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Monson CM, Pukay-Martin ND, Wagner AC, Crenshaw AO, Blount TH, Schobitz RP, Dondanville KA, Young-McCaughan S, Mintz J, Riggs DS, Brundige A, Hembree EA, Litz BT, Roache JD, Yarvis JS, Peterson AL. Cognitive-behavioural conjoint therapy versus prolonged exposure for PTSD in military service members and veterans: results and lessons from a randomized controlled trial. Eur J Psychotraumatol 2024; 15:2330305. [PMID: 38590124 PMCID: PMC11005874 DOI: 10.1080/20008066.2024.2330305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD. The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive-Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders - provider's treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD. There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments. This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships.
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Affiliation(s)
- Candice M. Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | | | - Anne C. Wagner
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
- Remedy, Toronto, Canada
| | | | - Tabatha H. Blount
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Richard P. Schobitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - David S. Riggs
- Hérbert School of Medicine, Uniformed Services University of the Health Sciences, and Center for Deployment Psychology, Bethesda, MD, USA
| | - Antoinette Brundige
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Brett T. Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - John D. Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jeffrey S. Yarvis
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - for the STRONG STAR Consortium
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
- Cincinnati VA Medical Center, Cincinnati, OH, USA
- Remedy, Toronto, Canada
- Kennesaw State University, Kennesaw, GA, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Hérbert School of Medicine, Uniformed Services University of the Health Sciences, and Center for Deployment Psychology, Bethesda, MD, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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2
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Crenshaw AO, Libet J, Petty K, Teves JB, Huang A, Mitchell J. Subjective emotion trajectories in couple therapy and associations with improvement in relationship satisfaction. Fam Process 2023; 62:1542-1554. [PMID: 36575606 DOI: 10.1111/famp.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
Existing couple therapies are generally effective for reducing romantic relationship distress and divorce, but therapy outcomes remain poor for many. Outcomes can be improved through greater understanding of session-by-session therapeutic processes, particularly in real-world treatment settings. Modern couple therapy models commonly emphasize the importance of emotional experiences as key change processes, yet few empirical studies have tested the merits of this focus. The present study addresses this limitation by examining trajectories of subjective emotions and their association with change in a key relationship outcome, relationship satisfaction, among military veterans and their partners at a VA Medical Center. Partners rated their relationship satisfaction prior to couple therapy sessions and subjective emotions immediately after sessions. Consistent with hypotheses, both hard (e.g., anger) and soft (e.g., sadness) negative emotions decreased significantly over the course of therapy. Those couples with greater decreases in hard negative, but not soft negative, emotions showed significantly more improvement in relationship satisfaction. Positive emotions did not significantly change across couples in general, but those couples whose positive emotions did increase also showed more improvement in relationship satisfaction. These results suggest change in subjective emotions may be one process underlying improvement in couple therapy and lend empirical support to the emphasis on emotion-based change processes underlying acceptance-based and emotion-focused couple therapies.
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Affiliation(s)
- Alexander O Crenshaw
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julian Libet
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Karen Petty
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jenna B Teves
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alice Huang
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Jerez Mitchell
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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3
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Morland LA, Wachsman T, Webster K, Fitzpatrick S, Valela R, Crenshaw AO, Monson CM, Knopp KC. A pilot of couple HOPES within the U.S. Veterans Affairs Healthcare System: PTSD and relationship outcomes in veteran couples. Psychol Serv 2023:2023-81997-001. [PMID: 37338435 DOI: 10.1037/ser0000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Conjoint interventions for posttraumatic stress disorder (PTSD) offer an opportunity to target symptoms' broader social impact, including couples' relationship satisfaction. Technology-assisted interventions may help overcome access to care barriers for couples. Couple Helping Overcome PTSD and Enhance Satisfaction (HOPES) is a coached internet-based couples' intervention for PTSD adapted from cognitive behavioral conjoint therapy, an evidence-based dyadic therapy for PTSD. This pilot study examined the implementation feasibility, acceptability, and preliminary efficacy of Couple HOPES in a sample of 15 United States veterans with PTSD and their romantic partners within a Veterans Affairs (VA) Medical Center setting. There were significant improvements in veterans' PTSD symptoms (self- and partner-reported) and both veterans' and partners' relationship satisfaction, though the effect sizes were small (all g's < .40). Importantly, the 73% retention rate and participant feedback at postassessment suggest this online adaptation may help couples overcome barriers to accessing care. More broadly, this pilot study helps answer questions regarding where digital health interventions fit into the continuum of PTSD care within the VA system. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Robert Valela
- Department of Psychology, Toronto Metropolitan University
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4
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Liebman RE, Schumm JA, Pukay-Martin ND, Bartsch AA, Crenshaw AO, Hart TL, Koerner N, Monson CM. Actor and partner effects of PTSD and relationship functioning in a recently traumatized sample. J Fam Psychol 2023; 37:517-527. [PMID: 36913297 DOI: 10.1037/fam0001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A robust negative association exists between self-reported posttraumatic stress disorder (PTSD) and self-reported interpersonal relationship functioning. However, the extent to which each member of a dyad's subjective PTSD ratings influence the other's subjective relationship functioning ratings is less understood. The present study tested: (a) associations between self- and partner-PTSD severity ratings and relationship functioning ratings and (b) whether exposure to the index trauma, gender, and relationship type (i.e., intimate vs. nonintimate dyad) moderated these associations in a sample of 104 dyads of individuals with PTSD and a close significant other. Each partners' ratings of PTSD severity were uniquely and positively associated with their own (actor) and their partner's ratings of relationship conflict, but not support or depth. Gender moderated the partner effect; women's (but not men's) subjective PTSD severity were positively associated with their partners' subjective relationship conflict. There was a relationship type by actor effect interaction for relationship support, which indicated that perceptions of PTSD severity were negatively associated with each partner's perceptions of relationship support for intimate but not nonintimate dyads. Results support a dyadic conceptualization of PTSD in which both partners' perception of symptoms are important for relationship functioning. Conjoint therapies may be particularly potent for PTSD and relationship functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Tae L Hart
- Department of Psychology, Toronto Metropolitan University
| | - Naomi Koerner
- Department of Psychology, Toronto Metropolitan University
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5
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Crenshaw AO, Whitfield KM, Collins A, Valela R, Varma S, Landy MSH, Ip J, Donkin V, Earle E, Siegel A, Samonas C, Bushe J, Mensah DH, Xiang A, Doss BD, Morland L, Wagner AC, Fitzpatrick S, Monson CM. Partner outcomes from an uncontrolled trial of Couple HOPES: A guided online couple intervention for posttraumatic stress disorder and relationship enhancement. J Trauma Stress 2023; 36:230-238. [PMID: 36116104 DOI: 10.1002/jts.22878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with significant individual and relationship impairment for people with PTSD and their romantic partners. Conjoint treatments, such as cognitive behavioral conjoint therapy for PTSD (CBCT), are designed to address individual and relationship factors, yet significant barriers impede accessing in-person therapy. Couple HOPES (i.e., Helping Overcome PTSD and Enhance Satisfaction) is a coach-guided, online couple intervention for PTSD based on CBCT that was designed to address these barriers. Previous investigations have found preliminary efficacy of Couple HOPES for improving PTSD symptoms, relationship functioning, and some individual functioning domains for the partner with probable PTSD. However, no study to date has tested individual outcomes for romantic partners, which is needed to fully evaluate the intervention's promise. The current study tested these partner outcomes in a combined, uncontrolled sample of 27 couples. Intent-to-intervene analyses found significant improvements at postintervention in four of eight tested outcomes, including ineffective arguing, g = 0.74; anger, g = 0.32; perceived health, g = 0.67; and quality of life, g = 0.56. Depressive symptoms, generalized anxiety, alcohol misuse, and work functioning did not significantly change, gs = 0.17-0.42. Among participants who completed a 1-month follow-up assessment, generalized anxiety, g = 0.43, and perceived health, g = 0.73, significantly improved over follow-up, whereas anger, g = -0.48, lost gains previously made. Results were largely consistent in the completer sample. These findings show the potential of Couple HOPES to have broad benefits not only for individuals with probable PTSD but also for their romantic partners.
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Affiliation(s)
| | | | - Alexis Collins
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Robert Valela
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Sonya Varma
- Department of Psychology, York University, Toronto, Canada
| | - Meredith S H Landy
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada.,MindBeacon, Toronto, Canada
| | - Jennifer Ip
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Victoria Donkin
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada.,Department of Psychology, York University, Toronto, Canada.,MindBeacon, Toronto, Canada
| | | | - Ashley Siegel
- Department of Psychology, York University, Toronto, Canada
| | - Christina Samonas
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Julianne Bushe
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | | | - Angela Xiang
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Brian D Doss
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Anne C Wagner
- Remedy, 703 Bloor St. W, #201, Toronto, ON, M6G 1L5, Canada
| | | | - Candice M Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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6
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Monson CM, Wagner AC, Crenshaw AO, Whitfield KM, Newnham CM, Valela R, Varma S, Di Bartolomeo AA, Fulham L, Collins A, Donkin V, Mensah DH, Landy MSH, Samonas C, Morland L, Doss BD, Fitzpatrick S. An uncontrolled trial of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. J Fam Psychol 2022; 36:1036-1042. [PMID: 35266773 DOI: 10.1037/fam0000976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Novel interventions that overcome limited access to empirically supported psychotherapies for posttraumatic stress disorder (PTSD) are sorely needed. Couple helping overcome PTSD and enhance relationships (HOPES), a guided, online couple intervention drawing from cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson, 2012), was designed to decrease PTSD symptoms and improve relationship satisfaction. The present study is the first uncontrolled trial of 17 couples in which one partner was a military member, veteran, or first responder and had probable PTSD (PTSD + partner) based on self-report assessment. Intent-to-intervene analyses revealed significant improvements from pre- to postintervention in PTSD + partners' self-reported PTSD symptoms (g = .72), as well as their intimate partner's relationship satisfaction (g = .34) and behavioral accommodation of PTSD symptoms (g = .84). There were also significant improvements in PTSD + partners' depression (g = .43) and perceived relationship arguments (g = .62). There were similar results found in the completer sample. There were no adverse events and high satisfaction with the intervention in those who completed the evaluation. These findings provide additional initial data on the safety, feasibility, and efficacy of Couple HOPES. The similarities of intent-to-intervene and completer results, as well as the need for randomized controlled trial designs to test Couple HOPES, are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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7
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Adamo C, Leo K, Hogan JN, Crenshaw AO, Baucom KJW, Baucom BRW. Negative Partner Attributions Moderate the Association between Heart Rate Reactivity During Relationship Conflict and Relationship Satisfaction. Fam Process 2021; 60:823-835. [PMID: 33064883 PMCID: PMC8050118 DOI: 10.1111/famp.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Abstract
Numerous theoretical models of relationship distress suggest that strong, negative reactions to conflict are directly associated with lower levels of relationship satisfaction. Consistent with this supposition, substantial evidence links higher levels of subjective negative emotion, more pronounced and frequent expressions of negative affect, and higher levels of negative communication behaviors to lower levels of relationship satisfaction (e.g., Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). However, the evidence linking stress-related physiological responding during relationship conflict and relationship satisfaction is less compelling than would be anticipated based on theory. We propose that these theoretically unexpected but empirically well-replicated findings may be the result of different patterns in association between physiological reactivity and relationship satisfaction for couples with varying styles in how they typically perceive unwanted behavior in one another. The present study tests negative attributions for undesirable partner behaviors as a moderator of the association between heart rate reactivity (HRR) during relationship conflict and relationship satisfaction in a sample of 60 married couples. A significant interaction emerged between HRR and negative attributions of partner behavior in predicting relationship satisfaction such that higher levels of HRR were associated with lower levels of relationship satisfaction for individuals who typically made more negative attributions for undesirable partner behaviors, but with higher levels of relationship satisfaction for individuals who typically made fewer negative attributions for undesirable partner behaviors. Implications for conceptualizing reactivity during relationship conflict and couple interventions are discussed.
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Affiliation(s)
- Colin Adamo
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Karena Leo
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Jasara N Hogan
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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8
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Fitzpatrick S, Wagner AC, Crenshaw AO, Varma S, Whitfield KM, Valela R, Di Bartolomeo AA, Fulham L, Martin-Newnham C, Mensah DH, Collins A, Landy MS, Morland L, Doss BD, Monson CM. Initial outcomes of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. Internet Interv 2021; 25:100423. [PMID: 34401382 PMCID: PMC8350611 DOI: 10.1016/j.invent.2021.100423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022] Open
Abstract
Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) is a guided, online couple intervention adapted from Cognitive-Behavioral Conjoint Therapy for posttraumatic stress disorder (PTSD). It was created to overcome a range of barriers to accessing evidence-based treatments for PTSD and the intimate relationship problems associated with it. This manuscript describes initial outcomes of the intervention in a series of 10 couples. Participants were military, veteran and first responders with probable PTSD and their intimate partners. Couples completed the program and measurements of PTSD, relationship satisfaction, and secondary outcomes at pre-, mid-, and post-intervention. Mean satisfaction for the program was high and it was completed by seven of ten couples. Participants with PTSD evidenced significant and large pre- to post-intervention effect size improvements in PTSD symptoms (g = 0.80) and perceived health (g = 1.13). They also exhibited non-significant but medium effect size pre- to post-intervention improvements in quality of life (g = 0.62), and depression (g = 0.53), and small effect size pre- to post-intervention improvements in argumentativeness (g = 0.43), anger (g = 0.31), and anxiety (g = 0.31). Partners reported significant and moderate pre- to post-intervention effect size improvements in relationship satisfaction (g = 0.68), and medium but not significant effect size improvements in accommodation of PTSD (g = 0.56). Results provide initial support for the feasibility, acceptability, and efficacy of Couple HOPES for improving PTSD and relationship satisfaction. However, more testing in larger samples, including with randomized controlled designs, is needed.
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Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada,Corresponding author at: Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
| | - Anne C. Wagner
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada,Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada
| | - Alexander O. Crenshaw
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Sonya Varma
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Kristen M. Whitfield
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Robert Valela
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | | | - Lindsay Fulham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Cait Martin-Newnham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Desiree H. Mensah
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Alexis Collins
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Meredith S.H. Landy
- Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada,MindBeacon, 175 Bloor St. E., Toronto, ON M4W 358, Canada
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, CA, USA and University of California San Diego, La Jolla, 3350 La Jolla Village Dr., San Diego, CA 92161, United States of America
| | - Brian D. Doss
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL, 33146, United States of America
| | - Candice M. Monson
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
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9
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Leo K, Crenshaw AO, Hogan JN, Bourne SV, Baucom KJW, Baucom BRW. A replication and extension of the interpersonal process model of demand/withdraw behavior: Incorporating subjective emotional experience. J Fam Psychol 2021; 35:534-545. [PMID: 32986456 PMCID: PMC8004543 DOI: 10.1037/fam0000802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The demand/withdraw (D/W) interaction pattern is a maladaptive cycle of behavior that is associated with a wide range of deleterious individual and relational outcomes. Partners' emotional responding during couple conflict has long been theorized to play a central role in the occurrence of D/W. The interpersonal process model of D/W behavior suggests that each partner's emotional responses are associated with their own as well as the other partner's behavior in the D/W cycle and that the nature of these associations varies across partners. A prior test of the interpersonal process model provided support for sex- and role-specific associations between vocal emotional expression and demanding and withdrawing behaviors. The current study expands the conceptual frame of the interpersonal process model by incorporating subjective emotional experience. Hypothesized associations between subjective emotional experience, emotional expression, and role-specific demanding and withdrawing behaviors were tested in a sample of 59 couples using an actor-partner interdependence model. Results reveal that spouses experience and express nonsignificantly different levels of negative affect but strongly differ in how the experience and expression of those emotions are related to demanding and withdrawing behaviors. High levels of women's demanding behavior were associated with the combination of experiencing and expressing high levels of negative affect, while high levels of men's withdrawing behavior were associated with experiencing high levels of negative affect but expressing low levels of negative affect. Implications of results for understanding emotional processes in maladaptive cycles and for clinical practice are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Karena Leo
- Department of Psychology, University of Utah
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10
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Monson CM, Fitzpatrick S, Wagner AC, Valela R, Whitfield KM, Varma S, Landy MSH, Di Bartolomeo A, Crenshaw AO, Fulham L, Morland L, Knopp K, Proctor DW, Toller A, Webster K, Doss BD. The development of Couple HOPES: a guided online intervention for PTSD and relationship satisfaction enhancement. Eur J Psychotraumatol 2021; 12:1917879. [PMID: 34104350 PMCID: PMC8158260 DOI: 10.1080/20008198.2021.1917879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) was created to help overcome a range of barriers to accessing psychotherapy for posttraumatic stress disorder (PTSD) and commonly associated intimate relationship problems. Objective: Couple HOPES is a guided, online self-help intervention adapted from Cognitive-Behavioural Conjoint Therapy for PTSD that aims to improve PTSD and enhance relationship satisfaction. Method/Results: This paper describes the processes and principles used to develop the Couple HOPES intervention platform as well as the coaching model and manual used to promote engagement and adherence to the intervention. Conclusions: Current research and future directions in testing Couple HOPES are outlined.
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Affiliation(s)
- Candice M Monson
- Psychology Department, Ryerson University, Toronto, Ontario, Canada
| | - Skye Fitzpatrick
- Psychology Department, York University, Toronto, Ontario, Canada
| | - Anne C Wagner
- Psychology Department, Ryerson University, Toronto, Ontario, Canada.,Psychology Department, Remedy, Toronto, Ontario, Canada
| | - Robert Valela
- Psychology Department, Ryerson University, Toronto, Ontario, Canada
| | | | - Sonya Varma
- Psychology Department, York University, Toronto, Ontario, Canada
| | | | | | | | - Lindsay Fulham
- Psychology Department, York University, Toronto, Ontario, Canada
| | - Leslie Morland
- Psychology Department, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Department, University of California San Diego, La Jolla, CA, USA
| | - Kayla Knopp
- Psychology Department, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Department, University of California San Diego, La Jolla, CA, USA
| | | | - Alec Toller
- Circlesnake Productions, Toronto, Ontario, Canada
| | - Katelyn Webster
- Psychology Department, VA San Diego Healthcare System, San Diego, CA, USA.,Psychology Department, University of California San Diego, La Jolla, CA, USA
| | - Brian D Doss
- Psychology Department, University of Miami, Miami, FL, USA
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Crenshaw AO, Leo K, Christensen A, Hogan JN, Baucom KJW, Baucom BRW. Relative importance of conflict topics for within-couple tests: The case of demand/withdraw interaction. J Fam Psychol 2021; 35:377-387. [PMID: 32730045 PMCID: PMC7891293 DOI: 10.1037/fam0000782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Researchers commonly employ observational methods, in which partners discuss topics of concern to them, to test gender differences and other within-couple differences in couple conflict behavior. We describe a previously unidentified assumption upon which statistical tests in these observational studies are frequently reliant: whether each partner is more concerned or dissatisfied with the topic selected for them than the partner is. We term this the relative importance assumption and show that common procedures for selecting conflict discussion topics can lead to widespread violations of the assumption in empirical studies. Study 1 conducts a systematic review of the literature and finds that few existing studies ensure relative importance is met. Study 2 uses two empirical samples to estimate how often relative importance is violated when not ensured, finding it is violated in one third of interaction tasks. Study 3 examines the potential consequences of violating the relative importance assumption when testing within-couple differences in observed behavior, focusing on gender differences in the demand/withdraw pattern. Results show that these tests were profoundly impacted by violations of relative importance. In light of these violations, we conduct a more rigorous test of demand/withdraw theories and clarify previously inconsistent results in the literature. We recommend explicit consideration of relative importance for studies testing within-couple effects, provide methodological recommendations for selecting topics in future studies, and discuss implications for clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Abstract
Current models of relationship functioning often emphasize conflict with a particular focus on the behaviors that occur in that context. Much less is known about the impact of time spent interacting in the absence of conflict. The primary aim of this study is to test associations between time spent in various forms of daily interaction (engaging in a shared activity, talking, and arguing) and multiple relationship outcomes while controlling for positive and negative communication during conflict. The present sample consists of 49 married couples (N = 98 individuals). Data were analyzed using multilevel models to account for non-independence of the data. Consistent with previous literature, communication behaviors were related to relationship outcomes. After controlling for communication, couples who spent more time arguing per day were less satisfied in their relationships, and perceived greater negative qualities in their relationships. Finally, couples who spend a larger proportion of their time together talking reported greater satisfaction, perceived more positive qualities in their relationships, and experienced greater closeness. These findings suggest that low salience interactions account for unique variance in relationship functioning above and beyond what is currently studied. Future research is needed to determine possible mechanisms by which low salience interactions are related to relationship outcomes.
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Abstract
Increasing evidence indicates that psychological factors important to therapy effectiveness are associated with physiological activity. Knowledge of the physiological correlates of therapy process variables has the potential to provide unique insights into how and why therapy works, but little is currently known about the physiological underpinnings of specific therapy processes that facilitate client growth and change. The goal of this article is to introduce therapy process researchers to the use of physiological methods for studying therapy process variables. We do this by (a) presenting a conceptual framework for the study of therapy process variables, (b) providing an introductory overview of physiological systems with particular promise for the study of therapy process variables, (c) introducing the primary methods and methodological decisions involved in physiological research, and (d) demonstrating these principles and methods in a case of therapeutic presence during couple therapy. We close with a discussion of the promise and challenges in the study of physiological correlates of therapy process variables and consideration of future challenges and open questions in this line of research. Online supplemental materials include additional resources for therapy process researchers interested in getting started with physiological research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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May AM, Crenshaw AO, Leifker F, Bryan CJ, Baucom BR. Knowledge of suicide history, current depressive symptoms, and future suicide risk within couples. Behav Res Ther 2019; 120:103394. [DOI: 10.1016/j.brat.2019.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 01/25/2019] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
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Abstract
Accurately understanding the thoughts and feelings of romantic partners, termed empathic accuracy, is critical for optimal relationship functioning. Empathic failure is linked to common reasons couples seek therapy (Doss, Simpson, & Christensen, 2004; Jacobson & Christensen, 1996) and is either implicitly or explicitly a target of many couple therapies (e.g., Jacobson & Christensen, 1996). More specifically, couple therapies target partners' abilities to accurately understand one another preceding and during conflict, periods characterized by high levels of stress. The current study tests the hypothesis that acute stress can be harmful for empathic accuracy in romantic couples, and tests two competing path models of the impact of stress on accuracy. Results show that an acute stressor affected accuracy of men and women differently, impairing accuracy in women but not observably affecting men's accuracy. The effect of the stressor on empathic accuracy for women was mediated by curvilinear arousal, and men's accuracy was also associated with curvilinear arousal. This pattern of results suggests that moderate arousal is optimal for empathic accuracy for both men and women, but this effect was twice as large for women relative to men. These findings point toward potential avenues to improve existing couple therapies by incorporating strategies to mitigate the effects of stress, thereby increasing couples' ability to accurately understand one another in therapy. These findings also suggest strategies for couples to be optimally productive when having important relationship conversations by attending to their level of arousal. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Karena Leo
- Department of Psychology, University of Utah
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Baucom BRW, Baucom KJW, Hogan JN, Crenshaw AO, Bourne SV, Crowell SE, Georgiou P, Goodwin MS. Cardiovascular Reactivity During Marital Conflict in Laboratory and Naturalistic Settings: Differential Associations with Relationship and Individual Functioning Across Contexts. Fam Process 2018; 57:662-678. [PMID: 29577270 DOI: 10.1111/famp.12353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cardiovascular reactivity during spousal conflict is considered to be one of the main pathways for relationship distress to impact physical, mental, and relationship health. However, the magnitude of association between cardiovascular reactivity during laboratory marital conflict and relationship functioning is small and inconsistent given the scope of its importance in theoretical models of intimate relationships. This study tests the possibility that cardiovascular data collected in laboratory settings downwardly bias the magnitude of these associations when compared to measures obtained in naturalistic settings. Ambulatory cardiovascular reactivity data were collected from 20 couples during two relationship conflicts in a research laboratory, two planned relationship conflicts at couples' homes, and two spontaneous relationship conflicts during couples' daily lives. Associations between self-report measures of relationship functioning, individual functioning, and cardiovascular reactivity across settings are tested using multilevel models. Cardiovascular reactivity was significantly larger during planned and spontaneous relationship conflicts in naturalistic settings than during planned relationship conflicts in the laboratory. Similarly, associations with relationship and individual functioning variables were statistically significantly larger for cardiovascular data collected in naturalistic settings than the same data collected in the laboratory. Our findings suggest that cardiovascular reactivity during spousal conflict in naturalistic settings is statistically significantly different from that elicited in laboratory settings both in magnitude and in the pattern of associations with a wide range of inter- and intrapersonal variables. These differences in findings across laboratory and naturalistic physiological responses highlight the value of testing physiological phenomena across interaction contexts in romantic relationships.
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Affiliation(s)
- Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT
| | | | - Jasara N Hogan
- Department of Psychology, University of Utah, Salt Lake City, UT
| | | | - Stacia V Bourne
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Panayiotis Georgiou
- Department of Electrical Engineering, University of Southern California, Los Angeles, CA
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Butner JE, Deits-Lebehn C, Crenshaw AO, Wiltshire TJ, Perry NS, Kent de Grey RG, Hogan JN, Smith TW, Baucom KJW, Baucom BRW. A multivariate dynamic systems model for psychotherapy with more than one client. J Couns Psychol 2017; 64:616-625. [DOI: 10.1037/cou0000238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Perry NS, Baucom KJW, Bourne S, Butner J, Crenshaw AO, Hogan JN, Imel ZE, Wiltshire TJ, Baucom BRW. Graphic methods for interpreting longitudinal dyadic patterns from repeated-measures actor-partner interdependence models. J Fam Psychol 2017; 31:592-603. [PMID: 28240919 DOI: 10.1037/fam0000293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Researchers commonly use repeated-measures actor-partner interdependence models (RM-APIM) to understand how romantic partners change in relation to one another over time. However, traditional interpretations of the results of these models do not fully or correctly capture the dyadic temporal patterns estimated in RM-APIM. Interpretation of results from these models largely focuses on the meaning of single-parameter estimates in isolation from all the others. However, considering individual coefficients separately impedes the understanding of how these associations combine to produce an interdependent pattern that emerges over time. Additionally, positive within-person, or actor, effects are commonly misinterpreted as indicating growth from one time point to the next when they actually represent decline. We suggest that change-as-outcome RM-APIMs and vector field diagrams (VFDs) can be used to improve the understanding and presentation of dyadic patterns of association described by standard RM-APIMs. The current article briefly reviews the conceptual foundations of RM-APIMs, demonstrates how change-as-outcome RM-APIMs and VFDs can aid interpretation of standard RM-APIMs, and provides a tutorial in making VFDs using multilevel modeling. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | | | - Zac E Imel
- Department of Educational Psychology, University of Utah
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Crenshaw AO, Christensen A, Baucom DH, Epstein NB, Baucom BRW. Revised scoring and improved reliability for the Communication Patterns Questionnaire. Psychol Assess 2016; 29:913-925. [PMID: 27618203 DOI: 10.1037/pas0000385] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Communication Patterns Questionnaire (CPQ; Christensen, 1987) is a widely used self-report measure of couple communication behavior and is well validated for assessing the demand/withdraw interaction pattern, which is a robust predictor of poor relationship and individual outcomes (Schrodt, Witt, & Shimkowski, 2014). However, no studies have examined the CPQ's factor structure using analytic techniques sufficient by modern standards, nor have any studies replicated the factor structure using additional samples. Further, the current scoring system uses fewer than half of the total items for its 4 subscales, despite the existence of unused items that have content conceptually consistent with those subscales. These characteristics of the CPQ have likely contributed to findings that subscale scores are often troubled by suboptimal psychometric properties such as low internal reliability (e.g., Christensen, Eldridge, Catta-Preta, Lim, & Santagata, 2006). The present study uses exploratory and confirmatory factor analyses on 4 samples to reexamine the factor structure of the CPQ to improve scale score reliability and to determine if including more items in the subscales is warranted. Results indicate that a 3-factor solution (constructive communication and 2 demand/withdraw scales) provides the best fit for the data. That factor structure was confirmed in the replication samples. Compared with the original scales, the revised scales include additional items that expand the conceptual range of the constructs, substantially improve reliability of scale scores, and demonstrate stronger associations with relationship satisfaction and sensitivity to change in therapy. Implications for research and treatment are discussed. (PsycINFO Database Record
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Affiliation(s)
| | | | - Donald H Baucom
- Department of Psychology, University of North Carolina, Chapel Hill
| | - Norman B Epstein
- Department of Family Science, University of Maryland, College Park
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