Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial

DesignA randomised control trial (RCT) was conducted to examine the efficacy of couple-based cognitive behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait-list control.MethodsTriangulation of quantitative and qualitative outcome measures evaluated changes pre-post intervention. Eighty three women were randomly allocated across three conditions, with 63 completing post-intervention measures, a retention rate of 76%.ResultsRepeated measures analysis of variance found a significant time by group interaction identifying that women in the two CBT conditions reported lower total premenstrual symptoms, emotional reactivity/mood, and premenstrual distress, in comparison to the wait list control. Significantly higher active behavioural coping post-intervention was found in the couple condition than in the one-to-one and wait list control groups. Qualitative analysis provided insight into the subjective experience of PMDs and participation in the intervention study. Across groups, women reported increased awareness and understanding of premenstrual change post-intervention. A larger proportion of women in the CBT conditions reported reduction in intensity and frequency of negative premenstrual emotional reactivity, increased communication and help-seeking, increased understanding and acceptance of embodied change, and the development of coping skills, post-intervention. Increased partner understanding and improved relationship post-intervention was reported by a greater proportion of participants in the CBT conditions, most markedly in the couple condition.ConclusionThese findings suggest that one-to-one and couple CBT interventions can significantly reduce women’s premenstrual symptomatology and distress, and improve premenstrual coping. Couple based CBT interventions may have a greater positive impact upon behavioural coping and perceptions of relationship context and support. This suggests that CBT should be available for women reporting moderate-severe PMDs, with couple-based CBT offering additional benefits to a one-to-one modality.研究设计：本研究开展一项随机对照试验（randomised control trial, RCT），旨在对比基于伴侣的认知行为疗法（couple-based cognitive behaviour therapy, CBT）、一对一认知行为疗法与等待列表对照组，评估其针对经前期障碍（Premenstrual Disorders, PMDs）的疗效。 研究方法：采用定量与定性结果指标三角验证法，评估干预前后的变化情况。共计83名女性被随机分配至三个实验组，其中63名完成了干预后测评，保留率达76%。 研究结果：重复测量方差分析显示，存在显著的时间×组间交互作用：相较于等待列表对照组，两种CBT组女性报告的经前期总症状、情绪反应/心境以及经前期痛苦程度均显著更低。干预后，伴侣CBT组的主动行为应对得分显著高于一对一CBT组与等待列表对照组。定性分析深入阐释了经前期障碍的主观体验以及参与本干预研究的感受。各组女性均报告，干预后对经前期变化的认知与理解有所提升。CBT组中更大比例的女性报告，干预后经前期负性情绪反应的强度与频率降低、沟通与求助行为增加、对躯体变化的理解与接纳程度提升，且应对技能得到发展。此外，CBT组中更多参与者报告，干预后伴侣的理解程度提升、伴侣关系得到改善，其中以伴侣CBT组的改善最为显著。 研究结论：上述结果表明，一对一与基于伴侣的CBT干预均可显著减轻女性的经前期症状与痛苦，并提升经前期应对能力。基于伴侣的CBT干预在行为应对以及对伴侣关系背景与支持的感知方面，可能带来更积极的影响。这提示，针对中度至重度经前期障碍的女性，应提供CBT干预，而基于伴侣的CBT相较于一对一治疗模式，可带来额外获益。