Study Suggests Couple Therapy is Effective for Treating PTSD
There are well-documented associations between PTSD and intimate relationship distress and aggression, and studies demonstrate that symptoms of PTSD in one partner are associated with caregiver burden and psychological distress in the other. It also has been shown that even when patients receive state-of-the-art individual psychotherapy, negative interpersonal relations predict worse treatment outcomes. This randomized trial compared cognitive-behavioral conjoint therapy (CBCT) for PTSD with a wait-list control. The conjoint therapy, designed to simultaneously treat PTSD symptoms and enhance relationship satisfaction, consisted of 15 sessions organized into three phases that built on one another and included both in- and out-of-session exercises to increase skill acquisition and use. The trial was conducted from 2008 to 2012 at one VA outpatient hospital setting in Boston, MA and one university-based research center in Toronto, Ontario, Canada, and included heterosexual and same-sex couples (n=40 couples) in which one partner met the criteria for PTSD. Couples were randomly assigned to participate in the 15-session CBCT for PTSD (n=20) or were placed on a wait-list for the therapy (n=20). Investigators then assessed data on PTSD symptoms, comorbid conditions, and relationship satisfaction at baseline, mid-treatment (8 weeks), and post-treatment (about 16 weeks) for both groups. Uncontrolled follow-up at 3 months also was conducted.
- Among couples in which one partner was diagnosed as having PTSD, a PTSD-specific couples therapy — compared with a wait-list for therapy — resulted in greater decreases in severity of PTSD and comorbid symptoms, and increases in relationship satisfaction; 81% of patients who received CBCT no longer had PTSD at the end of treatment vs. 21% of patients on the wait-list.
- CBCT did not increase relationship satisfaction among partners, which may have been due to a high level of satisfaction before treatment.
- Treatment gains were maintained at 3-month uncontrolled follow-up.
- The study's relatively small sample size limited the investigators' abilty to detect some statistical or clinically important differences between CBCT and a wait-list. The sample size also limited investigation of factors that might moderate drop-out or treatment outcome, i.e., comorbidity, type of trauma, and relationship characteristics.
- Because the study compared CBCT to a wait list, it is not posisble to determine how effective the treatment is compared with other types of therapy for PTSD.
- In the future, it will be important to determine if clinicians without specialized training in psychotherapy or couple therapy can achieve similar results, given that the therapy in this trial was delivered under close supervision in clinical research settings.
This study was funded by the National Institute of Mental Health. Drs. Monson, Fredman, Resick, and Schnurr are part of VA's National Center for PTSD.
Monson C, Fredman S, Macdonald A, Pukay-Martin N, Resick P, and Schnurr PP. Effect of Cognitive-Behavioral Couple Therapy for PTSD: A Randomized Trial. JAMA August 15, 2012;308(7):700-709.