Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples

Posttraumatic stress disorder and spousal relationships in natural disaster victims: a longitudinal study

BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms after natural disaster can have a detrimental effect on marital relationships, which may be through parenting-related factor.

AIMS

The study aimed to examine the mechanism underlying the long-term effects of PTSD symptoms on marital satisfaction via coparenting, and its differences between men and women following the Super Typhoon Lekima.

METHODS

Participants were 465 married victims with children. They reported their PTSD, coparenting, and marital satisfaction at three and fifteen months after the tropical cyclone.

RESULTS

The results showed that for women, only higher negative cognitive and emotional alterations (NCEA) symptoms were associated with lower marital satisfaction through conflict coparenting. For men, higher intrusion, NCEA, and hyperarousal symptoms were associated with marital satisfaction through different coparenting. To be specific, for men, higher intrusion symptoms were associated with lower marital satisfaction via less reprimand coparenting; higher NCEA symptoms were associated with lower marital satisfaction via less integrity coparenting, and associated with higher marital satisfaction via less conflict coparenting; higher hyperarousal symptoms were associated with lower marital satisfaction via more conflict coparenting.

CONCLUSIONS

These findings suggested that the long-term effect of PTSD symptoms on marital satisfaction via coparenting mainly showed for men.

The mental health of forcibly displaced couples

Most current research investigating traumatic stress is focused on its effects at the individual level, utilizing the implicit assumption that trauma-related disorders are mutually independent within families and communities. However, there is reason to assume that trauma-related symptoms within couples are influenced by each partner's risk factors and symptoms. Using the actor-partner interdependence model, this study aimed to test whether symptoms of posttraumatic stress disorder (PTSD) and depression were predicted by participants' partner's exposure to traumatic events over and above the influence of the participant's own experiences. For this purpose, we interviewed 687 heterosexual, married Iraqi and Syrian couples in Iraq's Kurdistan region who had been forcefully displaced. We assessed symptoms of PTSD and depression using locally validated scales. Nearly all participants (98.8%) reported exposure to at least one traumatic event, with husbands reporting exposure to a higher number of traumatic events than wives, d = 0.48, p < .001. More than half of the participants met the criteria for a probable PTSD (61.1%) or major depressive disorder diagnosis (60.4%). Within couples, significant actor effects of experienced trauma exposure on personal PTSD and depressive symptoms were observed for both husbands and wives. Further, there were significant partner effects of wives' traumatic experiences on husbands' PTSD and depressive symptoms as well as of husbands' traumatic experiences on wives' PTSD and depressive symptoms. The findings argue for the interdependence of trauma-related symptoms within dyads in a dual-trauma context, suggesting the presence of intracouple transmission of trauma-related symptoms.

An interpretative phenomenological analysis of the experience of couples’ recovery from the psychological symptoms of trauma following traumatic childbirth

Globally, a large proportion of birthing mothers, and a to a lesser extent their partners, experience birth trauma each year, and yet access to adequate post-natal trauma support is rarely available. Untreated birth trauma has been shown to negatively impact the family in terms of the parents’ relationship with one another, and long-term negative consequences for the child. Despite a drive towards integrating mental health support into maternity services and a call to provide mental health support for couples rather than solely the birthing mother, there is little research exploring what birthing couples find helpful in recovery from birth trauma. The current research interviewed six couples using an Interpretative Phenomenological Approach in order to explore their understanding of what supported their recovery from birth trauma. Four themes were identified: ‘We need validation’, ‘Feeling paper thin’, ‘This is a system failure’ and ‘Birth trauma is always going to be a part of you’. The data describes an understanding of parents’ feelings of vulnerability and loss of trust in services to provide support following birth trauma. Further, parents’ need for validation and repositioning of control away from healthcare professionals when considering the availability and knowledge of the support options available is discussed. Clinical implications for supporting parents following birth trauma are explored, including an identified need for trauma informed care communication training for all healthcare professionals involved in maternity care, and the requirement for sources of therapeutic support external from the parent dyad in order to maintain the couples’ interpersonal relationship.

Trauma and Relationship Strain: Oral Histories With World Trade Center Disaster Responders

Existing models of couple functioning after trauma are primarily based on the experiences of returning military veterans. In this study, we conducted thematic analysis of a purposive sample of 49 oral histories of responders to the 9/11/01 terrorist attacks to understand how they navigated life with their spouses after the response experience. Use of multiple coders and analytic matrices increased analytic rigor. In the sample, 34.7% disclosed a posttraumatic stress disorder (PTSD) diagnosis and another 22.7% mentioned experiencing at least one trauma symptom. Most responders had not sought mental health intervention, relying instead on their spouses' caregiving. Responders reported limited disclosure to their spouses about the details of their 9/11/01 response work, which may have helped them cope emotionally with repeated 9/11/01 clean-up duties. Shared values regarding the common good and patriotism were important for maintaining an intimate relationship after 9/11/01, and helping partners understand and feel understood by each other.

The Long Arm of Trauma During Childhood: Associations with Resources in Couple Relationships

Traumatic experiences within and outside the family of origin in childhood may disrupt couple functioning later in life. Using a sample of 3,958 couples assessed through the Relationship Evaluation Questionnaire (RELATE), an actor-partner independence model was fit to test direct and indirect associations between negative impact from one's family of origin (accounting for physical violence and sexual abuse) and resources in couple relationships. Resources were defined using intervention principles derived from the Conservation of Resources (COR) theory. Actor and partner effects suggested negative family impact associates with relationship instability and is mediated through negative couple communication. Actor effects suggested negative family impact associates with less calmness in one's self and is also mediated through negative couple communication.

Integrative Intensive Retreats for Veteran Couples and Families: A Pilot Study Assessing Change in Relationship Adjustment, Posttraumatic Growth, and Trauma Symptoms

We assessed a brief, systemic retreat-style intervention that was developed to address concerns about the utilization of services for veterans coping with traumatic stress. A total of 76 dyads (N = 152) were assessed before and after a 4-day retreat, which included psychoeducation, group and conjoint therapeutic sessions, and recreational relaxation components. Overall, participants reported a reduction in trauma symptoms, but only support persons experienced a significant increase in posttraumatic growth from pretest to posttest. Both veterans and their romantic partners reported an increase in relationship adjustment after the retreat. Opportunities to address the needs of this population by removing barriers to treatment and reducing feelings of isolation, as well as implications for similar treatments are discussed.