study was to explore participants' experiences of undergoing reliving as part of CBT for PTSD and help clinicians understand how clients experience this central element of treatment.

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) addresses relationship distress by facilitating the development of new patterns of interaction between partners. These new patterns of interaction are based on partners' vulnerable acknowledgement and expression of attachment needs. Partners' engagement in these new patterns of interaction is thought to improve their relationship-specific attachment bond. Although previous studies have shown EFT to result in excellent relationship satisfaction outcomes (Johnson, Hunsley, Greenberg & Schindler, 1999), research had yet clearly to demonstrate if and how EFT facilitates increases in partners' relationship-specific models attachment security over the course of therapy. To address this research gap, the current study employed Hierarchical Linear Modelling (HLM; Singer & Willet, 2003) to investigate the pattern of change in couples' (n=32) self-reported relationship satisfaction and relationship-specific attachment over the course of EFT. Couples reported significant linear increases in their relationship satisfaction and significant linear decreases in their relationship-specific attachment avoidance over the course of therapy. Couples who completed the blamer-softening therapeutic change event (n=16) demonstrated significant linear decreases in their relationship-specific attachment anxiety after completing this event. Decreases in relationship-specific attachment anxiety predicted increases in couples' relationship satisfaction over the course of therapy. Couples also demonstrated significant increases in the security of their pre-post-therapy relationship-specific attachment behaviour, as coded Secure Base Scoring System (Crowell, Treboux, Gao, Fyffe, Pan & Waters, 2002). The current study also used HLM (Singer & Willet, 2003) to examine how the completion of blamer-softening impacted softened couples' relationship-specific attachment anxiety, and whether the completion of blamer-softening had a similar impact on softened couples' relationship-specific attachment avoidance and relationship satisfaction. Softened couples reported an immediate increase in relationship satisfaction and immediate decrease relationship-specific attachment avoidance at the softening session. Further, softened couples' post-softening decreases in relationship-specific attachment anxiety were initially preceded by an increase at the softening session. These results provided an understanding of how EFT leads to increases in couples' relationship-specific attachment security. These results provide support for the use of attachment theory in the treatment of relationship distress, and also provide an illustration of how attachment can shift over the course of a therapeutic intervention.

Past research indicates a causal relationship between emotional writing and health benefits (Smyth, 1998). At present, little is known about the mechanisms underlying change or if the emotional writing paradigm may be applied to a clinical setting. This present study reviewed current models of trauma and hypothesised three mechanisms of change leading to future health benefits: exposure, devaluation, and benefit-finding. Instructions for the standard writing paradigm were manipulated to isolate and increase engagement with each of these processes. It was hypothesised that if any one of these processes were to underlie health benefits, participants assigned to that condition would obtain more benefit than standard writing participants. Individual differences were also hypothesised to interact with each process to amplify or detract from their influence in leading to future benefit. A total of 201 university students were recruited from Griffith University. Participants were assigned to one of five writing conditions: Control, Standard, Exposure, Devaluation, and Benefit-Finding. Sessions were conducted once a week for three weeks. Physiological and self-report measures were taken before, during and after writing sessions. Follow-up assessments of psychological and physical health were taken at 2 and 6-months post-writing. Essay content analysis suggested that participants wrote in the instructed manner. Participants assigned to each of the groups experienced expected amounts of distress and affect changes. Overall, results failed to replicate the beneficial health effects for the standard emotional writing paradigm. There were no significant physical or psychological benefits for the standard trauma-writing participants in comparison to control. However, a trend in the appropriate direction was noted for illness visits at 6-months. Furthermore, in support of Greenberg and Stone's (1992) findings, standard writing participants who disclosed more severe and personal experiences evidenced significant illness visit reductions in comparison to control. Comparisons between standard and experimental trauma writing groups failed to support hypotheses that any one mechanism was responsible for physical health benefits. Examination of psychological self-report measures indicated exposure participants experienced the greatest reduction on the Impact of Events Scale at two months. However, these participants experienced greater reduction of positive affect and growth for the experience. They also became more anxious, depressed, and stressed at six-months follow-up. Process variables were examined within the exposure condition to explain these findings. Habituation was found to be strongly associated with the alternate outcomes. Individual differences. Including alexithymia, absorption, and negative affect, were also related to outcome. Benefit-finding participants experienced the greatest increase on a measure of post-traumatic growth at two-months and positive affect for the experience, but the finding was significant only in comparison to exposure and devaluation groups. The results of this study failed to identify the process of change, but suggest specific areas for future research. The findings demonstrate the importance of comprehensive health research to avoid blanket statements that suggest a paradigm either does or does not lead to health benefits. The results also support the manipulation of the writing paradigm to examine the role of emotion processing in trauma and health research.

John, an urban African male who developed post traumatic stress disorder (PTSD) following an armed robbery at the petrol station where he worked, was treated with 12 sessions of Trauma-focused cognitive behaviour therapy. Intervention involved a combination of psycho-education, prolonged imaginal exposure, cognitive restructuring and behavioural assignments. This article is a systematic case study of his treatment which included a comprehensive narrative and tracking of progress by means of the Post traumatic Diagnostic Scale. John responded well to the treatment, finding it acceptable and credible and remained free of PTSD symptoms at 15 months follow up. It is argued, based on the principles of Elliott’s Hermeneutic Single Case Efficacy Design, that there is evidence from within the narrative that it was the treatment that led to remission of symptoms. This case study demonstrates the cognitive, emotional and behavioural processes underlying John’s PTSD, which fits with those extensively described in the research literature, and that this evidence-based treatment developed in a westernised context is transportable to work with urban Africans.

Critical Review of the LiteratureCan Borderline Personality Disorder be treated effectively in forensic settings? A systematic reviewBorderline Personality Disorder (BPD) is a common diagnosis in forensic settings. Certain features of BPD, such as impulsivity and emotional dysregulation, can create a vulnerability to impulsive acts. The condition is also associated with poor mental and physical health, making the treatment of BPD and its clinical features an important goal in forensic settings. This paper reviews evidence for the effectiveness of treating BPD and its symptoms using psychological approaches in forensic settings. A systematic search found 2913 papers, of which 13 met the inclusion criteria. The papers reported nine separate studies (six controlled) that implemented four distinct interventions, often adapted for particular forensic settings. Improvements in overall BPD symptomatology and specific BPD symptoms were reported for all types of intervention, although few differences in outcome between intervention and control groups were found. There were also reported improvements in BPD-related behaviours, but data on offending behaviour were absent. Heterogeneity in study quality and design makes it challenging to draw any firm conclusions about the effectiveness of any one form of treatment over another, nor about which treatment may best suit a particular setting. Further randomised controlled trials are needed to answer these questions. Service Improvement ProjectEvaluation of a brief educational intervention for clinical staff aimed at promoting trauma-informed approaches to careThere is growing evidence that trauma plays an important role in the aetiology of severe and enduring mental health problems. Yet staff can be reluctant to ask patients about trauma for reasons such as anxiety about harming patients and limited access to training. Where services have adopted trauma-informed approaches (TIAs) to mental health care (i.e., considering the ways in which trauma affects individuals when planning and delivering services), improved clinical outcomes have been observed. With this in mind, a new educational video was developed for mental health staff at an NHS trust. The video was intended to be (a) brief (10 minutes); (b) contemporary and engaging; and (c) accessible using computers, smartphones and tablets. Forty-one multidisciplinary staff viewed the video. Quantitative and qualitative evaluation indicated improvements in self-reported knowledge and confidence with regard to trauma, and a decrease in worries with regard to asking patients about such experiences. Participants found the video to be enjoyable, understandable and informative. Importantly, many indicated that it spurred them to further action, such as further training and asking patients about possible trauma. These findings indicate that a video of this type can offer an important ‘taster’ of trauma-related learning, constituting an important step towards embedding trauma-informed ways of working at a service. Main Research ProjectThe Role of Intrusive Imagery in Hoarding DisorderThe cardinal feature of Hoarding Disorder (HD) is persistent difficulty discarding possessions, with the resulting clutter compromising the intended use of living areas. Within the dominant cognitive-behavioural model of hoarding (Frost & Hartl, 1996), hoarding behaviours are positively and negatively reinforced in the context of certain object-related beliefs. Available treatments for HD have so far yielded modest outcomes, indicating a need for new approaches. Intrusive imagery has so far been neglected in HD research, despite the frequency of trauma in the histories of people with the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about their everyday experiences of mental imagery. Participants were also asked about the images they experienced during two recent real-life examples of actual or attempted discard of (1) an object of low subjective value; and (2) an object of high subjective value. Everyday imagery in the HD group commonly reflected themes of illness, death and reminiscence. Imagery in HD participants tended to carry negative emotional valence in comparison with CCs, and was associated with greater interference in everyday life and attempts to avoid the imagery. HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD participants experienced positive imagery when discarding, or trying to discard, high value objects. These findings indicate that although people with HD frequently report traumatic histories, this is not reflected in the everyday imagery that they experience. There is some evidence to suggest that the negative and positive memories experienced in relation to low and high value objects may aid our understanding of discarding and saving behaviour in HD. The theoretical and clinical implications of these findings are further discussed.

Volume 1 of this thesis examines the predictors of response to trauma-focused treatment for posttraumatic stress disorder (PTSD). It is presented in three parts. Part 1 is a literature review of research evaluating the impact of trauma-focused therapy for PTSD on comorbid symptoms of depression. The Downs and Black (1998) checklist was used to assess study quality. Results indicated that both trauma-focused CBT and EMDR treatments were effective in reducing comorbid depression symptoms. However, as interventions varied widely and some studies were affected by significant methodological problems, the generalisability of these results may be limited, and thus areas for further research are also suggested. Part 2 is an empirical study exploring early in-session client and therapist factors that predict later response to treatment. Audio and video recordings of the first or second therapy session of 54 known treatment responders or non-responders were blind-rated for client perseverative thinking, therapist adherence and therapeutic alliance. Results revealed that more perseverative thinking was observed for non-responders than responders to treatment. No group differences were found in regards to therapist adherence or therapeutic alliance. Exploratory analyses revealed that across the sample as a whole, perseverative thinking was associated with reduced therapist adherence to the treatment manual and poorer therapeutic alliance. As this study is one of the first of its kind in this area, recommendations were made for future research opportunities to explore these findings further. Part 3 is a critical appraisal of the empirical study. This elaborates on the main findings of this project and discusses the methodological challenges involved in undertaking this type of research, particularly developing and applying a novel coding frame.

Background & objective Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) have been the treatment of choice for problem or pathological gambling in the field in Western countries, and their efficacy has been supported by a considerable empirical research. Alternative treatments are little known; and such treatments for minority ethnic populations have been scarce. This study adopted Kazdin‘s procedures for assessing the acceptability of treatments (Kazdin, 1980a, 1980b, 1981) to test alternative treatments of problem or pathological gambling as a part of the broadening of treatment choices. This thesis presented 2009 survey results from counselling service providers in New Zealand on the acceptability of alternative treatments to problem or pathological gambling. The thesis, therefore, reports the responses of counsellors to counselling vignette case examples, not the views of actual clients viewing counselling. Methods The survey pack was distributed to counselling service providers in New Zealand. The survey included descriptions of sixteen vignettes of case examples of counselling treatments. Categories of clients in the vignette case examples included two genders (male, female) and three ethnicities (Pakeha, Maori, and Asian). Four counselling treatment conditions were selected from Solution-Focused Brief Counselling (SFBC), SFBC+Multicultural Counselling (SFBC+MC), Cognitive-Behavioural Therapy (CBT), and Motivational Interviewing (MI). CBT and MI were only administered to Pakeha clients for the purpose of comparison of the alternatives. Two measurements were used. The first a modified Problem Gambling Treatment Evaluation Inventory (TEI) was used to measure the acceptability levels of the alternative treatments for problem or pathological gambling. The Cross-Cultural Counselling Inventory-Revised (CCCI-R) was used for measuring the perceived cross-cultural competency of counsellors depicted in the vignette case examples. Findings Counsellors‘ ratings of the vignette case examples revealed the following findings: Measurement 1: Problem Gambling Treatment Evaluation Inventory (TEI). Overall, 1) The survey results of TEI questionnaires showed significant main effects across the four treatment conditions and the three client ethnicities, and there was no difference according to client genders. 1.1) SFBC+MC and SFBC were slightly more acceptable than CBT, and much more acceptable than MI. 1.2) The TEI scores for Pakeha clients were much higher than for Maori clients, and the scores for the Asian clients were in between. 2) There was a significant interaction effect between the four treatments and the three client ethnicities. 2.1) For Maori clients: SFBC+MC was much more acceptable than SFBC; for Pakeha clients: SFBC+MC was the most acceptable, closely followed by SFBC, CBT, then MI; and for Asian clients: SFBC was more acceptable than SFBC+MC. 2.2) SFBC+MC was most acceptable to Maori clients across all treatments and ethnic groups. 2.3) The variation in acceptability ratings for SFBC was larger than for SFBC+MC in Maori and Asian clients, and less variable in Pakeha. 2.4) Maori clients had the largest mean variation between SFBC and SFBC+MC, and Pakeha clients had the smallest mean variation. Measurement 2: Cross-Cultural Counselling Inventory-Revised (CCCI-R). The survey results of the CCCI-R showed significant main effects across the four treatment conditions and the three ethnicities. 1) The counsellors depicted in the vignette case examples under the SFBC+MC treatment condition were rated with the highest mean competence score and least variability across all the treatments and the ethnicities, the MI treatment condition were rated with the lowest mean score, CBT and SFBC were in between. 2) The counsellors described in the vignette case examples were rated more culturally competent with Pakeha clients and Maori clients than with Asian clients in the vignette case examples, the rating levels for both Pakeha and Maori were similar. 3) The Maori client in the vignette case examples had the largest mean gap between SFBC and SFBC+MC, and Pakeha client in the vignette case examples had the smallest mean gap. Clinical implications The tests of the acceptability of alternative treatment for problem or pathological gambling could provide useful information about 1) whether the above alternatives would be recommended or selected by the counselling service providers in their clinical practice, 2) which treatment would be more/less preferred by which ethnic group, 3) whether it would work or be worth the efforts to introduce or promote the above alternatives to the counselling service providers, 4) what needs to be explored for increasing levels of the acceptability of alternative treatment to problem or pathological gambling, 5) adding training in the techniques to counsellors training programme and curricula. The limitation of this study was discussed and future research was suggested.

An alarming portion of youth experience traumatic events during childhood, and there is a robust body of literature documenting the adverse consequences of trauma exposure on the developing child. Fortunately, numerous empirically-supported phase-based interventions have been developed for youth that target the deleterious effects of trauma. While several of these interventions have demonstrated symptom reduction from the baseline to completion of treatment, much less is known regarding the trajectory of posttraumatic stress symptoms (PTSS) during the course of treatment. Information in this regard may have important implications for service delivery and help to illuminate the mechanisms of change responsible for treatment outcomes. Furthermore, gender-related differences in the prevalence and expression of PTSS following trauma exposure have been observed, but the reasons for these differences is unclear and there is a paucity of research concerning whether boys and girls may progress differently through trauma-focused treatment. As a result, the aims of this study were to (1) examine the progression of PTSS during the various components of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); (2) assess whether symptoms progress differently for males and females; (3) examine whether (a) sexual abuse history or (b) age moderates any gender-related symptom differences identified; and (4) explore the trauma narratives of boys and girls. This study utilized an embedded sequential mixed methods design. For the quantitative strand, aggregate scores on the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) were mapped for the entire sample and then according to gender at baseline, during various components of TF-CBT, and at termination among a sample (N = 138) of polyvictimized youth ages 7-18 who completed TF-CBT at a university-based child trauma treatment clinic. Mixed Analysis of Variance (ANOVA) analyses were conducted for each of the outcome measures (UCLA-PTSD RI overall, arousal, avoidance, and intrusion scores) to examine whether there were symptom differences between males and females from baseline to completion of TF-CBT, and 2 X 2 full factorial ANOVAs were conducted to determine whether sexual violence history or age moderated the relationship between gender and symptom severity during any phase of TF-CBT. For the qualitative strand, trauma narratives (N = 16) completed during TF-CBT were analyzed through the use of thematic analysis. Findings revealed that males and females reported differences in PTSS symptoms from baseline to termination of treatment, and during various phases of treatment. Additionally, thematic analysis of the trauma narratives augmented findings from the quantitative strand and revealed variations in the narratives of males and females. Although further investigation is warranted, study findings help to further understand the complex interplay between gender and the progression of PTSS during treatment. Implications for practice, policy and social work education are discussed.

In South Africa sexual abuse has reached pandemic proportions and continues to increase in the sense that thousands of people are being sexually abused every day and the long term effects of sexual abuse are there to stay. These long term effects are imprinted in the pre-verbal dynamics of the living body and they can appear at any time in the present upon a conscious trigger. This research study seeks to investigate the effectiveness of two therapeutic modalities which are Philophonetics counselling and Trauma Focused Cognitive Behavioural Therapy in the treatment of sexually abused individuals within the South African context. Philophonetics counselling extends the therapeutic conversation into the nonverbal dimension of human communication, which enables the client to go beyond the limitations of verbal expression and access directly feelings, emotions, reactive patterns, old defenses and new potential embedded in the deep layers of the living body. It is a method of exploration, expression, and transformation of inner experiences, since words are limited in the amount of our experience that they convey. Trauma-Focused Cognitive Behavioural Therapy is a type of intervention modality that represents a synthesis of traumasensitive interventions and well established CBT (Cognitive Behavioural Therapy) principles developed from the Cognitive Behavioural school of Psychology.

This study investigated temporal patterns of therapeutic alliance development across treatment and their relationship to outcome, and the relationship between client attachment styles and interpersonal problems and alliance strength and patterns across treatment. Sixty-six clients diagnosed with major depression participated in one of two 16-week treatment conditions: Process-experiential therapy and Cognitive-behavioural therapy. Results revealed two alliance “shape” patterns; Stable Linear and Steep Linear-Quadratic, as well as two alliance “shape and level” patterns; High Strength Linear-Quadratic and Low-to-Mid Strength Stable. Results indicated that the two alliance “shape” patterns did not differentially predict treatment outcome. With respect to “shape and level” patterns, results revealed that clients with a High Strength Linear-Quadratic alliance pattern had better treatment outcomes than clients with a Low-to-Mid Strength Stable alliance pattern. In terms of client attachment style, results indicated that clients with a Steep Linear-Quadratic “shape” pattern report more discomfort with closeness at pre-treatment. Further, clients with a High-Strength Linear-Quadratic “shape and level” pattern report more confidence and less need for approval at pre-treatment. With respect to client interpersonal problems, results revealed that clients with a Steep Linear- Quadratic “shape” pattern report being more cold and distant at pre-treatment and clients with a Low-Mid Strength Stable “shape and level” pattern report being more socially inhibited, less assertive, and more overly-accommodating at pre-treatment. Lastly, results revealed that specific client attachment characteristics and interpersonal problems differentially predict total average alliance strength as well as the average strength of the client and therapist bond across treatment.

Dissertação de mestrado em Psicologia Aplicada
O principal objetivo deste estudo consiste na avaliação do impacto do Momento de Inovação de reconceptualização no resultado terapêutico. Mais especificamente, avaliar se a reconceptualização na fase final do processo terapêutico prediz a mudança sintomatológica na última sessão. Para este efeito, foi utilizada uma amostra composta por 20 casos, com o diagnóstico de depressão major, acompanhados em Terapia Focada nas Emoções e Terapia Cognitiva-Comportamental. A codificação da reconceptualização envolveu o uso do Sistema de Codificação da reconceptualização e a mudança sintomatológica foi medida através do Outcome Questionnaire 45.2 e do Beck Depression Inventory II. Os dados obtidos foram analisados através de uma regressão linear simples que mostrou existir uma relação estatisticamente significativa entre a ocorrência da reconceptualização na fase final da terapia e a mudança sintomatológica. Ou seja, os clientes que apresentam maior proporção de reconceptualização na fase final do tratamento têm menor probabilidade de apresentarem sintomatologia clínica significativa na última sessão. Desta forma, os resultados obtidos corroboram dados anteriormente obtidos em outros estudos, que demonstram que a reconceptualização parece desempenhar um papel fundamental na mudança terapêutica.
The main purpose of this study consists in the evaluation of the impact of reconceptualization Innovative Moment (IM) in the therapeutic outcome. More specifically, the current study aims to evaluate if reconceptualization, in the final phase of the therapeutic process, predicts symptomatic change in last session of therapy. For this purpose, we used a sample of 20 cases with the diagnosis of major depression disorder treated with emotion-focused therapy or cognitive-behavioural therapy. The reconceptualization coding system was used to analyse reconceptualization IMs, and symptomatic change was measured by the Outcome Questionnaire 45.2 and Beck Depression Inventory II. A simple linear regression showed a statistically significant relationship between the occurrence of reconceptualization in the final phase of therapy and symptomatic change in the final session. More specifically, the clients that have higher proportion of reconceptualization IMs at the end of treatment present less significant clinical symptomatology in the last session. These results confirm the previous data obtained in previous studies, which shows the relevant role reconceptualization IMs play in therapeutic change.

La vestibulodynie provoquée (VP) est la forme la plus répandue de douleur génito-pelvienne/trouble de la pénétration et la cause la plus fréquente de douleur vaginale chez les femmes pré-ménopausées. Les femmes qui en souffrent rapportent plus de détresse psychologique ainsi qu’un fonctionnement sexuel appauvri, une diminution de la fréquence des activités sexuelles et du plaisir, et plus d’attitudes négatives à l’égard de la sexualité. Les recherches portant sur les couples souffrant de VP ont montré le rôle prépondérant des variables relationnelles dans la modulation des conséquences sexuelles et psychologiques pour les femmes et leurs partenaires. Cependant, aucune analyse dyadique n’a été appliquée au facteur de risque étiologique le plus robuste, soit la maltraitance durant l’enfance. Par ailleurs, malgré des recommandations répétées pour inclure le partenaire dans le traitement psychologique pour la VP, aucune étude à ce jour n’a examiné l’efficacité d’une psychothérapie qui inclut systématiquement le partenaire et dont la cible est le couple. L’objectif général de cette thèse a été d’utiliser une perspective dyadique afin d’examiner les antécédents de maltraitance et l’efficacité d’une intervention conçue pour améliorer les issues des couples souffrant de VP. Le premier article vise à examiner les liens entre la maltraitance durant l’enfance des femmes souffrant de VP et leurs partenaires, et leur fonctionnement sexuel, leur ajustement psychologique, leur satisfaction conjugale et enfin avec la douleur rapportée par les femmes durant les relations sexuelles. Quarante-neuf couples souffrant de VP ont complété des questionnaires auto-rapportés. La maltraitance durant l’enfance chez les femmes était associée à un fonctionnement sexuel plus faible chez les femmes et les hommes, une augmentation de l’anxiété chez les femmes seulement, et une douleur affective accrue durant les relations sexuelles. La maltraitance durant l’enfance chez les hommes était associée à un fonctionnement sexuel plus faible, moins de satisfaction conjugale, plus d’anxiété chez les femmes et les hommes, et une douleur affective accrue durant les relations sexuelles rapportée par les femmes. En se basant sur les recommandations issues des études empiriques, une thérapie cognitive et comportementale pour les couples (TCCC) souffrant de VP a été développée. Le deuxième article présente les résultats d’une étude pilote testant son efficacité, fidélité et faisabilité potentielles. Neuf couples ont complété des questionnaires auto-rapportés pré- et post-traitement. La TCCC de 12 rencontres était manualisée. Les femmes ont rapporté une amélioration significative de la douleur, du fonctionnement et de la satisfaction sexuels, et les partenaires ont rapporté une amélioration significative de leur satisfaction sexuelle. Les couples ont rapporté des niveaux élevés de satisfaction quant à la psychothérapie, et les psychothérapeutes ont rapporté suivre le manuel de traitement de manière fidèle. Le troisième article, s’appuyant sur les résultats prometteurs de l’étude pilote, décrit le protocole de recherche pour un essai clinique randomisé mesurant l’efficacité de la TCCC comparée à une intervention médicale de première ligne, la lidocaïne topique, pour le traitement de la VP. Enfin, les implications cliniques et théoriques de la thèse sont discutées.
Provoked vestibulodynia (PVD), a chronic, recurrent pain elicited via pressure to the vulvar vestibule or attempted vaginal penetration, is the most common form of pain during intercourse (genito-pelvic pain/penetration disorder), and the most frequent cause of vulvar pain in pre-menopausal women. Because of its deleterious impact on sexuality, it carries a heavy psychosexual burden for afflicted women, who report impoverished sexual function, decreased sexual frequency and pleasure, and more negative attitudes about sex. Research among couples with PVD has demonstrated the prominent role of partner variables in the modulation of PVD-associated consequences for women, and the negative sexual and psychological consequences experienced by partners. Yet, a dyadic analysis has not been applied to the most robust etiological risk factor for adult-onset PVD, childhood trauma or maltreatment. Furthermore, despite repeated recommendations to include the partner in psychological treatment of PVD, no study to date has examined the effectiveness of a treatment that systematically includes the partner and targets the couple. The overarching goal of this thesis was to use a dyadic perspective in examining trauma antecedents of PVD and treatment effectiveness of an intervention designed to improve outcomes for couples with PVD. The first article aimed to examine associations between childhood maltreatment of both women with PVD and their partners and their sexual functioning, psychological adjustment and couple satisfaction, as well as women’s reported pain during sexual intercourse. Forty-nine couples with PVD completed self-report questionnaires. Women’s childhood maltreatment was associated with lower sexual functioning for women and men, increased anxiety for women only, and increased affective pain during sexual intercourse. Male partners’ childhood maltreatment was associated with lower sexual functioning, decreased couple satisfaction and increased anxiety for women and men, and higher affective pain reported by women during sexual intercourse. Drawing from the recommendations in the empirical literature, a Cognitive-Behavioural Couple Therapy (CBCT) for PVD was developed. The second article presents the results from its pilot testing for potential effectiveness, reliability and feasibility. Nine couples completed pre- and post-treatment self-report measures following the 12-session, manualized intervention. Women reported significant improvements in pain, sexual function and satisfaction, and partners reported significant improvements in sexual satisfaction. Exploratory analyses revealed improvements in anxiety, depression and pain-related cognitions, such as pain catastrophizing, for both women and partners. Couples reported high rates of treatment satisfaction and therapists reported good treatment reliability. The third article, building on the promising pilot study results, describes the research protocol for a randomized clinical trial to assess the efficacy of CBCT compared to a first-line medical intervention, topical lidocaine, for the treatment of PVD. In this ongoing trial, couples with PVD are randomized to one of the two treatment options. The clinical and theoretical implications of the thesis are discussed.