An Uncontrolled Trial of a Present‐Focused Cognitive‐Behavioral Conjoint Therapy for Posttraumatic Stress Disorder

Pukay‐Martin, Nicole D.; Torbit, Lindsey; Landy, Meredith S. H.; Wanklyn, Sonya G.; Shnaider, Philippe; Lane, Jeanine E. M.; Monson, Candice M.

doi:10.1002/jclp.22166

Cited by 26 publications

(25 citation statements)

References 31 publications

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“…Existing couple therapies for PTSD commonly teach couples to resist avoiding distressing topics or emotions and, instead, to communicate empathically and collectively approach trauma‐related thought and feelings (e.g., Monson & Fredman, ; Sautter, Glynn, Cretu, Senturk, & Vaught, ). In so doing, these treatments directly counter the patterns of mutual avoidance and behavioral accommodation that may emerge in couples such as those seen in the present study, and indeed, research suggests dyadic treatment of PTSD does reduce accommodation (e.g., Pukay‐Martin et al., ). These practices have the added effect of enhancing intimacy by encouraging self‐disclosure.…”

Section: Discussionsupporting

confidence: 57%

Daily Posttraumatic Stress Disorder Symptom Accommodation and Relationship Functioning in Military Couples

Campbell

Renshaw

2018

Family Process

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Romantic partners' accommodation of trauma survivors' posttraumatic stress disorder (PTSD) symptoms (e.g., taking on tasks, survivors avoid participating in social withdrawal) is associated with lower relationship satisfaction for both partners and survivors. Little is known about associations of partner accommodation with other aspects of relationship functioning, like intimacy. Sixty-four male military veterans with at least subclinical PTSD and their partners participated in a 2-week daily diary study. Veterans completed nightly measures of PTSD symptoms, while female partners completed nightly measures of accommodating behaviors performed that day. Both partners reported feelings of intimacy each night. Multilevel models revealed that accommodation was significantly, negatively associated with feelings of intimacy, with stronger effects for partners (t = -8.70) than for veterans (t = -5.40), and stronger effects when veterans had lower (t = -7.43) rather than higher (t = -5.20) levels of daily PTSD symptoms. Therapists should consider accommodating behaviors as a potential impediment to relationship intimacy, particularly when veterans have less severe symptoms of PTSD. Accommodating behaviors are an ideal treatment target in behavioral couple therapies.

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Section: Discussionsupporting

confidence: 57%

Daily Posttraumatic Stress Disorder Symptom Accommodation and Relationship Functioning in Military Couples

Campbell

Renshaw

2018

Family Process

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“…Moreover, accommodating partners may need specific psychoeducation about PTSD symptoms and the role of avoidance, as well as clear treatment rationales for exposure-based treatments. Such efforts can successfully modify levels of accommodation (Pukay-Martin et al, 2015).…”

Section: Summary and Implicationsmentioning

confidence: 99%

Posttraumatic stress disorder and relationship functioning: A comprehensive review and organizational framework

Campbell

Renshaw

2018

Clinical Psychology Review

104

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Posttraumatic stress disorder (PTSD) is associated with impairments in relationship functioning. Beyond the abundance of research that has demonstrated this basic link, more recent research has begun to explore possible mediators and moderators of this association. The present paper reviews and synthesizes existing literature in the context of an overarching organizational framework of potential ways in which PTSD impacts relationship functioning. The framework organizes findings in terms of specific elements of PTSD and comorbid conditions, mediators (factors that are posited to explain or account for the association), and moderators (factors that are posited to alter the strength of the association). Specific symptoms of PTSD, comorbid symptoms, and many of the potential mediators explored have extensive overlap, raising questions of possible tautology and redundancy in findings. Some findings suggest that non-specific symptoms, such as depression or anger, account for more variance in relationship impairments than trauma-specific symptoms, such as re-experiencing. Moderators, which are characterized as individual, relational, or environmental in nature, have been the subject of far less research in comparison to other factors. Recommendations for future research and clinical implications of the findings reviewed are also presented.

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“…In a small, uncontrolled trial of a present-focused version of CBCT for PTSD that did not include discussion of trauma-focused content, Pukay-Martin and colleagues (2015) found moderate and significant pre/post decreases in partner accommodation, suggesting that partner accommodation is an important treatment target in couple therapy for PTSD. It is also presumed that patients whose partners are more accommodating at the start of therapy would be especially likely to benefit from CBCT for PTSD.…”

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confidence: 99%

Partner accommodation moderates treatment outcomes for couple therapy for posttraumatic stress disorder.

Fredman

Pukay‐Martin

Macdonald

et al. 2016

Journal of Consulting and Clinical Psychology

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Objective Partner accommodation of posttraumatic stress disorder (PTSD) symptoms (i.e., altering one’s own behaviors to minimize patient distress and/or relationship conflict due to patients’ PTSD symptoms) has been shown to be positively associated with patient and partner psychopathology and negatively associated with patient and partner relationship satisfaction cross-sectionally. However, the prognostic value of partner accommodation in treatment outcomes is unknown. The goals of the present study were to determine if partner accommodation decreases as a function of couple therapy for PTSD and if pretreatment partner accommodation moderates the efficacy of couple therapy for PTSD. Method Thirty-nine patients with PTSD and their intimate partners (n = 39) were enrolled in a randomized controlled trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012) and received CBCT for PTSD immediately or after three months of waiting. Blinded assessors determined clinician-rated PTSD symptoms and patient-rated PTSD and depressive symptoms and relationship satisfaction at baseline, mid-treatment/4 weeks of waiting, and posttreatment/12 weeks of waiting. Results Contrary to expectation, partner accommodation levels did not change over time for either treatment condition. However, baseline partner accommodation significantly moderated treatment outcomes. Higher levels of partner accommodation were associated with greater improvements in PTSD, depressive symptoms, and relationship satisfaction among patients receiving CBCT for PTSD compared with waiting list. At lower levels of partner accommodation, patients in both groups improved or remained at low levels of these outcomes. Conclusions Individuals with PTSD who have more accommodating partners may be particularly well-suited for couple therapy for PTSD.

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An Uncontrolled Trial of a Present‐Focused Cognitive‐Behavioral Conjoint Therapy for Posttraumatic Stress Disorder

Abstract: Results from this pilot study suggest that present-focused CBCT for PTSD may be a promising alternative for individuals who are unwilling to engage in a trauma-focused treatment.

Cited by 26 publications

References 31 publications

Daily Posttraumatic Stress Disorder Symptom Accommodation and Relationship Functioning in Military Couples

Daily Posttraumatic Stress Disorder Symptom Accommodation and Relationship Functioning in Military Couples

Posttraumatic stress disorder and relationship functioning: A comprehensive review and organizational framework

Partner accommodation moderates treatment outcomes for couple therapy for posttraumatic stress disorder.

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