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MacIntosh HB. Developmental couple therapy for complex trauma: Results of an implementation pilot study. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:545-566. [PMID: 38803035 DOI: 10.1111/jmft.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/20/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024]
Abstract
This pilot study examined the process and outcome of Developmental Couple Therapy for Complex Trauma (DCTCT) with seven couples. DCTCT is a novel form of couple therapy designed to address complex posttraumatic stress disorder symptomatology and couple-level distress in trauma survivors and their partners. These couples showed statistically significant improvements in overall trauma symptoms, emotion regulation capacities, and reductions in attachment-related anxiety. These results suggest that DCTCT may be a promising approach to intervention. Future directions include the development of a sequential care model, because resource limitations may not allow for all couples to receive the full treatment model over 40 weeks; it will also be important to address measurement issues in relation to mentalizing, to allow for observational coding across the course of therapy.
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Affiliation(s)
- Heather B MacIntosh
- School of Social Work, MScA Couple and Family Therapy, McGill University, Montreal, QC, Canada
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Dodge J, Sullivan K, Grau PP, Chen C, Sripada R, Pfeiffer PN. Retention in Individual Trauma-Focused Treatment Following Family-Based Treatment Among US Veterans. JAMA Netw Open 2023; 6:e2349098. [PMID: 38127345 PMCID: PMC10739069 DOI: 10.1001/jamanetworkopen.2023.49098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Despite the availability of several empirically supported trauma-focused interventions, retention in posttraumatic stress disorder (PTSD) psychotherapy is poor. Preliminary efficacy data shows that brief, family-based interventions may improve treatment retention in a veteran's individual PTSD treatment, although whether this occurs in routine clinical practice is not established. Objective To characterize receipt of family therapy among veterans diagnosed with PTSD and evaluate whether participation in family therapy is associated with an increased likelihood of completing individual trauma-focused treatment. Design, Setting, and Participants This retrospective cohort study used the Veterans Health Administration (VHA) Informatics and Computing Infrastructure to extract electronic health record data of participants. All participants were US veterans diagnosed with PTSD between October 1, 2015, and December 31, 2019, who attended at least 1 individual trauma-focused treatment session. Statistical analysis was performed from May to August 2023. Exposures Receipt of any family psychotherapy and subtype of family-based psychotherapy. Main Outcomes and Measures Minimally adequate individual trauma-focused treatment completion (ie, 8 or more sessions of trauma-focused treatment in a 6-month period). Results Among a total of 1 516 887 US veterans with VHA patient data included in the study, 58 653 (3.9%) received any family therapy; 334 645 (23.5%) were Black, 1 006 168 (70.5%) were White, and 86 176 (6.0%) were other race; 1 322 592 (87.2%) were male; 1 201 902 (79.9%) lived in urban areas; and the mean (SD) age at first individual psychotherapy appointment was 52.7 (15.9) years. Among the 58 653 veterans (3.9%) who received any family therapy, 36 913 (62.9%) received undefined family therapy only, 15 528 (26.5%) received trauma-informed cognitive-behavioral conjoint therapy (CBCT) only, 5210 (8.9%) received integrative behavioral couples therapy (IBCT) only, and 282 (0.5%) received behavioral family therapy (BFT) only. Compared with receiving no family therapy, the odds of completing individual PTSD treatment were 7% higher for veterans who also received CBCT (OR, 1.07 [95% CI, 1.01-1.13]) and 68% higher for veterans received undefined family therapy (OR, 1.68 [95% CI, 1.63-1.74]). However, compared with receiving no family therapy care, veterans had 26% lower odds of completing individual PTSD treatment if they were also receiving IBCT (OR, 0.74 [95% CI, 0.66-0.82]). Conclusions and Relevance In this cohort study of US veterans, family-based psychotherapies were found to differ substantially in their associations with individual PTSD psychotherapy retention. These findings highlight potential benefits of concurrently providing family-based therapy with individual PTSD treatment but also the need for careful clinical attention to the balance between family-based therapies and individual PTSD treatment.
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Affiliation(s)
- Jessica Dodge
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
| | | | - Peter P. Grau
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Charity Chen
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
| | - Rebecca Sripada
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Paul N. Pfeiffer
- Health Services Research and Development/Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital (152), Ann Arbor, Michigan
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
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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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Maladaptive cognitions and emotion regulation in posttraumatic stress disorder. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023:10.1007/s40211-022-00453-w. [PMID: 36692809 PMCID: PMC9872076 DOI: 10.1007/s40211-022-00453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/26/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The present study investigated the interactions between emotion regulation strategies and cognitive distortions in posttraumatic stress disorder (PTSD). We also examined differences in emotion regulation and cognitive distortions across the trauma spectrum. METHODS The study was conducted in France between December 2019 and August 2020 and was approved by the university ethics committee. We recruited 180 participants aged over 18, with 3 groups of 60 each: (1) patients diagnosed with PTSD, (2) trauma-exposed without PTSD, (3) no history of trauma. Exclusion criteria were a history of neurological or mental disorders, psychoactive substance abuse, and a history of physical injury that could affect outcomes. All participants completed the Life Events Checklist‑5 (LEC-5), Post-traumatic Check List‑5 (PCL-5), Dissociative Experiences Scale (DES), Cognitive Emotion Regulation Questionnaire (CERQ), and Cognitive Distortions scale for Adults (EDC-A). Correlation analysis was performed to observe the relationship between PTSD severity and cognitive functioning. Correlations between cognitive distortions and maladaptive emotion regulation strategies were calculated for the PTSD group. A moderation analysis of the whole sample was conducted to examine the relationship between cognitive distortions, emotion regulation strategies, and PTSD. RESULTS Participants with PTSD scored significantly higher on the PCL‑5 and for dissociation than the other groups. PCL‑5 scores were positively correlated with maladaptive emotion regulation strategies and acceptance. They were also correlated with positive and negative dichotomous reasoning and negative minimization. Analysis of the PTSD group revealed correlations between maladaptive emotion regulation strategies and negative cognitive distortions. The moderation analysis revealed the cognitive distortions explaining the relationship between emotion regulation strategies and trauma exposure overall, and how they exacerbate emotional problems in PTSD. CONCLUSION The study provides indications for management of PTSD patients. Inclusion of an intermediate group of individuals exposed to trauma without PTSD revealed differences in the observed alterations. It would be interesting to extend the cross-sectional observation design to study traumatic events that may cause a specific type of disorder.
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Ouhmad N, Deperrois R, Combalbert N, El Hage W. The Role of Anxiety and Depression in the Emotion Regulation Strategies of People Suffering from Post-Traumatic Stress Disorder. THE JOURNAL OF PSYCHOLOGY 2023; 157:143-159. [PMID: 36796009 DOI: 10.1080/00223980.2022.2134279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Researchers have explored the links between cognitive emotion regulation, impaired cognitive functioning, and anxiety-depression, including the link to anxiety and depression levels. However, very few studies have examined these dimensions in clinical populations with post-traumatic stress disorder (PTSD). A sample of 183 participants was divided into three groups: 59 trauma-exposed with PTSD, 61 trauma-exposed without PTSD, and 63 non-trauma-exposed non-PTSD (controls). All participants were assessed on the following dimensions: PTSD (PCL-5), cognitive emotion regulation (CERQ), anxiety and depression (HADS). Results indicate a specific profile of emotion regulation associated with PTSD. Compared to other groups, participants with PTSD showed more difficulty managing their emotions, with more rumination, self-blame, and catastrophizing. Moreover, these difficulties were also correlated with levels of anxiety and depression, that is, participants with PTSD who had higher anxiety and depression scores used more maladaptive strategies. The PTSD group used significantly more maladaptive cognitive emotion regulation strategies than the other groups, with distinct profiles related to anxiety and depressive symptomatology.
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Lonergan M, Saumier D, Pigeon S, Etienne PE, Brunet A. Treatment of adjustment disorder stemming from romantic betrayal using memory reactivation under propranolol: A open-label interrupted time series trial. J Affect Disord 2022; 317:98-106. [PMID: 36031005 DOI: 10.1016/j.jad.2022.08.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES In a sustained relationship, romantic betrayal is a catastrophic event that can precipitate an adjustment disorder (AD). Surprisingly, there exists no empirically validated treatment for AD, despite its high prevalence in clinical practice. Considering the promise of memory reactivation under propranolol (i.e., reconsolidation interference) for treating posttraumatic stress disorder, we sought to extend this finding to AD, given that in both disorders, symptoms stem from an identified stressor. METHOD A single-blind interrupted time series design was used to examine the efficacy of memory reactivation under propranolol to alleviate symptoms of AD. After being placed on a 4-week waitlist, sixty-one participants received 5 weekly 25-min treatments during which they recalled the betrayal event, 1 h after having orally ingested the beta-blocker propranolol. RESULTS Segmented regression analyses on the intent-to-treat sample revealed that AD symptoms significantly decreased during the treatment phase (pre/post Cohen's d = 1.44), compared to the waitlist phase (d = 0.01). Significant pre/post reductions in anxio-depressive symptomatology were also found. Improvement was maintained at the 4-month follow-up on all outcomes. CONCLUSION Memory reactivation under propranolol shows promise in reducing symptoms of AD. This study provides the theoretical framework and necessary effect sizes to inform larger, double-blind, placebo-controlled clinical trials.
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Affiliation(s)
- Michelle Lonergan
- University of Ottawa, School of Psychology, Ottawa, Ontario, Canada; Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Daniel Saumier
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada; University of Sherbrooke, Department of Psychology, Longueuil, Québec, Canada
| | - Sereena Pigeon
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada; McGill University, Department of Educational and Counselling Psychology, Montreal, Québec, Canada
| | - Pierre E Etienne
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Alain Brunet
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada; McGill University, Department of Psychiatry, Montreal, Québec, Canada.
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Sijercic I, Liebman RE, Ip J, Whitfield KM, Ennis N, Sumantry D, Sippel LM, Fredman SJ, Monson CM. A systematic review and meta-analysis of individual and couple therapies for posttraumatic stress disorder: Clinical and intimate relationship outcomes. J Anxiety Disord 2022; 91:102613. [PMID: 35970071 DOI: 10.1016/j.janxdis.2022.102613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 10/16/2022]
Abstract
The association between symptoms of posttraumatic stress disorder (PTSD) in adults and difficulties in intimate relationships is well documented. Growing literature suggests that interpersonally-oriented therapies, such as couple and family interventions, may lead to improvements in both PTSD symptoms and intimate relationship functioning. However, it is unknown how individual PTSD treatments compare to couple/family interventions in relational outcomes. The present study was a systematic review and meta-analysis of individual and couple/family treatments to examine changes in PTSD symptoms and intimate relationship functioning. Twelve couple treatment studies with 13 unique samples and 7 individual treatment studies with 9 unique samples met inclusion criteria. No family-based treatments were identified. Meta-analytic findings indicated moderate to large reductions in PTSD symptoms for both couple and individual studies. Small but significant improvements in intimate relationship functioning across individual and couple studies were observed. Moderation analysis suggested that across both individual and couple treatment formats, trauma-focused treatments had larger effects on PTSD symptoms. Trauma-focused treatments had larger effects on intimate relationship functioning for individual studies. Military status did not moderate outcomes. This study supports the utility of both individual and couple treatment formats for treating PTSD and provides preliminary support for these modalities for also enhancing intimate relationship functioning.
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Affiliation(s)
| | - Rachel E Liebman
- Toronto Metropolitan University, Toronto, Canada; University Health Network, Toronto General Hospital, Toronto, Canada
| | - Jennifer Ip
- Toronto Metropolitan University, Toronto, Canada
| | | | - Naomi Ennis
- Toronto Metropolitan University, Toronto, Canada
| | | | - Lauren M Sippel
- National Center for PTSD, USA; Geisel School of Medicine at Dartmouth, NH, USA
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Pukay-Martin ND, Fredman SJ, Martin CE, Le Y, Haney A, Sullivan C, Monson CM, Chard KM. Effectiveness of cognitive behavioral conjoint therapy for posttraumatic stress disorder (PTSD) in a U.S. Veterans Affairs PTSD clinic. J Trauma Stress 2022; 35:644-658. [PMID: 34942022 PMCID: PMC9035020 DOI: 10.1002/jts.22781] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
Cognitive behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) is a 15-session conjoint treatment for PTSD designed to improve PTSD symptoms and enhance intimate relationship functioning. Numerous studies of CBCT for PTSD document improvements in patient PTSD and comorbid symptoms, partner mental health, and relationship adjustment. However, little is known about its effectiveness in real-world clinical settings. Using an intention-to-treat sample of couples who participated in CBCT for PTSD in an outpatient U.S. Veterans Affairs (VA) PTSD clinic (N = 113), trajectories of session-by-session reports of veterans' PTSD symptoms and both partners' relationship happiness were examined. Across sessions, there were significant reductions in veteran-rated PTSD symptoms, d = -0.69, and significant increases in veteran- and partner-rated relationship happiness, ds = 0.36 and 0.35, respectively. Partner ratings of veterans' PTSD symptoms increased before significantly decreasing, d = -0.24. Secondary outcomes of veteran and partner relationship satisfaction, ds = 0.30 and 0.42, respectively; veteran and partner depressive symptoms, ds = -0.75 and -0.29, respectively; and partner accommodation of PTSD symptoms, d = -0.44, also significantly improved from pre- to posttreatment. The findings suggest that CBCT for PTSD was effective for decreasing PTSD and comorbid symptoms in veterans, as well as for improving relationship functioning and partners' mental health, among a sample of real-world couples seeking treatment in a VA PTSD specialty clinic.
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Affiliation(s)
- Nicole D. Pukay-Martin
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Steffany J. Fredman
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Colleen E. Martin
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Yunying Le
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alison Haney
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Connor Sullivan
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | | | - Kathleen M. Chard
- Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
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McWey LM. Systemic interventions for traumatic event exposure: A 2010-2019 decade review. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:204-230. [PMID: 34418120 DOI: 10.1111/jmft.12547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
Trauma exposure is a pervasive issue worldwide. People exposed to traumatic events may develop PTSD, depression, anxiety, and other mental health symptoms. Family and intimate partner relationship problems also are frequently associated with trauma exposure. The purpose of this study was to conduct a systematic research synthesis of the empirical evidence on systemic interventions for traumatic event exposure from 2010 to 2019. A search of peer-reviewed research resulted in 31 articles that met inclusion criteria and were included in this review. Systemic interventions were grouped by modality (e.g., parent-child, couple, group). The collective evidence was strongest for systemic youth-caregiver interventions, group, and couple treatment categories for traumatic event exposure. Youth-centered interventions that included various combinations of family member participation can be considered probably efficacious. Overall, results indicated that systemic interventions for traumatic event exposure were successful in reducing posttraumatic stress symptoms including PTSD, depression, and anxiety, and improving relational outcomes.
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The buffering role of higher romantic relationship satisfaction on the association of hazardous drinking with PTSD and depression symptoms among female military service members/veterans. Addict Behav 2021; 123:107081. [PMID: 34418870 DOI: 10.1016/j.addbeh.2021.107081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023]
Abstract
Studies show that more positive relationship satisfaction can mitigate the effects of posttraumatic stress disorder (PTSD) and depression severity on hazardous drinking in military samples. However, past studies were not circumscribed to female service members/veterans (SM/V), who represent the fastest growing demographic in the military. Moreover, studies did not examine moderators of specific symptom clusters of PTSD and depression with hazardous drinking. Indeed, recent studies have shown that the more depressive and cognitive clusters are associated with greater dysfunction. The current study extended this literature in a convenience sample of 584 female SM/V who completed self-report measures of hazardous drinking, PTSD, depression, and relationship satisfaction. PTSD or depression severity, relationship satisfaction, and their interaction, were examined as correlates of hazardous drinking after accounting for relationship, demographic, and military characteristics. For both overall PTSD and depression severity, higher relationship satisfaction weakened their association with hazardous drinking. Such results were consistent when global scores were replaced with PTSD-related negative alterations in cognitions and mood and somatic depression symptom clusters, but not for PTSD-related dysphoric arousal, anhedonia, or non-somatic depression symptom clusters. Findings suggest that to lessen the association of PTSD or depressive symptoms with problematic drinking, interventions aimed at improving relationship satisfaction may be worth considering among women in relationships. Moreover, symptom cluster analyses show that the cognitive and depressive components of PTSD, as well as the physical symptoms of depression, are most problematic, pinpointing specific areas of function on which to intervene.
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Whelan J, Eichler M, Norris D, Landry D. The Politics of Treatment: A Qualitative Study of Canadian Military PTSD Clinicians. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Watkins LE, Laws HB. A Dyadic Analysis of PTSD and Psychological Partner Aggression Among U.S. Iraq and Afghanistan Veterans: The Impact of Gender and Dual-Veteran Couple Status. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:2393-2408. [PMID: 29502510 DOI: 10.1177/0886260518760016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) symptoms have been repeatedly linked to intimate partner aggression (IPA), and previous research has suggested that this association may be stronger among veterans and men. However, few studies have examined veteran status and gender as moderators of the association between PTSD and psychological IPA, taking both partners' perspectives into account (i.e., within a dyadic framework). The current study aimed to address this limitation by using dyadic multilevel modeling to examine the association between PTSD symptoms and psychological IPA perpetration among a sample of 159 Operation Iraqi Freedom and Operation Enduring Freedom veterans and their partners (N = 318 participants). Findings revealed that both one's own and one's partner's PTSD symptoms were positively associated with greater psychological IPA. In addition, the effects of partner PTSD symptoms on psychological IPA perpetration differed across gender and veteran status. Results suggested that the association of partner PTSD and IPA perpetration may be stronger for male veterans than for female veterans. Findings from the current study are consistent with previous research showing associations between PTSD and IPA, and have clinical implications for treatment of PTSD and IPA among Operation Iraqi Freedom and Operation Enduring Freedom veterans.
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Affiliation(s)
| | - Holly B Laws
- VA Connecticut Healthcare System, West Haven, USA
- University of Massachusetts Amherst, Amherst, MA, USA
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Gregory VL. Cognitive-Behavioral Therapy for Relationship Distress: Meta-analysis of RCTs with Social Work Implications. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2021; 18:49-70. [PMID: 32808591 DOI: 10.1080/26408066.2020.1806164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The purpose of the present meta-analysis is twofold: 1) determine the aggregated statistical effect of cognitive-behavioral couples therapy (CBCT) for relationship distress in randomized controlled trials and 2) use the findings to inform clinical social work practice and research. METHODS A systematic review was conducted using electronic databases and the reference lists of included studies. The random effects model meta-analysis used a hedges' g effect size. RESULTS After the removal of an outlier, a homogeneous (Q = 16.66, df = 12, p = .16, I 2 = 27.96), significant, moderate effect favoring CBCT (Hedges' g summary effect = .421, Z = 4.51, p < .0001, 95% confidence interval: 0.238 to 0.604, standard error = .093, variance = .009, k = 13) was obtained. DISCUSSION It is anticipated that cognitive-behavioral/evidence-based social work clinicians and researchers will use the findings to support their clinical practice and advance their clinical research, respectively.
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Affiliation(s)
- Virgil L Gregory
- School of Social Work - MSW Direct, Indiana University , Indianapolis, Indiana, USA
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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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Fedynich AL, Birkley EL, Chard KM. Cognitive-Behavioral Conjoint Therapy for PTSD: A Case Study of a Transgender Male Co-Parenting With Former Spouse and Perpetrator of Domestic Violence. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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Fredette C, Rizkallah E, El-Baalbaki G, Palardy V, Guay S. A qualitative analysis of the quality of social and marital support for PTSD victims. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2019.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Reed-Fitzke K, Lucier-Greer M. The Buffering Effect of Relationships on Combat Exposure, Military Performance, and Mental Health of U.S. Military Soldiers: A Vantage Point for CFTs. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:321-336. [PMID: 31436335 DOI: 10.1111/jmft.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined the role of cumulative combat experiences with regard to military performance and conduct and mental health among a sample of young soldiers from the Army STARRS dataset (N = 5,283). Higher levels of cumulative combat experiences were directly related to poorer performance and conduct and a greater likelihood of anxiety, depression, and post-traumatic stress disorder (PTSD). Military performance and conduct served as a linking mechanism between combat experiences and mental health. Using moderated mediation structural equation modeling, relationship disruptions were found to exacerbate the adverse effects of combat experiences; conversely, unit cohesion buffered the impact of combat experiences. Implications for military helping professionals include identifying leverage points for intervention, particularly strengthening the social connections of service members within and outside the military.
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Blais RK, Livingston WS, Fargo JD. Higher depression severity mediates the association of assault military sexual trauma and sexual function in partnered female service members/veterans. J Affect Disord 2020; 261:238-244. [PMID: 31655379 DOI: 10.1016/j.jad.2019.09.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/16/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Military sexual trauma (MST), and assault as opposed to harassment-only MST in particular, is associated with lower sexual function among female service members/veterans (SM/Vs). Recent research revealed that higher posttraumatic stress disorder (PTSD) symptom clusters of anhedonia and dysphoric arousal mediated the association of assault MST and sexual function. Such clusters represent the depressive symptoms of PTSD, and theories of sexual function suggest that depression worsens sexual function. The impact of depression on the association of MST and sexual function has yet to be tested. METHOD Using path analysis, the study examined whether depression severity mediated the association of MST and sexual function after accounting for demographics and mediators of PTSD-related anhedonia and dysphoric arousal. Female SM/Vs (N = 697) completed measures of MST (history, severity), depression, PTSD-related anhedonia and dysphoric arousal, sexual function, and a demographic inventory. RESULTS One hundred twenty-two (17.50%) indicated that they did not experience MST, 336 (48.21%) reported that they experienced harassment-only MST, and 239 (34.29%) reported assault MST. Fit indices evidenced strong model fit, χ2(12, N = 697)=18.85, p=.09, CFI=1.00, TLI=0.99, SRMR=0.02, and RMSEA=0.03. The indirect effect of depression severity was significant (p<.001). LIMITATIONS Use of cross-sectional data in a convenience sample of female SM/Vs. CONCLUSIONS Even after accounting for established covariates and mediators of assault MST and sexual function, depression accounted for a significant amount of variance in this association. Treatment of poor sexual function must address depressive symptoms. As medications for depression can exacerbate sexual issues, psychotherapy may be the most effective treatment strategy.
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Suomi A, Evans L, Rodgers B, Taplin S, Cowlishaw S. Couple and family therapies for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2019; 12:CD011257. [PMID: 31797352 PMCID: PMC6890534 DOI: 10.1002/14651858.cd011257.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) refers to an anxiety or trauma- and stressor-related disorder that is linked to personal or vicarious exposure to traumatic events. PTSD is associated with a range of adverse individual outcomes (e.g. poor health, suicidality) and significant interpersonal problems which include difficulties in intimate and family relationships. A range of couple- and family-based treatments have been suggested as appropriate interventions for families impacted by PTSD. OBJECTIVES The objectives of this review were to: (1) assess the effects of couple and family therapies for adult PTSD, relative to 'no treatment' conditions, 'standard care', and structured or non-specific individual or group psychological therapies; (2) examine the clinical characteristics of studies that influence the relative effects of these therapies; and (3) critically evaluate methodological characteristics of studies that may bias the research findings. SEARCH METHODS We searched MEDLINE (1950- ), Embase (1980- ) and PsycINFO (1967- ) via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) to 2014, then directly via Ovid after this date. We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We conducted supplementary searches of PTSDPubs (all available years) (this database is formerly known as PILOTS (Published International Literature on Traumatic Stress)). We manually searched the early editions of key journals and screened the reference lists and bibliographies of included studies to identify other relevant research. We also contacted the authors of included trials for unpublished information. Studies have been incorporated from searches to 3 March 2018. SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs) of couple or family therapies for PTSD in adult samples. The review considered any type of therapy that was intended to treat intact couples or families where at least one adult family member met criteria for PTSD. It was required that participants were diagnosed with PTSD according to recognised classification systems. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures prescribed by Cochrane. Three review authors screened all titles and abstracts and two authors independently extracted data from each study deemed eligible and assessed the risk of bias for each study. We used odds ratios (OR) to summarise the effects of interventions for dichotomous outcomes, and standardised mean differences (SMD) to summarise post-treatment between-group differences on continuous measures. MAIN RESULTS We included four trials in the review. Two studies examined the effects of cognitive behavioural conjoint/couple's therapy (CBCT) relative to a wait list control condition, although one of these studies only reported outcomes in relation to relationship satisfaction. One study examined the effects of structural approach therapy (SAT) relative to a PTSD family education (PFE) programme; and one examined the effects of adjunct behavioural family therapy (BFT) but failed to report any outcome variables in sufficient detail - we did not include it in the meta-analysis. One trial with 40 couples (80 participants) showed that CBCT was more effective than wait list control in reducing PTSD severity (SMD -1.12, 95% CI -1.79 to -0.45; low-quality evidence), anxiety (SMD -0.93, 95% CI -1.58 to -0.27; very low-quality evidence) and depression (SMD -0.66, 95% CI -1.30 to -0.02; very low-quality evidence) at post-treatment for the primary patient with PTSD. Data from two studies indicated that treatment and control groups did not differ significantly according to relationship satisfaction (SMD 1.07, 95% CI -0.17 to 2.31; very low-quality evidence); and one study showed no significant differences regarding depression (SMD 0.28, 95% CI -0.35 to 0.90; very low-quality evidence) or anxiety symptoms (SMD 0.15, 95% CI -0.47 to 0.77; very low-quality evidence) for the partner of the patient with PTSD. One trial with 57 couples (114 participants) showed that SAT was more effective than PFE in reducing PTSD severity for the primary patient (SMD -1.32, 95% CI -1.90 to -0.74; low-quality evidence) at post-treatment. There was no evidence of differences on the other outcomes, including relationship satisfaction (SMD 0.01, 95% CI -0.51 to 0.53; very low-quality evidence), depression (SMD 0.21, 95% CI -0.31 to 0.73; very low-quality evidence) and anxiety (SMD -0.16, 95% CI -0.68 to 0.36; very low-quality evidence) for intimate partners; and depression (SMD -0.28, 95% CI -0.81 to 0.24; very low-quality evidence) or anxiety (SMD -0.34, 95% CI -0.87 to 0.18; very low-quality evidence) for the primary patient. Two studies reported on adverse events and dropout rates, and no significant differences between groups were observed. Two studies were classified as having a 'low' or 'unclear' risk of bias in most domains, except for performance bias that was rated 'high'. Two studies had significant amounts of missing information resulting in 'unclear' risk of bias. There were too few studies available to conduct subgroup analyses. AUTHORS' CONCLUSIONS There are few trials of couple-based therapies for PTSD and evidence is insufficient to determine whether these offer substantive benefits when delivered alone or in addition to psychological interventions. Preliminary RCTs suggest, however, that couple-based therapies for PTSD may be potentially beneficial for reducing PTSD symptoms, and there is a need for additional trials of both adjunctive and stand-alone interventions with couples or families which target reduced PTSD symptoms, mental health problems of family members and dyadic measures of relationship quality.
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Affiliation(s)
- Aino Suomi
- Australian Catholic UniversityInstitute of Child Protection StudiesCanberraAustralia
- The University of MelbourneMelbourne Graduate School of EducationMelbourneAustralia
| | - Lynette Evans
- La Trobe UniversitySchool of Psychological Studies, Faculty of Science, Technology and EngineeringMelbourneAustralia
| | - Bryan Rodgers
- The Australian National UniversitySchool of Demography, ANU College of Arts and Social SciencesCanberraAustralia
| | - Stephanie Taplin
- Australian Catholic UniversityInstitute of Child Protection StudiesCanberraAustralia
| | - Sean Cowlishaw
- The University of MelbournePhoenix Australia Centre for Posttraumatic Mental Health, Department of PsychiatryMelbourneAustralia
- University of BristolBristol Medical SchoolBristolUK
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Marshall AD, Le Y, Fredman SJ, Feinberg ME, Taverna EC, Jones DE. Prospective, dyadic links between posttraumatic stress disorder symptoms and family violence in the early years of parenthood. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2019; 33:1000-1006. [PMID: 31318268 PMCID: PMC6878120 DOI: 10.1037/fam0000557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cross-sectional research has suggested that posttraumatic stress disorder (PTSD) symptom severity may be an important predictor of family violence perpetration; however, causal inference is limited by the absence of studies designed to prospectively predict family violence by PTSD symptoms. In the current study, PTSD symptoms were assessed among 250 trauma-exposed heterosexual couples 10 months after having their 1st child. The number of acts of psychological and physical intimate partner aggression (IPA) and parent-to-child aggression (PCA) that occurred during the past year was assessed at 10 and 24 months postpartum to account for stability in family violence perpetration when prospectively predicting perpetration. Longitudinal actor-partner interdependence models revealed that women's and men's PTSD symptoms positively predicted increases in the frequency of their own perpetration of psychological and physical IPA as well as psychological PCA. Additionally, partners' PTSD symptoms prospectively predicted psychological and physical IPA perpetration but not psychological or physical PCA perpetration, suggesting that partners' PTSD symptoms may directly impact dyadic processes during incidents of IPA but may not generally affect the family environment in a way that potentiates all forms of aggression. No significant gender differences were revealed. Overall, results of the current study largely support existing research and theory while clarifying inconsistencies that have emerged when examining cross-sectional associations. Further, the current results highlight the potential utility of PTSD treatment as an avenue for aggression prevention and intervention efforts during the early parenting years. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Yunying Le
- Department of Human Development and Family Studies
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Kugler J, Andresen FJ, Bean RC, Blais RK. Couple‐based interventions for PTSD among military veterans: An empirical review. J Clin Psychol 2019; 75:1737-1755. [DOI: 10.1002/jclp.22822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jordan Kugler
- Department of PsychologyUtah State University Logan Utah
| | | | - Ron C. Bean
- Department of PsychologyUtah State University Logan Utah
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23
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Love HA, Torgerson CN. Traumatic Experiences in Childhood and Adult Substance Use in a Nonclinical Sample: The Mediating Role of Arousal/Reactivity. JOURNAL OF MARITAL AND FAMILY THERAPY 2019; 45:508-520. [PMID: 30009525 DOI: 10.1111/jmft.12348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The vast majority of adults in the United States experience at least one traumatic event during childhood. According to the self-medication hypothesis of substance use disorders, adult survivors of childhood trauma may cope with trauma-related symptoms via alcohol or drug use. The purpose of this study is to identify through which specific PTSD symptom clusters childhood trauma exposure are associated with adult substance use. Participants of this study (N = 627) were not recruited based on substance use or traumatic exposure. Results of this study demonstrate that arousal/reactivity partially mediates the association between childhood trauma and current substance use. Implications for treatment include recommendations for trauma-informed approaches that aim to decrease arousal/reactivity and subsequently substance use.
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24
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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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25
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Stadtmann MP, Maercker A, Binder J, Schnepp W. Mastering life together - symptom management, views, and experiences of relatives of persons with CPTSD: a grounded theory study. J Patient Rep Outcomes 2018. [PMCID: PMC6195499 DOI: 10.1186/s41687-018-0070-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Complex posttraumatic stress disorder is described as a chronic condition with several severe and concurrent symptoms. Symptoms influence and impair not only the affected individuals but also their social surroundings and their relatives. The literature describes relatives as a key factor in managing symptoms, both as a barrier and a facilitator. Aim This research aimed to explore and to reconstruct the views, perceptions, experiences, facilitations and barriers of relatives who support the symptom management of persons with CPTSD in everyday life. Methods A theoretical sampling was used to recruit for an interview 18- to 65-year-old relatives of patients with diagnosed CPTSD. The 17 semi-structured interviews were audio-recorded and transcribed verbatim. The transcriptions were uploaded into MAXQDA, and a Grounded Theory method based on that of Corbin and Strauss was used to analyse the data. Results We provide a process model with 5 interacting phases: the initial situation, state of permanence, being an anchor, recognizing limits, and potential outcomes. Each phase is further divided into subcategories. Discussion Participants experienced their condition as unpredictable. Although they mastered different strategies through own exploration and in cooperation, there is a clear need for more education, advice and support for relatives caring for those affected by CPTSD. Health care services should consider providing family support, educational services and increase the involvement of relatives in treatment. Over all, well-supported relatives can play a facilitative, key role in improving symptom management. Trial registration Ethical approval was obtained from the Swiss Cantonal Ethic Commission (Nr 201,500,096). This research was also registered at the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268.
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26
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Bannister JA, Lopez FG, Menefee DS, Norton PJ, Wanner J. Military and Premilitary Trauma, Attachment Orientations, and Posttraumatic Stress Disorder Severity Among Male and Female Veterans. J Trauma Stress 2018; 31:558-567. [PMID: 30091801 DOI: 10.1002/jts.22309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/14/2018] [Accepted: 04/23/2018] [Indexed: 11/08/2022]
Abstract
Samples in prior studies examining attachment theory in the military have been predominantly composed of male combat veterans. Given the rates of sexual trauma among female veterans and differences in the association between attachment and posttraumatic stress disorder (PTSD) severity for sexual trauma survivors, it was necessary to consider the attachment characteristics of veterans within a mixed-sex sample. Participants were a mixed-sex veteran sample seeking inpatient trauma-related treatment (N = 469). Using independent samples t tests, we examined sex differences in attachment. Consistent with our hypothesis, women reported a higher level of attachment anxiety than did men, t(351) = -2.12, p = .034. Women also reported a higher level of attachment avoidance, t(351) = -2.44, p = .015. Using hierarchical regression, we examined the contribution of attachment anxiety and avoidance to PTSD severity, partialing out variance accounted for by demographic variables and traumatic experiences. Consistent with our hypotheses, attachment avoidance predicted PTSD severity on the Clinician-Administered PTSD Scale for DSM-IV (CAPS), β = .20, p < .001, and the PTSD Checklist-Civilian Version (PCL-C), β = .18, p < .001. Attachment anxiety did not predict CAPS severity but did predict PCL-C severity, β = .11, p = .020. These results suggest the association between attachment avoidance and PTSD is not exclusive to combat trauma and may apply more generally to the larger veteran population. Higher levels of attachment anxiety and avoidance among female veterans potentially implicate the presence of greater attachment fearfulness among this particular subpopulation of veterans.
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Affiliation(s)
- Jenny A Bannister
- Michael E. DeBakey VA Medical Center (MEDVAMC), Houston, Texas.,Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Frederick G Lopez
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center (MEDVAMC), Houston, Texas.,The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Peter J Norton
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jill Wanner
- Michael E. DeBakey VA Medical Center (MEDVAMC), Houston, Texas.,The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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27
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Bachem R, Levin Y, Zhou X, Zerach G, Solomon Z. The Role of Parental Posttraumatic Stress, Marital Adjustment, and Dyadic Self-Disclosure in Intergenerational Transmission of Trauma: A Family System Approach. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:543-555. [PMID: 28869760 DOI: 10.1111/jmft.12266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Research indicates that posttraumatic stress symptoms (PTSS) induced by war trauma may be transmitted to veterans' wives and offspring (secondary traumatic stress; STS). However, the interplay between family members' characteristics has not been accounted for in such processes. Taking a family systems perspective, we examine the contributions of fathers' PTSS, mothers' STS, marital adjustment, and self-disclosure of both parents to offspring's STS and test whether marital quality applies as a mechanism of parent-child transmission. Combat veterans and former prisoners of war (N = 123), their spouses, and adult offspring were investigated in a multiple-step mediation analysis. The results highlight the mother's crucial role in trauma transmission and suggest that strengthening the marital relationship may buffer the transmission of fathers' PTSS to offspring.
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Affiliation(s)
- Rahel Bachem
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
| | - Yafit Levin
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
| | - Xiao Zhou
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
| | | | - Zahava Solomon
- University of Tel Aviv
- I-Core Research Center for Mass Trauma
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28
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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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29
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Blount TH, Peterson AL, Monson CM. A Case Study of Cognitive-Behavioral Conjoint Therapy for Combat-Related PTSD in a Same-Sex Military Couple. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Vest BM, Heavey SC, Homish DL, Homish GG. Marital Satisfaction, Family Support, and Pre-Deployment Resiliency Factors Related to Mental Health Outcomes for Reserve and National Guard Soldiers. ACTA ACUST UNITED AC 2017; 5:313-323. [PMID: 30505630 DOI: 10.1080/21635781.2017.1343694] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to examine the relationship between resiliency factors and mental health outcomes among US Army Reserve and National Guard soldiers. Our results demonstrate that higher marital satisfaction is significantly associated with lower anger, depression, anxiety, and PTSD. Importantly, our results provide evidence that among the assessed resiliency factors (pre-deployment preparation, unit social support, martial satisfaction and family support), marital satisfaction has the strongest evidence for promoting resiliency. Future research should develop interventions that can be provided jointly to the soldier and his partner to facilitate stronger relationships and promote improved mental health and reintegration post-deployment.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, Buffalo NY
| | - Sarah Cercone Heavey
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - Gregory G Homish
- Department of Family Medicine, University at Buffalo, Buffalo NY.,Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
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31
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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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32
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Perlick DA, Sautter FJ, Becker-Cretu JJ, Schultz D, Grier SC, Libin AV, Schladen MM, Glynn SM. The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder. Mil Med Res 2017; 4:21. [PMID: 28680693 PMCID: PMC5492909 DOI: 10.1186/s40779-017-0130-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/06/2017] [Indexed: 01/25/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a disabling, potentially chronic disorder that is characterized by re-experience and hyperarousal symptoms as well as the avoidance of trauma-related stimuli. The distress experienced by many veterans of the Vietnam War and their partners prompted a strong interest in developing conjoint interventions that could both alleviate the core symptoms of PTSD and strengthen family bonds. We review the evolution of and evidence base for conjoint PTSD treatments from the Vietnam era through the post-911 era. Our review is particularly focused on the use of treatment strategies that are designed to address the emotions that are generated by the core symptoms of the disorder to reduce their adverse impact on veterans, their partners and the relationship. We present a rationale and evidence to support the direct incorporation of emotion-regulation skills training into conjoint interventions for PTSD. We begin by reviewing emerging evidence suggesting that high levels of emotion dysregulation are characteristic of and predict the severity of both PTSD symptoms and the level of interpersonal/marital difficulties reported by veterans with PTSD and their family members. In doing so, we present a compelling rationale for the inclusion of formal skills training in emotional regulation in couple-/family-based PTSD treatments. We further argue that increased exposure to trauma-related memories and emotions in treatments based on learning theory requires veterans and their partners to learn to manage the uncomfortable emotions that they previously avoided. Conjoint treatments that were developed in the last 30 years all acknowledge the importance of emotions in PTSD but vary widely in their relative emphasis on helping participants to acquire strategies to modulate them compared to other therapeutic tasks such as learning about the disorder or disclosing the trauma to a loved one. We conclude our review by describing two recent innovative treatments for PTSD that incorporate a special emphasis on emotion-regulation skills training in the dyadic context: structured approach therapy (SAT) and multi-family group for military couples (MFG-MC). Although the incorporation of emotion-regulation skills into conjoint PTSD therapies appears promising, replication and comparison to cognitive-behavioral approaches is needed to refine our understanding of which symptoms and veterans might be more responsive to one approach versus others.
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Affiliation(s)
- Deborah A Perlick
- JJPeters Department of Veterans Affairs Medical Center and VISN2 South Mental Illness Research, Education and Clinical Center, 130 West Kingsbridge Rd, Bronx, NY 10468 USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Frederic J Sautter
- Southeast Louisiana Veterans Health Care System, 1601 Perdido St, New Orleans, LA 70112 USA.,Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Julia J Becker-Cretu
- Southeast Louisiana Veterans Health Care System, 1601 Perdido St, New Orleans, LA 70112 USA.,Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Danielle Schultz
- JJPeters Department of Veterans Affairs Medical Center and VISN2 South Mental Illness Research, Education and Clinical Center, 130 West Kingsbridge Rd, Bronx, NY 10468 USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Savannah C Grier
- JJPeters Department of Veterans Affairs Medical Center and VISN2 South Mental Illness Research, Education and Clinical Center, 130 West Kingsbridge Rd, Bronx, NY 10468 USA
| | - Alexander V Libin
- Research and Development, Washington DC VA Medical Center, 50 Irving St NW, Washington, DC 20422 USA.,Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007 USA
| | - Manon Maitland Schladen
- Research and Development, Washington DC VA Medical Center, 50 Irving St NW, Washington, DC 20422 USA.,Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007 USA
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA.,David Geffen School of Medicine, UCLA, 10833 LeConte Ave #12138, Los Angeles, CA 90095 USA
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Oseland L, Gallus KS, Nelson Goff BS. Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2016. [DOI: 10.1080/15332691.2014.938284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Monk JK, Ogolsky BG, Bruner V. Veteran Couples Integrative Intensive Retreat Model: An Intervention for Military Veterans and Their Relational Partners. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2016. [DOI: 10.1080/15332691.2015.1089803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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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36
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Erford BT, Gunther C, Duncan K, Bardhoshi G, Dummett B, Kraft J, Deferio K, Falco M, Ross M. Meta-Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress Disorder. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Chelsea Gunther
- Education Specialties Department; Loyola University Maryland
| | - Kelly Duncan
- Division of Counseling and Psychology; University of South Dakota
- Now at School of Education; Northern University
| | - Gerta Bardhoshi
- Division of Counseling and Psychology; University of South Dakota
- Now at Department of Rehabilitation and Counselor Education; University of Iowa
| | - Beth Dummett
- Education Specialties Department; Loyola University Maryland
| | - Jennifer Kraft
- Education Specialties Department; Loyola University Maryland
| | - Katie Deferio
- Education Specialties Department; Loyola University Maryland
| | - Michelle Falco
- Education Specialties Department; Loyola University Maryland
| | - Margaret Ross
- Education Specialties Department; Loyola University Maryland
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37
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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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Trauma- und Gewaltfolgen – psychische Auswirkungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 59:28-34. [DOI: 10.1007/s00103-015-2259-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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40
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Blow AJ, Curtis AF, Wittenborn AK, Gorman L. Relationship Problems and Military Related PTSD: The Case for Using Emotionally Focused Therapy for Couples. CONTEMPORARY FAMILY THERAPY 2015. [DOI: 10.1007/s10591-015-9345-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Pukay-Martin ND, Torbit L, Landy MSH, Wanklyn SG, Shnaider P, Lane JEM, Monson CM. An Uncontrolled Trial of a Present-Focused Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder. J Clin Psychol 2015; 71:302-12. [DOI: 10.1002/jclp.22166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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42
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Cowlishaw S, Evans L, Suomi A, Rodgers B. Couple and family therapies for post-traumatic stress disorder (PTSD). Hippokratia 2014. [DOI: 10.1002/14651858.cd011257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sean Cowlishaw
- University of Bristol; Centre for Academic Primary Care, School of Social and Community Medicine; Canygne Hall 39 Whatley Road Bristol UK BS8 2PS
- Australian National University; School of Sociology, ANU College of Arts and Social Sciences; Canberra Australia
| | - Lynette Evans
- La Trobe University; School of Psychological Science, Faculty of Science, Technology and Engineering; Melbourne Australia
| | - Aino Suomi
- Australian National University; School of Sociology, ANU College of Arts and Social Sciences; Canberra Australia
| | - Bryan Rodgers
- Australian National University; School of Sociology, ANU College of Arts and Social Sciences; Canberra Australia
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43
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Shnaider P, Pukay-Martin ND, Fredman SJ, Macdonald A, Monson CM, Limmathuroskul D, Praditsuwan R. Effects of cognitive-behavioral conjoint therapy for PTSD on partners' psychological functioning. J Trauma Stress 2014; 27:129-36. [PMID: 24706354 PMCID: PMC4412356 DOI: 10.1002/jts.21893] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in "one" partner are negatively associated with their intimate partner's psychological functioning. The present study investigated intimate partners' mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive-behavioral conjoint therapy for PTSD (Monson & Fredman, 2012). There were no significant differences between active treatment and waitlist in intimate partners' psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive-behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress.
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Affiliation(s)
- Philippe Shnaider
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | - Steffany J. Fredman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, 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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Avery M, McDevitt-Murphy M. Impact of Combat and Social Support on PTSD and Alcohol Consumption in OEF/OIF Veterans. ACTA ACUST UNITED AC 2014; 2:217-223. [PMID: 25071980 DOI: 10.1080/21635781.2014.891433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We tested buffering and direct effect theories of social support to determine if combat exposure level moderated relationships between two aspects of social support (unit cohesion and postdeployment support) and two outcomes (PTSD and alcohol consumption) in 69 hazardous-drinking OEF/OIF veterans (65% Caucasian, 91% male). Combat exposure moderated the relationship between unit cohesion and PTSD. Unit cohesion was related to lower PTSD severity only for veterans with less severe combat exposure. Higher postdeployment support was related to less severe PTSD for all veterans. Alcohol consumption results were not significant.
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Affiliation(s)
- Megan Avery
- The University of Memphis, Memphis, Tennessee; Memphis Veterans' Affairs Medical Center, Memphis, Tennessee
| | - Meghan McDevitt-Murphy
- The University of Memphis, Memphis, Tennessee; Memphis Veterans' Affairs Medical Center, Memphis, Tennessee
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45
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Wolf EJ, Harrington KM, Reardon AF, Castillo D, Taft CT, Miller MW. A dyadic analysis of the influence of trauma exposure and posttraumatic stress disorder severity on intimate partner aggression. J Trauma Stress 2013; 26:329-37. [PMID: 23636815 PMCID: PMC3674162 DOI: 10.1002/jts.21805] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study used structural equation modeling to evaluate a mediation model of the relationship between trauma exposure, posttraumatic stress disorder (PTSD) symptoms, and perpetration of intimate partner physical and psychological aggression in trauma-exposed veterans and their cohabitating spouses (n = 286 couples; 88% male veteran and female spouse, 80.8% White, non-Hispanic). Dyadic data analyses were used to simultaneously evaluate actor and partner effects using the actor-partner interdependence model (Kashy & Kenny, 2000). The primary hypothesis was that PTSD would mediate the association between trauma exposure and intimate partner physical and psychological aggression with these effects evident both within and across members of a couple (i.e., actor and partner effects). The best-fitting model included (a) equivalent actor and partner direct effects of trauma on veterans' acts of psychological aggression (β = .17 to .20, p = .001), and (b) equivalent actor and partner indirect effects via PTSD on veterans' acts of physical aggression (β = .08 to .10, p < .001). There were no direct or indirect effects predicting the spouses' aggression. Results suggest it is important to consider the trauma histories and possible presence of PTSD in both partners as this may be a point of intervention when treating distressed couples.
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Affiliation(s)
- Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System & Department of Psychiatry, Boston University School of Medicine
| | | | | | | | - Casey T. Taft
- National Center for PTSD at VA Boston Healthcare System & Department of Psychiatry, Boston University School of Medicine
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System & Department of Psychiatry, Boston University School of Medicine
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Campbell SB, Renshaw KD. PTSD symptoms, disclosure, and relationship distress: explorations of mediation and associations over time. J Anxiety Disord 2013; 27:494-502. [PMID: 23917126 PMCID: PMC8628599 DOI: 10.1016/j.janxdis.2013.06.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 06/21/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
Emotional numbing symptoms of posttraumatic stress disorder (PTSD) are negatively associated with relationship satisfaction in combat veterans and their romantic partners. Many speculate that one mechanism of this association may be decreased disclosure by veterans, but previous studies lacked appropriate data to test this hypothesis. In a sample of 224 OIF/OEF-era National Guard service members (SMs) and 214 of their romantic partners, we measured SMs' PTSD symptoms. Four to six months later, we assessed both partners' reports of SMs' emotional disclosure and both partners' relationship satisfaction (83 SMs and 91 partners completed Time 2). In a path analysis, SMs' emotional numbing was negatively associated with their later relationship satisfaction. Furthermore, SMs' emotional numbing was negatively associated with both partners' reports of SMs' emotional disclosure. Finally, SMs' emotional numbing exerted significant or nearly significant indirect effects on both partners' relationship satisfaction via decreased emotional disclosure. The findings demonstrated the importance of accounting for both partners' perceptions when studying couple functioning in the context of PTSD or treating PTSD via conjoint intervention.
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Affiliation(s)
- Sarah B. Campbell
- Corresponding author at: Department of Psychology, George Mason University, 4400 University Drive MSN 3F5, Fairfax, VA 22030-4444, United States. Tel.: +1 917 306 5786; fax: +1 703 993 1359. (S.B. Campbell)
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Cognitive Behavior Couple Therapy-REBT Model for Traumatic Bereavement. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2013. [DOI: 10.1007/s10942-013-0164-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Davis LW, Paul R, Tarr D, Eicher AC, Allinger J, Knock H. Operation restoration: couples reunification retreats for veterans of operations enduring and iraqi freedom. J Psychosoc Nurs Ment Health Serv 2012; 50:20-9. [PMID: 23066828 DOI: 10.3928/02793695-20121003-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 07/27/2012] [Indexed: 11/20/2022]
Abstract
Couples interventions are promising approaches to help veterans successfully reintegrate into civilian life and recover from combat-related trauma. However, few programs are available to address these needs. This article describes a weekend retreat program we developed called Operation Restoration, which focuses on strengthening the relationships of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans and their partners. We also report results from program evaluations completed by participants of the initial two retreats, aimed at further developing and refining Operation Restoration. The program evaluations explored participants' perceptions of the retreat, including benefits gained, suggestions for improvement, and mental health treatment interests. Information gathered from 43 couples suggests that such retreats may be a useful approach for strengthening the intimate relationships of OEF/OIF veterans and gives direction for future programs.
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Morland LA, Love AR, Mackintosh M, Greene CJ, Rosen CS. Treating anger and aggression in military populations: Research updates and clinical implications. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/cpsp.12007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Foote FO, Schwartz L. Holism at the National Intrepid Center of Excellence (NICoE). Explore (NY) 2012; 8:282-90. [DOI: 10.1016/j.explore.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Indexed: 11/24/2022]
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