The U.S. military deployed in support to Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) show high rates of posttraumatic stress disorder (PTSD) and relationship, partner, and parenting distress. Given the pervasive effect of combat-related PTSD on returning veterans and its effect on their loved ones, the investigators have developed a couples-based treatment, structured approach therapy (SAT), to reduce PTSD while simultaneously decreasing relationship and partner distress. This study presents treatment outcome data measuring PTSD and relationship outcomes from a randomized clinical trial (RCT) comparing SAT, a manualized 12-session novel couples-based PTSD treatment, to a manualized 12-session couples-based educational intervention (PTSD Family Education [PFE]). Data were collected from 57 returning veterans meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision; DSM-IV-TR) criteria for PTSD and their cohabiting partners; data collection was scheduled for pretreatment, posttreatment, and 3-month follow-up. Findings from an intent-to-treat analysis revealed that veterans receiving SAT showed significantly greater reductions in self-rated (PTSD Checklist; p < .0006) and Clinician-Administered PTSD Scale (CAPS)-rated PTSD (p < .0001) through the 3-month follow-up compared with veterans receiving PFE; 15 of 29 (52%) veterans receiving SAT and 2 of 28 (7%) receiving PFE no longer met DSM-IV-TR criteria for PTSD. Furthermore, SAT was associated with significant improvements in veteran relationship adjustment, attachment avoidance, and state anxiety. Partners showed significant reductions in attachment anxiety. This couples-based treatment for combat-related PTSD appears to have a strong therapeutic effect on combat-related PTSD in recently returned veterans.

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Seven married couples, each consisting of a veteran who had been deployed to Operation Iraqi Freedom and a cohabiting female spouse, participated in an uncontrolled trial of structured approach therapy (SAT), a couple-based treatment for posttraumatic stress disorder (PTSD). After completing treatment, the group of 7 returning veterans showed significant reductions in both self- and clinician-related PTSD with posttreatment Hedge g effect size improvements of 2.51 and 3.54, indicating an extremely high magnitude of change in posttraumatic stress. Paired t tests also indicated significant decreases in spousal anxiety, with a trend toward a significant decrease in spousal depression. Analyses of reliable change on the individual level indicated that 4 of 5 veterans and 3 of 4 spouses with dyadic adjustment scores in the distressed range prior to treatment showed reliable decreases in distress over the course of SAT placing them in the nondistressed range at posttreatment. Five of 7 spouses showed reliable decreases in depression, and 4 of 7 spouses showed reliable decreases in anxiety over the course of treatment with SAT. These results support the hypothesis that participation in SAT reduces PTSD in returning veterans while reducing relationship problems and distress in their spouses. More extensive research is being conducted with a larger sample in a randomized clinical trial.