A cognitive-behavioral couples therapy specially targeted at posttraumatic stress disorder helped improve symptoms and increased patient satisfaction within the relationship.
"There is increasing recognition that intimate relationships play a potent role in recovery from PTSD, its comorbid symptoms, and the psychosocial impairments that accompany it," Candice M. Monson, Ph.D., and her colleagues wrote in the Aug. 15 issue of JAMA. "Cognitive behavioral conjoint therapy may be used to efficiently address individual and relational dimensions of traumatization and might be indicated for individuals with PTSD who have stable relationships and partners who are willing to engage in treatment with them."
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Dr. Monson, professor of psychology at Ryerson University in Toronto, examined the efficacy of an intervention called cognitive-behavioral conjoint therapy, which stressed education, communication, and conflict resolution. She and her associates randomized 40 couples to either the 3-month PTSD program or a wait list. The primary end point was change on the CAPS (Clinician-Administered PTSD Scale). Secondary end points included change on the PTSD Checklist, the DAS (Dyadic Adjustment Scale), the BDI (Beck Depression Inventory), and the State-Trait Anxiety Inventory (JAMA 2012;308:700-9).
The participants were a mean of 40 years old and had been married for 5-8 years. Causes of PTSD included adult or childhood sexual trauma, noncombat physical assault, motor vehicle collision, witnessing or learning about death or illness, and combat-related issues. Time since the trauma ranged from 44 years to fewer than 12 months. Many of the partners with PTSD also had at least one comorbid condition, including mood disorder (up to 90%), anxiety disorder (50%), and substance abuse or dependence (45%).
The intervention consisted of 15 sessions covering three psychosocial realms; the sessions were held twice a week. Phase 1 targeted learning about PTSD and its relational effects. Phase 2 focused on enhanced communication. Phase 3 challenged couples to actively improve their relationships by putting these new skills to work. Couples also were followed for an additional 3 months to determine whether improvements could be maintained.
At the conclusion of the treatment period, PTSD symptom severity had decreased almost three times as much as it did in the control arm. Partner relationship satisfaction had improved four times more. There were also gains in the secondary end points of depression, anger, and anxiety.
After the 3-month follow-up period, 81% of couples reported sustained gains in PTSD symptoms and 81% no longer met the criteria for a PTSD diagnosis. All of the couples reported satisfaction with their relationship.
The investigators cautioned, however, that the relatively high partner satisfaction reported at baseline might have skewed the results somewhat. There was "little evidence of differences between the [intervention group] and the wait list in partner-reported relationship satisfaction, and partners’ ratings of PTSD symptom improvements were not as consistent with the clinicians’ ratings," they said.
Past research in this area yielded more partner-rated benefits, which were similar to those observed by clinicians, wrote Dr. Monson and her coauthors.
The study was sponsored by the National Institute of Mental Health. Dr. Monson had no financial declarations. Dr. Najavits reported no financial disclosures.