Design of a randomized superiority trial of a brief couple treatment for PTSD

Abstract

Interpersonal difficulties are common among veterans with posttraumatic stress disorder (PTSD) and are associated with poorer treatment response. Treatment outcomes for PTSD, including relationship functioning, improve when partners are included and engaged in the therapy process. Cognitive-behavioral conjoint therapy for PTSD (CBCT) is a manualized 15-session intervention designed for couples in which one partner has PTSD. CBCT was developed specifically to treat PTSD, engage a partner in treatment, and improve interpersonal functioning. However, recent research suggests that an abbreviated CBCT protocol may lead to sufficient gains in PTSD and relationship functioning, and yield lower dropout rates. Likewise, many veterans report a preference for receiving psychological treatments through clinical videoteleconferencing (CVT) rather than traditional face-to-face modalities that require travel to VA clinics. This manuscript describes the development and implementation of a novel randomized controlled trial (RCT) that examines the efficacy of an abbreviated 8-session version of CBCT (“brief CBCT,” or B-CBCT), and compares the efficacy of this intervention delivered via CVT to traditional in-person platforms. Veterans and their partners were randomized to receive B-CBCT in a traditional Veterans Affairs office-based setting (B-CBCT-Office), CBCT through CVT with the veteran and partner at home (B-CBCT-Home), or an in office-delivered, couple-based psychoeducation control condition (PTSD Family Education). This study is the first RCT designed to investigate the delivery of B-CBCT specifically to veterans with PTSD and their partners, as well as to examine the delivery of B-CBCT over a CVT modality; findings could increase access to care to veterans with PTSD and their partners.

Advances in PTSD Treatment Delivery: Review of Findings and Clinical Considerations for the Use of Telehealth Interventions for PTSD

“…A treatment for couples, cognitive-behavioral conjoint therapy (CBCT; [51]), has been shown to improve PTSD symptoms, interpersonal functioning, and relationship satisfaction. Morland and colleagues [52] are conducting an RCT to examine the efficacy of an 8-session version of CBCT (B-CBCT) compared with PTSD family education, with delivery of B-CBCT being conducted both in-person and via home-based CVT. The findings from this study will inform providers about the provision of B-CBCT through CVT and the unique concerns when delivering couples therapy over CVT (e.g., ongoing assessment of intimate partner violence and safety risk).…”

The Use of a Brief Family Intervention to Reduce Dropout Among Veterans in Individual Trauma‐Focused Treatment: A Randomized Controlled Trial

“…There are also a number of family-inclusive treatments for PTSD (Johnson, 2002;Monson et al, 2012;Sautter et al, 2015), but all of the existing protocols require multiple conjoint sessions over several months, posing a significant barrier to treatment access. The most well-known and commonly used family-inclusive treatment is cognitive behavioral conjoint therapy for PTSD (CBCT; Monson et al, 2012), a 15-session, fully dyadic intervention based on the cognitive behavioral interpersonal theory of PTSD (Monson et al, 2010); an 8-session CBCT protocol (Morland et al, 2019) and an intensive multicouple CBCT protocol (Fredman et al, 2020) have also been tested. The CBCT intervention includes many treatment elements, including addressing maladaptive traumaand relationship-related thoughts and encouraging couples to undertake in vivo exposure exercises.…”

Testing adaptations of cognitive-behavioral conjoint therapy for PTSD: A randomized controlled pilot study with veterans.

“…These studies, along with the current study, suggest the promise of offering various forms of conjoint PTSD treatments in clinical settings. Another study currently underway compares a brief 8-session version of CBCT delivered to Veterans and their partners in a traditional VA office setting with the same protocol delivered through videoconferencing and an office-delivered PTSD Family Education control group (Morland et al, 2019). Additional studies are needed to identify which intervention characteristics are essential ingredients for effectiveness, such as content condensed into a briefer time frame (i.e., a weekend retreat) and present focused versus relationship focused versus trauma focused intervention content.…”