A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder.

Abstract

This study tested a family-based skills-building intervention in veterans with chronic combat-related posttraumatic stress disorder (PTSD). Veterans and a family member were randomly assigned to 1 of 3 conditions: (a) waiting list, (b) 18 sessions of twice-weekly exposure therapy, or (c) 18 sessions of twice-weekly exposure therapy followed by 16 sessions of behavioral family therapy (BFT). Participation in exposure therapy reduced PTSD positive symptoms (e.g., reexperiencing and hyperarousal) but not PTSD negative symptoms. Positive symptom gains were maintained at 6-month follow-up. However, participation in BFT had no additional impact on PTSD symptoms.

Couple/family therapy for posttraumatic stress disorder: Review to facilitate interpretation of VA/DOD Clinical Practice Guideline

“…Both were conducted with samples of male combat Veterans and their family members. As previously reviewed, in another published RCT including BFT after DTE, Glynn and colleagues found that those receiving DTEBFT had significantly more improvements in interpersonal problem-solving than those who did not receive BFT [4].…”

“…Evidence that the intervention is effective is lacking or poor quality, or conflicting, and the balance of benefits to harms cannot be determined" [8, p. 202]. The supporting evidence offered for this conclusion includes three studies: Devilly [9], Glynn et al [4], and Monson et al [10]. Upon review of these studies, the CPG summarizes that "BFT [behavioral family therapy] did not significantly improve the PTSD symptoms and was inferior to other psychotherapies" [8, p. 144].…”

“…Glynn et al conducted one of the most rigorous tests of family therapy for PTSD to date [4]. In their study, they used an additive research design to test the incremental utility of a specific BFT focused on improving communication and problem-solving skills [11].…”

“…This is in spite of research showing that Veterans desire greater family involvement in their treatment (e.g., Batten et al [3]) and the presence of significant mental health problems in Veterans' loved ones who may individually profit from family therapy. In addition, treatments for PTSD do not necessarily improve couple and family functioning (e.g., Glynn et al [4]; Lunney and Schnurr [5]; Monson et al * ) and negative family interactions have been associated with poorer individual cognitive-behavioral treatment outcomes [6][7]. To further treatment and research efforts in this area, this article reviews the recommendations regarding couple/ family therapy offered in the newest version of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress.…”

Behavioral couples therapy for comorbid substance use disorders and combat-related posttraumatic stress disorder among male veterans: An initial evaluation

“…In recognition of this fact, family concepts and therapy have appeared in the clinical traumatic stress literature. However, in the only controlled study of its kind, behavioral family therapy did not improve outcomes of an exposure-based treatment of combat-related PTSD without SUD (Glynn et al, 1999).…”