A Closer Examination of Relational Outcomes from a Pilot Study of Abbreviated, Intensive, Multi‐Couple Group Cognitive‐Behavioral Conjoint Therapy for PTSD with Military Dyads

Abstract

Cognitive‐behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is associated with improvements in patients’ PTSD symptoms, partners’ psychological distress, and relationship satisfaction. However, little is known about whether CBCT for PTSD is associated with changes in other relationship domains that have theoretical and clinical relevance to the relational context of PTSD. The current study is a secondary analysis of relational outcomes from an uncontrolled, within‐group trial designed to examine whether an abbreviated, intensive, multi‐couple group version of CBCT for PTSD (AIM‐CBCT for PTSD) delivered in a retreat during a single weekend was associated with improvements in PTSD symptoms and relationship satisfaction. In this investigation, we examined whether AIM‐CBCT for PTSD is also associated with improvements in ineffective arguing, supportive dyadic coping by partner, joint dyadic coping, and partners’ accommodation of patients’ PTSD symptoms. Participants were 24 couples who included a post‐9/11 U.S. service member or veteran with PTSD. At 1‐ and 3‐month follow‐up, patients reported significant reductions in couples’ ineffective arguing (ds = −.71 and −.78, respectively) and increases in supportive dyadic coping by partners relative to baseline (ds = .50 and .44, respectively). By 3‐month follow‐up, patients also reported significant increases in couples’ joint dyadic coping (d = .57), and partners reported significant reductions in their accommodation of patients’ PTSD symptoms (d = −.44). Findings suggest that AIM‐CBCT for PTSD is associated with improvements in multiple relationship domains beyond relationship satisfaction but that these may be differentially salient for patients and partners.

Effectiveness of cognitive behavioral conjoint therapy for posttraumatic stress disorder (PTSD) in a U.S. Veterans Affairs PTSD clinic

“…Finally, partner accommodation of PTSD symptoms significantly decreased from pre‐ to posttreatment. This result is counter to findings from the RCT in which partner accommodation did not significantly decrease over the course of treatment (Fredman et al., 2016) but similar to findings from a small pilot study of a present‐focused version of CBCT for PTSD (Pukay‐Martin et al., 2015) and a recent adaptation of CBCT for PTSD in which treatment was abbreviated and delivered intensively in a multicouple group format (Fredman et al., 2021). As CBCT for PTSD has developed over time, more attention has been focused on targeting partner accommodation to reduce couple‐level PTSD avoidance and promote more direct expression of thoughts and feelings about relationship concerns.…”

“…(2020), increases in general relationship adjustment or satisfaction for one or both partners were also seen across studies, as were improvements in patient comorbid symptoms and partner mental health (i.e., depression, anxiety, anger). Improvements in PTSD symptoms and relationship functioning and decreases in partner accommodation have also been observed for several adaptations of CBCT for PTSD, including an abbreviated version delivered in multicouple groups over a single weekend (Fredman et al., 2020, 2021), a present‐focused version (Pukay‐Martin et al., 2015), and a mindfulness‐based version delivered in multicouple groups in a retreat format (Davis et al., 2021).…”

An uncontrolled trial of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement.

“…The slight reductions in partner reports of PTSD symptoms for the PTSD+ partner may reflect an improvement in their ability to recognize the manifestation of PTSD symptoms and significant symptom reduction for the PTSD+ partner. Partners also had large effect size improvements in accommodation, with effects larger than those previously found for CBCT for PTSD (e.g., Fredman et al, 2021). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

“…The PTSD+ partners’ report of the couple’s ability to effectively communicate during conflict was assessed with the Ineffective Arguing Scale (IAS; Kurdek, 1994; α = .93 in the present sample). Finally, partners completed the Significant Others’ Responses to Trauma Scale (Fredman et al, 2014), which is a 20-item scale that assesses partners’ behavioral accommodation of PTSD symptoms, with strong internal consistency, high test–retest reliability, and associations with individual and relationship distress (Fredman et al, 2021; α = .83 in the present sample).…”

Secondary individual outcomes following multicouple group therapy for posttraumatic stress disorder: An uncontrolled pilot study with military dyads

“…The results from this uncontrolled study indicated that at 1‐month and 3‐month follow‐up, there were significant reductions in clinician‐rated PTSD symptoms ( d s = −0.77 and −0.98, respectively) and patients’ self‐reported symptoms of PTSD ( d s = −0.73 and −1.17, respectively), depression ( d s = −0.60 and −0.75, respectively), anxiety ( d s = −0.63 to −0.73, respectively), and anger ( d s = −0.45 and −.60, respectively), relative to baseline (Fredman et al, 2020). There were also significant improvements in partners’ ratings of mental health and relationship satisfaction (Fredman et al., 2020) and patients’ ratings of perceptions of couples’ conflict communication and feeling supported by partners (Fredman et al., 2021). In addition, all couples completed treatment (i.e., 0% dropout).…”