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Meuleman EM, Karremans JC, van Ee E. Stronger together: the longitudinal relations between partner responsiveness, dyadic coping and PTSD recovery. Eur J Psychotraumatol 2024; 15:2358682. [PMID: 38836379 PMCID: PMC11155418 DOI: 10.1080/20008066.2024.2358682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/12/2024] [Indexed: 06/06/2024] Open
Abstract
Background: Past research has primarily focused on negative associations between PTSD and relationships. Therefore, this investigation delves into the potential positive role of these relational aspects in aiding PTSD recovery during treatment.Objective: This study aimed to examine the impact of dyadic coping and perceived partner responsiveness on treatment trajectories of PTSD patients.Method: The study included 90 participants, who were requested to complete online questionnaires twice, with a six-month gap between the measures.Results: The results from linear regression analyses indicated that perceived partner responsiveness had a positive effect on PTSD recovery, whereas dyadic coping had the opposite effect: higher levels of dyadic coping were associated with an increase in posttraumatic stress symptoms over time. Additional examination of the subscales indicated that heightened communication between clients and partners regarding stress was related with increased posttraumatic stress symptoms.Conclusions: These findings underscore the importance and complexity of effective and supportive communication between patients with PTSD and their partners. While existing literature supports both perceived partner responsiveness and dyadic coping as beneficial, this study indicates that only perceived partner responsiveness positively impacted PTSD recovery.
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Affiliation(s)
- Eline M. Meuleman
- Psychotraumacentrum Zuid-Nederland, 's-Hertogenbosch, the Netherlands
| | - Johan C. Karremans
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Elisa van Ee
- Psychotraumacentrum Zuid-Nederland, 's-Hertogenbosch, the Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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2
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Zaks I, Dekel R, Zuckerman YS, Horesh D. Study protocol: A multimethod psychophysiological randomized controlled trial of a couple therapy for post-traumatic stress disorder. Contemp Clin Trials 2023; 132:107280. [PMID: 37419309 DOI: 10.1016/j.cct.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) sequelae often have ripple effects on victims' families and spouses. Yet there has been a lag in the development and study of couple therapy for PTSD. To fill this gap, we present here a protocol for a study examining the efficacy of Cognitive Behavioral Conjoint Therapy (CBCT), a 15- session couple therapy protocol meant to alleviate PTSD and improve relationship satisfaction, in the Israeli context. The study will be a randomized controlled trial examining outcomes and processes of change via self-report questionnaires, qualitative interviews, and physiological measures (e.g., both partners' heart rate variability and electrodermal activity). We will employ a modified remote treatment protocol via video conferencing. The study will examine whether there is a reduction in couples' levels of symptomatic, emotional, and behavioral difficulties following CBCT and whether relationship satisfaction and couples' physiological synchrony increases. The study will also examine physiological and psychological change mechanisms in CBCT. Sixty Israeli couples (n = 120) will be randomly assigned to either a CBCT group or a wait-list control group. Outcomes will be assessed at four timepoints: before treatment, during treatment, post-treatment, and four months after treatment. The proposed study has the potential to shed light on the unique psychological and physiological mechanisms underlying CBCT and will be the first RCT study to employ this unique methodology in CBCT research, particularly in a video conferencing setting. This study may increase our ability to offer effective, cost-efficient, and attainable treatments for patients with PTSD and their spouses.
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Affiliation(s)
- Ilil Zaks
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel.
| | - Rachel Dekel
- Bar-Ilan University School of Social Work, Ramat Gan 590002, Israel.
| | | | - Danny Horesh
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel; Grossman School of Medicine, Department of Psychiatry, New York University, 550 First Avenue, New York, NY 10016, USA.
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3
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Meuleman E, Sloover M, van Ee E. Involving a Significant Other in Treatment of Patients With PTSD Symptoms: A Systematic Review of Treatment Interventions. TRAUMA, VIOLENCE & ABUSE 2023; 24:2034-2044. [PMID: 35389279 DOI: 10.1177/15248380221082939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Previous studies have called for the inclusion of social support in the treatment of PTSD. The current review identifies interventions for adults with PTSD symptoms, which include a significant other as a source of social support. 11 articles focusing on eight interventions were found, including a total of 495 participants who had experienced trauma. These interventions were divided according to level of involvement of the significant other in treatment. Significant others were either passively or actively involved in the treatment. Preliminary results show that interventions actively involving a significant other in the treatment of the patient with posttraumatic stress symptoms were most effective in reducing PTSD symptoms. The current review provides recommendations for future research and suggests that significant others should be actively involved in the treatment of PTSD symptoms.
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Affiliation(s)
- Eline Meuleman
- Psychotraumacentrum Zuid Nederland, Reinier van Arkel, 's-Hertogenbosch, The Netherlands
| | - Mèlanie Sloover
- Psychotraumacentrum Zuid Nederland, Reinier van Arkel, 's-Hertogenbosch, The Netherlands
| | - Elisa van Ee
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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4
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Crenshaw AO, Whitfield KM, Collins A, Valela R, Varma S, Landy MSH, Ip J, Donkin V, Earle E, Siegel A, Samonas C, Bushe J, Mensah DH, Xiang A, Doss BD, Morland L, Wagner AC, Fitzpatrick S, Monson CM. Partner outcomes from an uncontrolled trial of Couple HOPES: A guided online couple intervention for posttraumatic stress disorder and relationship enhancement. J Trauma Stress 2023; 36:230-238. [PMID: 36116104 DOI: 10.1002/jts.22878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with significant individual and relationship impairment for people with PTSD and their romantic partners. Conjoint treatments, such as cognitive behavioral conjoint therapy for PTSD (CBCT), are designed to address individual and relationship factors, yet significant barriers impede accessing in-person therapy. Couple HOPES (i.e., Helping Overcome PTSD and Enhance Satisfaction) is a coach-guided, online couple intervention for PTSD based on CBCT that was designed to address these barriers. Previous investigations have found preliminary efficacy of Couple HOPES for improving PTSD symptoms, relationship functioning, and some individual functioning domains for the partner with probable PTSD. However, no study to date has tested individual outcomes for romantic partners, which is needed to fully evaluate the intervention's promise. The current study tested these partner outcomes in a combined, uncontrolled sample of 27 couples. Intent-to-intervene analyses found significant improvements at postintervention in four of eight tested outcomes, including ineffective arguing, g = 0.74; anger, g = 0.32; perceived health, g = 0.67; and quality of life, g = 0.56. Depressive symptoms, generalized anxiety, alcohol misuse, and work functioning did not significantly change, gs = 0.17-0.42. Among participants who completed a 1-month follow-up assessment, generalized anxiety, g = 0.43, and perceived health, g = 0.73, significantly improved over follow-up, whereas anger, g = -0.48, lost gains previously made. Results were largely consistent in the completer sample. These findings show the potential of Couple HOPES to have broad benefits not only for individuals with probable PTSD but also for their romantic partners.
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Affiliation(s)
| | | | - Alexis Collins
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Robert Valela
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Sonya Varma
- Department of Psychology, York University, Toronto, Canada
| | - Meredith S H Landy
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada.,MindBeacon, Toronto, Canada
| | - Jennifer Ip
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Victoria Donkin
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada.,Department of Psychology, York University, Toronto, Canada.,MindBeacon, Toronto, Canada
| | | | - Ashley Siegel
- Department of Psychology, York University, Toronto, Canada
| | - Christina Samonas
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Julianne Bushe
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | | | - Angela Xiang
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Brian D Doss
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Anne C Wagner
- Remedy, 703 Bloor St. W, #201, Toronto, ON, M6G 1L5, Canada
| | | | - Candice M Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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5
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Cavarra M, Falzone A, Ramaekers JG, Kuypers KPC, Mento C. Psychedelic-Assisted Psychotherapy-A Systematic Review of Associated Psychological Interventions. Front Psychol 2022; 13:887255. [PMID: 35756295 PMCID: PMC9226617 DOI: 10.3389/fpsyg.2022.887255] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Modern clinical research on psychedelics is generating interesting outcomes in a wide array of clinical conditions when psychedelic-assisted psychotherapy is delivered to appropriately screened participants and in controlled settings. Still, a number of patients relapse or are less responsive to such treatments. Individual and contextual factors (i.e., set and setting) seem to play a role in shaping the psychedelic experience and in determining clinical outcomes. These findings, coupled with data from literature on the effectiveness of psychotherapy, frame the therapeutic context as a potential moderator of clinical efficacy, highlighting the need to investigate how to functionally employ environmental and relational factors. In this review, we performed a structured search through two databases (i.e., PubMed/Medline and Scopus) to identify records of clinical studies on psychedelics which used and described a structured associated psychotherapeutic intervention. The aim is to construct a picture of what models of psychedelic-assisted psychotherapy are currently adopted in clinical research and to report on their clinical outcomes. Ad-hoc and adapted therapeutic methods were identified. Common principles, points of divergence and future directions are highlighted and discussed with special attention toward therapeutic stance, degree of directiveness and the potential suggestive effects of information provided to patients.
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Affiliation(s)
- Mauro Cavarra
- Department of Cognitive, Psychological Science and Cultural Studies, University of Messina, Messina, Italy.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alessandra Falzone
- Department of Cognitive, Psychological Science and Cultural Studies, University of Messina, Messina, Italy
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kim P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Carmela Mento
- Department of Biomedical, Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
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6
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Hendrikx LJ, Murphy D. Supporting the Mental Health Needs of Military Partners Through the Together Webinar Program: Pilot Randomized Controlled Trial. JMIR Ment Health 2021; 8:e25622. [PMID: 34636734 PMCID: PMC8548968 DOI: 10.2196/25622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite an increased risk of psychological difficulties, there remains a lack of evidence-based support for the mental health needs of military partners. OBJECTIVE This study aims to investigate whether the Together Webinar Programme (TTP-Webinar), a 6-week structured, remote access group intervention would reduce military partners' experience of common mental health difficulties and secondary trauma symptoms. METHODS A pilot randomized controlled trial was used to compare the TTP-Webinar intervention with a waitlist control. The sample was UK treatment-seeking veterans engaged in a mental health charity. A total of 196 military partners (1 male and 195 females; aged mean 42.28, SD 10.82 years) were randomly allocated to the intervention (n=97) or waitlist (n=99) condition. Outcome measures were self-reported measures of common mental health difficulties, secondary trauma symptoms, and overall quality of life rating. RESULTS Compared with the waitlist, military partners in the TTP-Webinar had reduced common mental health difficulties (P=.02) and secondary trauma symptoms (P=.001). However, there was no difference in quality-of-life ratings (P=.06). CONCLUSIONS The results suggest that TTP-Webinar is an effective intervention to support the mental health difficulties of military partners. This study provides promising evidence that webinars may be an appropriate platform for providing group-based support. TRIAL REGISTRATION ClinicalTrials.gov NCT05013398; https://clinicaltrials.gov/ct2/show/NCT05013398.
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Affiliation(s)
| | - Dominic Murphy
- Combat Stress, Leatherhead, United Kingdom
- King's Centre for Military Health Research, King's College London, London, United Kingdom
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7
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Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21:1159-1177. [PMID: 34519235 DOI: 10.1080/14737175.2021.1981289] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburg Medisch Centrum Hardenberg, The Netherlands
| | - Emily Aupers
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands
| | - Annemarie Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Board, ADRZ (Admiraal De Ruyter Ziekenhuis), Goes, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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8
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Wagner AC, Liebman RE, Mithoefer AT, Mithoefer MC, Monson CM. Relational and Growth Outcomes Following Couples Therapy With MDMA for PTSD. Front Psychiatry 2021; 12:702838. [PMID: 34262496 PMCID: PMC8273271 DOI: 10.3389/fpsyt.2021.702838] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
Healing from trauma occurs in a relational context, and the impacts of traumatic experiences that result in post-traumatic stress disorder (PTSD) go beyond the diagnosis itself. To fully understand a treatment for PTSD, understanding its impact on interpersonal, relational, and growth outcomes yields a more fulsome picture of the effects of the treatment. The current paper examines these secondary outcomes of a pilot trial of Cognitive Behavioral Conjoint Therapy (CBCT) for PTSD with MDMA. Six romantic dyads, where one partner had PTSD, undertook a course of treatment combining CBCT for PTSD with two MDMA psychotherapy sessions. Outcomes were assessed at mid-treatment, post-treatment, and 3- and 6-month follow-up. Both partners reported improvements in post-traumatic growth, relational support, and social intimacy. Partners reported reduced behavioral accommodation and conflict in the relationship, and patients with PTSD reported improved psychosocial functioning and empathic concern. These improvements were maintained throughout the follow-up period. These findings suggest that CBCT for PTSD with MDMA has significant effect on relational and growth outcomes in this pilot sample. Improvements in these domains is central to a holistic recovery from traumatic experiences, and lends support to the utility of treating PTSD dyadically.
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Affiliation(s)
- Anne C. Wagner
- Remedy, Toronto, ON, Canada
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Rachel E. Liebman
- Department of Psychology, Ryerson University, Toronto, ON, Canada
- Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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9
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Fredman SJ, Macdonald A, Monson CM, Dondanville KA, Blount TH, Hall-Clark BN, Fina BA, Mintz J, Litz BT, Young-McCaughan S, Hancock AK, Rhoades GK, Yarvis JS, Resick PA, Roache JD, Le Y, Wachen JS, Niles BL, McGeary CA, Keane TM, Peterson AL. Intensive, Multi-Couple Group Therapy for PTSD: A Nonrandomized Pilot Study With Military and Veteran Dyads. Behav Ther 2020; 51:700-714. [PMID: 32800299 PMCID: PMC10760800 DOI: 10.1016/j.beth.2019.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 11/25/2022]
Abstract
Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients' self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients' PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD.
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Affiliation(s)
| | | | | | | | | | | | - Brooke A Fina
- The University of Texas Health Science Center at San Antonio
| | - Jim Mintz
- The University of Texas Health Science Center at San Antonio
| | - Brett T Litz
- VA Boston Healthcare System; Boston University School of Medicine
| | | | | | | | | | | | - John D Roache
- The University of Texas Health Science Center at San Antonio
| | | | - Jennifer S Wachen
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | - Barbara L Niles
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | - Cindy A McGeary
- The University of Texas Health Science Center at San Antonio
| | - Terence M Keane
- National Center for PTSD; VA Boston Healthcare System; Boston University School of Medicine
| | - Alan L Peterson
- The University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System; The University of Texas at San Antonio
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10
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Morgan E, Wieling E, Hubbard J, Dwanyen L. Perceptions of War Trauma and Healing of Marital Relations Among Torture-surviving Congolese Couples Participating in Multicouple Therapy. FAMILY PROCESS 2020; 59:1128-1143. [PMID: 31574182 DOI: 10.1111/famp.12487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC. The group was designed to address the relational effects of torture and war trauma. Participants reported profound negative effects of the war on their relationships; mostly positive experiences during the group, including marital and peer connection and relationship growth; and a number of improvements in their relationship after the group. Implications include support for the use of relational interventions informed by both treatments for traumatic stress and couple approaches to promote trauma healing. Future directions call for increased funding, research, training, and clinical action to treat the effects of traumatic stress on relational family dynamics.
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Affiliation(s)
| | - Elizabeth Wieling
- Human Development and Family Science, Marriage and Family Therapy Emphasis, University of Georgia, Athens, GA
| | - Jon Hubbard
- Formerly of Center for Victims of Torture, St Paul, MN
| | - Lekie Dwanyen
- Department of Family and Social Science, University of Minnesota, St. Paul, MN
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11
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Harnessing the Healing Power of Relationships in Trauma Recovery: a Systematic Review of Cognitive-Behavioral Conjoint Therapy for PTSD. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00211-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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12
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Bidirectional Relationships Between Posttraumatic Stress Disorder and Social Functioning During Cognitive Processing Therapy. Behav Ther 2020; 51:447-460. [PMID: 32402260 PMCID: PMC7232057 DOI: 10.1016/j.beth.2019.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
This study investigated temporal relationships between posttraumatic stress symptoms and two indicators of social functioning during cognitive processing therapy. Participants were 176 patients (51.5% female, M age = 39.46 [SD = 11.51], 89.1% White, 42.6% active duty military/veteran) who participated in at least two assessment time points during a trial of cognitive processing therapy. Posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-IV) and interpersonal relationship and social role functioning problems (Outcome Questionnaire-45) were assessed prior to each of 12 sessions. Multivariate multilevel lagged analyses indicated that interpersonal relationship problems predicted subsequent PTSD symptoms (b = .22, SE = 0.09, cr = 2.53, p = .01, pr = .46) and vice versa (b = .05, SE = 0.02, cr = 2.11, p = .04, pr = .16); and social role functioning problems predicted subsequent PTSD symptoms (b = .21, SE = 0.10, cr = 2.18, p = .03, pr = .16) and vice versa (b = .06, SE = 0.02, cr = 3.08, p < .001, pr = .23). Military status moderated the cross-lag from social role functioning problems to PTSD symptoms (b = -.35, t = -2.00, p = .045, pr = .16). Results suggest a robust association between PTSD symptoms and social functioning during cognitive processing therapy with a reciprocal relationship between PTSD symptoms and social functioning over time. Additionally, higher social role functioning problems for patients with military status indicate smaller reductions in PTSD symptoms from session to session.
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13
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Koizia LJ, Wilson F, Reilly P, Fertleman MB. Delirium after emergency hip surgery – common and serious, but rarely consented for. World J Orthop 2019; 10:228-234. [PMID: 31259146 PMCID: PMC6591697 DOI: 10.5312/wjo.v10.i6.228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
A quarter of patients admitted with a proximal femoral fracture suffer from an acute episode of delirium during their hospital stay. Yet it is often unrecognised, poorly managed, and rarely discussed by doctors. Delirium is important not only to the affected individuals and their families, but also socioeconomically to the broader community. Delirium increases mortality and morbidity, leads to lasting cognitive and functional decline, and increases both length of stay and dependence on discharge. Delirium should be routinely and openly discussed by all members of the clinical team, including surgeons when gaining consent. Failing to do so may expose surgeons to claims of negligence. Here we present a concise review of the literature and discuss the epidemiology, causative factors, potential consequences and preventative strategies in the perioperative period.
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Affiliation(s)
- Louis J Koizia
- Geriatric Medicine, Imperial College NHS Trust, London W2 1NY, United Kingdom
| | - Faye Wilson
- Geriatric Medicine, City Hospitals Sunderland, Sunderland SR4 7TP, United Kingdom
| | - Peter Reilly
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom
| | - Michael B Fertleman
- Geriatric Medicine, Imperial College NHS Trust, London W2 1NY, United Kingdom
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14
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Wagner AC, Mithoefer MC, Mithoefer AT, Monson CM. Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example. J Psychoactive Drugs 2019; 51:166-173. [PMID: 30890035 DOI: 10.1080/02791072.2019.1589028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Treatments for posttraumatic stress disorder (PTSD) have evolved significantly in the past 35 years. From what was historically viewed as a pervasive, intractable condition have emerged multiple evidence-based intervention options. These treatments, predominantly cognitive behavioral in orientation, provide significant symptom improvement in 50-60% of recipients. The treatment of PTSD with MDMA-assisted psychotherapy using a supportive, non-directive approach has yielded promising results. It is unknown, however, how different therapeutic modalities could impact or improve outcomes. Therefore, to capitalize on the strengths of both approaches, Cognitive Behavioral Conjoint Therapy for PTSD (CBCT) was combined with MDMA in a small pilot trial. The current article provides a case study of one couple involved in the trial, chosen to provide a demographically representative example of the study participants and a case with a severe trauma history, to offer a detailed account of the methodology and choices made to integrate CBCT and MDMA, as well as an account of their experience through the treatment and their treatment gains. This article offers a description of the combination of CBCT for PTSD and MDMA, and demonstrates that it can produce reductions in PTSD symptoms and improvements in relationship satisfaction.
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Affiliation(s)
- Anne C Wagner
- a Department of Psychology , Ryerson University , Toronto , Canada.,b Remedy , Toronto , Canada
| | | | | | - Candice M Monson
- a Department of Psychology , Ryerson University , Toronto , Canada
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Malaktaris AL, Buzzella BA, Siegel ME, Myers US, Browne KC, Norman SB, Angkaw AC. OEF/OIF/OND Veterans Seeking PTSD Treatment: Perceptions of Partner Involvement in Trauma-Focused Treatment. Mil Med 2019; 184:e263-e270. [PMID: 30215768 DOI: 10.1093/milmed/usy231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/03/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) has been linked to a variety of adverse mental and physical health outcomes including distressed relationships. Involving romantic partners in PTSD treatment appears to be a promising new avenue for PTSD treatment; however, additional research is necessary to clarify veteran preferences for inclusion of significant others in treatment and relationship characteristics that may influence such preferences. Accordingly, the present study was designed to evaluate Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans' desire to include romantic partners in trauma-focused care (n = 74) and to explore psychological and relationship variables associated with preference for partner inclusion in PTSD treatment. MATERIALS AND METHODS This study surveyed male (N = 74) OEF/OIF/OND combat veterans seeking mental health services at a Veterans Health Administration PTSD treatment program. Relationships between PTSD symptoms, romantic relationship functioning, and interest in including their romantic partner in PTSD treatment were examined. RESULTS Consistent with previous research, OEF/OIF/OND veterans seeking treatment at a specialty PTSD program report low relationship satisfaction. The majority of participants reported that PTSD symptoms interfere with relationship functioning; specifically, numbing symptoms were a significant predictor of PTSD-related relationship impairment. A minority (26%) of participants reported a desire to include their romantic partner in PTSD treatment. Greater behavioral avoidance and communication difficulties were associated with increased interest in including a romantic partner in PTSD treatment. CONCLUSION We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for PTSD, Strategic Approach Therapy). For veterans with PTSD, relationship distress, and communication difficulties, conjoint psychotherapies may offer a way of increasing engagement in PTSD treatment by parsimoniously addressing multiple treatment targets at once (PTSD symptoms, relationship distress, communication problems) and providing veteran-centered care.
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Affiliation(s)
- Anne L Malaktaris
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA.,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA (MC 116 A)
| | - Brian A Buzzella
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA
| | - Maya E Siegel
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA
| | - Ursula S Myers
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA
| | - Kendall C Browne
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA.,VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, San Diego, CA (MC 116 A).,National Center for PTSD, 1234 VA Cutoff Rd, White River Junction, VT
| | - Abigail C Angkaw
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA.,Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA.,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA.,National Center for PTSD, 1234 VA Cutoff Rd, White River Junction, VT
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16
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Shepherd-Banigan ME, Shapiro A, McDuffie JR, Brancu M, Sperber NR, Van Houtven CH, Kosinski AS, Mehta NN, Nagi A, Williams JW. Interventions That Support or Involve Caregivers or Families of Patients with Traumatic Injury: a Systematic Review. J Gen Intern Med 2018; 33:1177-1186. [PMID: 29736752 PMCID: PMC6025684 DOI: 10.1007/s11606-018-4417-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/17/2018] [Accepted: 03/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Almost 40 million family caregivers care for a loved one with severe physical or cognitive impairments. The purpose of this review is to summarize evidence about the benefits of interventions to support or involve family members/caregivers of patients with trauma-related injury on caregiver, patient, and household outcomes. METHODS English-language peer-reviewed publications in MEDLINE, CINAHL, and PsycINFO from 1995 through December 2016 were identified. Eligible studies included RCT or quasi-experimental studies evaluating interventions designed to support or involve caregivers or family members of patients with TBI, PTSD, or polytrauma. Abstractions were completed by one reviewer and checked by a second; two reviewers independently assessed risk of bias using the Cochrane Effective Practice and Organization of Care Review Criteria. RESULTS Thirteen studies (n = 9 TBI; n = 4 PTSD, n = 0 polytrauma) evaluated psychological or rehabilitation interventions involving caregivers. Interventions did not improve TBI patients' functional status (standardized mean difference [SMD], 0.29 [95% confidence interval [CI], - 0.51 to 1.08]) or psychological symptoms (SMD - 0.25, CI - 0.62 to 0.12). Qualitative analysis shows potential intervention benefit for TBI symptoms. Interventions did not improve TBI caregiver psychological symptoms (SMD - 0.26, CI - 0.57 to 0.05); however, qualitative analysis suggests mixed effects for caregiver burden and quality of life. Positive intervention effects on patients' PTSD symptoms, mental health service use, and PTSD caregivers' psychological symptoms were identified with certain interventions. Strength of evidence ranged from moderate to very low. DISCUSSION Studies showed mixed patterns of intervention effects on caregiver and patient outcomes; evidence about intervention impact is inconclusive. This review is the first to identify caregiving interventions for patients with TBI and polytrauma and extends past reviews about patients with PTSD. Limitations include a small evidence base, low study quality, disparate methods, varied outcome measures, and high heterogeneity. PROSPERO Registration CRD42017053516.
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Affiliation(s)
- Megan E Shepherd-Banigan
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Abigail Shapiro
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer R McDuffie
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Mira Brancu
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nina R Sperber
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Courtney H Van Houtven
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Neha N Mehta
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
| | - Avishek Nagi
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - John W Williams
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center Durham, Durham, NC, USA
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17
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Silver KE, Kumari M, Conklin D, Karakurt G. Trauma and Health Symptoms in a Community Sample: Examining the Influences of Gender and Daily Stress. THE AMERICAN JOURNAL OF FAMILY THERAPY 2018; 46:153-167. [PMID: 30872885 PMCID: PMC6411092 DOI: 10.1080/01926187.2018.1461031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although there is a rich body of literature on trauma and health, limited research has investigated the variables of gender, trauma symptoms, physical health, mental health, and daily stress together in a community sample. Considering the deleterious effects of trauma on health, our overarching inquiry was whether trauma symptoms can predict overall mental and physical health with attention to gender and daily stress as potential moderators. Participants (n = 103; 50.5% women) completed self-report measures of trauma symptoms, mental health, physical health, and daily stress, along with demographic information. Trauma symptoms predicted 25.2% of the variance in general health symptoms. Gender significantly added to the variance accounted for, but daily stress was not significant in the model. Trauma symptoms predicted 37.1% of the variance in mental health symptoms. Daily stress significantly added to the model, but gender did not. Results are interpreted through the integration of family stress theory and feminist frameworks, adding to the literature by further illuminating the relationships between gender, daily stress, health symptoms, and trauma in a community sample.
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Affiliation(s)
- Kristin E. Silver
- Department of Psychology, The University of Akron, Akron,
OH, 44325, USA
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18
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Monk JK, Oseland LM, Nelson Goff BS, Ogolsky BG, Summers K. Integrative Intensive Retreats for Veteran Couples and Families: A Pilot Study Assessing Change in Relationship Adjustment, Posttraumatic Growth, and Trauma Symptoms. JOURNAL OF MARITAL AND FAMILY THERAPY 2017; 43:448-462. [PMID: 28394016 DOI: 10.1111/jmft.12230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We assessed a brief, systemic retreat-style intervention that was developed to address concerns about the utilization of services for veterans coping with traumatic stress. A total of 76 dyads (N = 152) were assessed before and after a 4-day retreat, which included psychoeducation, group and conjoint therapeutic sessions, and recreational relaxation components. Overall, participants reported a reduction in trauma symptoms, but only support persons experienced a significant increase in posttraumatic growth from pretest to posttest. Both veterans and their romantic partners reported an increase in relationship adjustment after the retreat. Opportunities to address the needs of this population by removing barriers to treatment and reducing feelings of isolation, as well as implications for similar treatments are discussed.
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Shnaider P, Sijercic I, Wanklyn SG, Suvak MK, Monson CM. The Role of Social Support in Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder. Behav Ther 2017; 48:285-294. [PMID: 28390493 DOI: 10.1016/j.beth.2016.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
The current study examined the effect of total, as well as different sources (i.e., family, friends, significant other) of, pretreatment/baseline social support on posttraumatic stress disorder (PTSD) severity and treatment response to cognitive-behavioral conjoint therapy (CBCT) for PTSD. Thirty-six patients were randomized to receive treatment immediately or to a waitlist condition. Those in the treatment condition were offered CBCT for PTSD, a couple-based therapy aimed at reducing PTSD symptoms and improving relationship functioning. PTSD symptoms were assessed at pre-/baseline, mid-/4 weeks of waiting, and posttreatment/12 weeks of waiting using the Clinician-Administered PTSD Scale, and patients self-reported on their levels of pretreatment/baseline social support using the Multidimensional Scale of Perceived Social Support. Total support, as well as social support from family and friends, was not associated with initial PTSD severity or treatment response. However, there was a significant positive association between social support from a significant other and initial PTSD severity (g = .92). Additionally, significant other social support moderated treatment outcomes, such that higher initial significant other support was associated with larger decreases in PTSD severity for those in the treatment condition (g = -1.14) but not the waitlist condition (g = -.04). Social support from a significant other may influence PTSD treatment outcomes within couple therapy for PTSD. The inclusion of intimate partners and other family members may be a fruitful avenue for improving PTSD treatment outcomes; however, future studies are needed to examine whether support can be increased with treatment and whether those improvements lead to greater PTSD symptom response.
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20
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Epstein NB, Zheng L. Cognitive-behavioral couple therapy. Curr Opin Psychol 2016; 13:142-147. [PMID: 28813285 DOI: 10.1016/j.copsyc.2016.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/23/2016] [Accepted: 09/20/2016] [Indexed: 01/12/2023]
Abstract
This article describes how cognitive-behavioral couple therapy (CBCT) provides a good fit for intervening with a range of stressors that couples experience from within and outside their relationship. It takes an ecological perspective in which a couple is influenced by multiple systemic levels. We provide an overview of assessment and intervention strategies used to modify negative behavioral interaction patterns, inappropriate or distorted cognitions, and problems with the experience and regulation of emotions. Next, we describe how CBCT can assist couples in coping with stressors involving (a) a partner's psychological disorder (e.g. depression), (b) physical health problems (e.g. cancer), (c) external stressors (e.g. financial strain), and (d) severe relational problems (e.g. partner aggression).
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Affiliation(s)
| | - Le Zheng
- University of Maryland, College Park, USA
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21
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Fischer MS, Baucom DH, Cohen MJ. Cognitive-Behavioral Couple Therapies: Review of the Evidence for the Treatment of Relationship Distress, Psychopathology, and Chronic Health Conditions. FAMILY PROCESS 2016; 55:423-42. [PMID: 27226429 DOI: 10.1111/famp.12227] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cognitive-behavioral couple therapy (CBCT) is an approach to assisting couples that has strong empirical support for alleviating relationship distress. This paper provides a review of the empirical status of CBCT along with behavioral couple therapy (BCT), as well as the evidence for recent applications of CBCT principles to couple-based interventions for individual psychopathology and medical conditions. Several meta-analyses and major reviews have confirmed the efficacy of BCT and CBCT across trials in the United States, Europe, and Australia, and there is little evidence to support differential effectiveness of various forms of couple therapy derived from behavioral principles. A much smaller number of effectiveness studies have shown that successful implementation in community settings is possible, although effect sizes tend to be somewhat lower than those evidenced in randomized controlled trials. Adapted for individual problems, cognitive-behavioral couple-based interventions appear to be at least as effective as individual cognitive behavioral therapy (CBT) across a variety of psychological disorders, and often more effective, especially when partners are substantially involved in treatment. In addition, couple-based interventions tend to have the unique added benefit of improving relationship functioning. Findings on couple-based interventions for medical conditions are more varied and more complex to interpret given the greater range of target outcomes (psychological, relational, and medical variables).
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Affiliation(s)
- Melanie S Fischer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew J Cohen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
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22
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Macdonald A, Pukay-Martin ND, Wagner AC, Fredman SJ, Monson CM. Cognitive-behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2016; 30:157-62. [PMID: 26651352 PMCID: PMC4749018 DOI: 10.1037/fam0000177] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Numerous studies document an association between posttraumatic stress disorder (PTSD) and impairments in intimate relationship functioning, and there is evidence that PTSD symptoms and associated impairments are improved by cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012). The present study investigated changes across treatment in clinician-rated PTSD symptom clusters and patient-rated trauma-related cognitions in a randomized controlled trial comparing CBCT for PTSD with waitlist in a sample of 40 individuals with PTSD and their partners (N = 40; Monson et al., 2012). Compared with waitlist, patients who received CBCT for PTSD immediately demonstrated greater improvements in all PTSD symptom clusters, trauma-related beliefs, and guilt cognitions (Hedge's gs -.33 to -1.51). Results suggest that CBCT for PTSD improves all PTSD symptom clusters and trauma-related cognitions among individuals with PTSD and further supports the value of utilizing a couple-based approach to the treatment of PTSD.
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Affiliation(s)
- Alexandra Macdonald
- National Center for PTSD-VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA, USA 02130
- The Citadel, The Military College of South Carolina, 171 Moultrie St, Charleston, SC 29409
| | | | - Anne C. Wagner
- Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3
| | - Steffany J. Fredman
- The Pennsylvania State University, 315 Health and Human Development East, University Park, PA, USA 16802
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23
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Shnaider P, Pukay-Martin ND, Sharma S, Jenzer T, Fredman SJ, Macdonald A, Monson CM. A Preliminary Examination of the Effects of Pretreatment Relationship Satisfaction on Treatment Outcomes in Cognitive-Behavioral Conjoint Therapy for PTSD. ACTA ACUST UNITED AC 2015; 4:229-238. [PMID: 27840775 DOI: 10.1037/cfp0000050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The primary goal of the present study was to investigate whether pre-treatment relationship satisfaction predicted treatment drop-out and posttraumatic stress disorder (PTSD) symptom outcomes within a trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012). Additionally, we examined the influence of pre-treatment relationship distress on relationship outcomes. METHOD Thirty-seven patients and their intimate partners who participated in a course of CBCT for PTSD were assessed for PTSD symptoms with the Clinician-Administered PTSD Scale and PTSD Checklist, and for intimate relationship functioning with the Dyadic Adjustment Scale. CBCT for PTSD is a conjoint therapy designed to improve PTSD symptoms and enhance relationship functioning. Patients had to meet diagnostic criteria for PTSD to be included in the study; however, couples were not required to be in distressed relationships to receive treatment. RESULTS Neither patients' nor partners' pre-treatment relationship satisfaction, nor their interaction, predicted treatment drop-out (ORs = .97-1.01) or completing patients' post-treatment PTSD symptom severity (sr2 ≤ .03). However, participants who were in distressed relationships prior to treatment made greater gains in relationship satisfaction compared with those who began treatment in more satisfied relationships (g = 1.02). CONCLUSIONS Among patients receiving CBCT for PTSD, treatment drop-out and improvements in PTSD symptoms may be independent of pre-treatment relationship functioning, whereas improvements in relational functioning may be greater among those distressed prior to treatment.
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Affiliation(s)
- Philippe Shnaider
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | - Shankari Sharma
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Tiffany Jenzer
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Steffany J Fredman
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alexandra Macdonald
- Women's Health Sciences Division, U.S. VA National Center for PTSD, Boston, Massachusetts, USA; Department of Psychiatry, Boston University, Boston, Massachusetts, USA
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Blount T, Fredman SJ, Pukay-Martin ND, Macdonald A, Monson CM. Cognitive-Behavioral Conjoint Therapy for PTSD: Application to an Operation Enduring Freedom Veteran. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Baucom DH, Belus JM, Adelman CB, Fischer MS, Paprocki C. Couple-based interventions for psychopathology: a renewed direction for the field. FAMILY PROCESS 2014; 53:445-461. [PMID: 24773298 DOI: 10.1111/famp.12075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article provides a rationale and empirical support for providing couple-based interventions when one partner in a relationship is experiencing individual psychopathology. Several investigations indicate that relationship distress and psychopathology are associated and reciprocally influence each other, such that the existence of relationship distress predicts the development of subsequent psychopathology and vice versa. Furthermore, findings indicate that for several disorders, individual psychotherapy is less effective if the client is in a distressed relationship. Finally, even within happy relationships, partners often inadvertently behave in ways that maintain or exacerbate symptoms for the other individual. Thus, within both satisfied and distressed relationships, including the partner in a couple-based intervention provides an opportunity to use the partner and the relationship as a resource rather than a stressor for an individual experiencing some form of psychological distress. The authors propose that a promising approach to including the partner in treatment involves (a) integrating intervention principles from empirically supported interventions for individual therapy for specific disorders with (b) knowledge of how to employ relationships to promote individual and dyadic change. Based on this logic, the article includes several examples to demonstrate how couple-based interventions can be focused on a specific type of psychopathology, including encouraging empirical findings for these interventions. The article concludes with recommendations for how clinicians and researchers can adapt their knowledge of couple therapy to assist couples in which one partner is experiencing notable psychological distress or diagnosable psychopathology.
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Affiliation(s)
- Donald H Baucom
- Psychology Department, University of North Carolina, Chapel Hill, NC
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