Effectiveness of cognitive behavioral conjoint therapy for posttraumatic stress disorder (PTSD) in a U.S. Veterans Affairs PTSD clinic

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 intentionto-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-bysession 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 This article has been contributed to by US Government employees and their work is in the public domain in the USA.

A randomized trial of brief couple therapy for PTSD and relationship satisfaction.

“…Importantly, both bCBCT and PFE produced improvements in functional impairment and relationship satisfaction, though counter to our hypotheses, bCBCT was not statistically superior to PFE on these outcomes. Completion rates in the present study (70%) were on par with prior smaller trials of the 15-session CBCT protocol (Liebman et al, 2020) but much higher than a recently published CBCT study in a VA PTSD clinic where completion rates where 52% (Pukay-Martin et al, 2021) and individual PTSD treatment in the VA where completion rates were reported in a recent large trial to be approximately 44% for PE and 53% for CPT (Schnurr et al, 2022). Unexpectedly, both completion and treatment process metrics were similar across the three treatment arms, with the exception of partners’ treatment satisfaction and working alliance, which were significantly higher in OB-PFE than in HB-bCBCT.…”

Partner outcomes from an uncontrolled trial of Couple HOPES: A guided online couple intervention for posttraumatic stress disorder and relationship enhancement

“…However, studies of CBCT have tended to find improvements in partner depression and anxiety, particularly for those with higher initial symptoms (Shnaider et al., 2014), whereas improvement in partner anger has not been observed (see Liebman et al., 2020 for a review). Moreover, a recent open trial of CBCT in the U.S. Department of Veterans Affairs health care system found significant improvement in partner depression despite partners starting in the mild range (Pukay‐Martin et al., 2022). More research is needed with larger samples to estimate the effect of Couple HOPES on partner mental health more precisely.…”

“…Given the negative impact of PTSD on relationships and the well‐being of romantic partners, conjoint interventions that target all of these domains, such as cognitive behavioral conjoint therapy (CBCT; Monson & Fredman, 2012), may be particularly promising. Research has demonstrated that CBCT is effective in improving PTSD symptoms and relationship satisfaction in individuals with PTSD, as well as their partners’ relationship satisfaction, relationship happiness, and depressive and anxiety symptoms (Liebman et al., 2020; Pukay‐Martin et al., 2022). However, significant barriers impede access to face‐to‐face evidence‐based treatments, including limited numbers of trained clinicians, geographical distance, scheduling, and perceived stigma (Kazdin & Blase, 2011), all of which have been exacerbated by the COVID‐19 pandemic.…”

Retention in Individual Trauma-Focused Treatment Following Family-Based Treatment Among US Veterans

“…14,17 Lastly, CBCT is 15 sessions and is designed to treat PTSD in a couples setting using principles of cognitive behavioral therapy applied to the couple. [17][18][19] In order to understand the utilization of these therapies and test whether participation in each was associated with better outcomes in PTSD treatment, the current study used VHA electronic health record (EHR) data to address 2 research questions. (1) What family therapies are veterans diagnosed with PTSD using?…”