Efficacy of structured approach therapy in reducing PTSD in returning veterans: A randomized clinical trial.

Abstract

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.

Longitudinal Associations Between PTSD Symptoms and Dyadic Conflict Communication Following a Severe Motor Vehicle Accident

“…The symptom-specific cross-lagged associations with dyadic conflict communication found in the current study suggest that a dyadic approach to recovery following traumatization among couples deemed at high risk, either by virtue of high levels of avoidance symptoms on the part of the trauma survivor and/or high levels of dysfunctional dyadic conflict communication, could be particularly helpful during the early months of recovery from trauma. For example, several existing couple-based interventions for PTSD (e.g., cognitive-behavioral conjoint therapy for PTSD [Monson & Fredman, 2012]; strategic approach therapy [Sautter, Glynn, Cretu, Senturk, & Vaught, 2015; Sautter, Glynn, Thompson, Franklin, & Han, 2009]) seek to simultaneously improve PTSD symptoms and enhance intimate relationship functioning by improving conflict management skills, decreasing effortful avoidance, and enriching emotional expression and dyadic communication and have demonstrated effects on both individual symptom clusters and relationship adjustment (Macdonald, Pukay-Martin, Wagner, Fredman, & Monson, 2016; Monson et al, 2012; Sautter et al, 2009, 2015). Future research that explores the extent to which these treatments may be adapted and delivered, perhaps in abbreviated form, to couples deemed at high risk early in the trauma recovery period could determine the safety and feasibility of conducting dyadic early interventions for trauma survivors and their loved ones.…”

A dyadic perspective on PTSD symptoms’ associations with couple functioning and parenting stress in first-time parents.

“…Couples tend to be most receptive to interventions during this phase of the family life cycle, as it represents the chance for a fresh start and the opportunity to “do right by their kids” (Feinberg, 2002). Such interventions could integrate components of empirically supported transition to parenthood programs focused on strengthening the couple’s relationship and co-parenting alliance (e.g., Doss et al, 2014; Feinberg et al, 2016; Halford, Petch, & Creedy, 2010) with components of empirically supported couple-based treatments for PTSD (Monson et al, 2012; Sautter, Glynn, Cretu, Senturk, & Vaught, 2015). This type of program could also be an important way to involve fathers, as most transition to parenthood programs for parents considered to be high risk by virtue of individual psychopathology (e.g., depression) are focused on mothers.…”

Couple‐based interventions for PTSD among military veterans: An empirical review

“…Seven unique couple‐based interventions were identified across the 16 studies for the treatment of PTSD symptoms and improvement of relationship outcomes. The seven interventions included Cognitive‐Behavioral Conjoint Therapy for PTSD (CBCT; n = 8, 47%; Monson, Guthrie, & Stevens, ), Mindfulness‐Based Cognitive‐Behavioral Conjoint Therapy for PTSD (MB‐CBCT, n = 1, 6%; Luedtke, Davis, & Monson, ), Couple Treatment for Alcohol Use Disorder (AUD) and PTSD (CTAP; n = 1, 6%; Schumm, Monson, O'Farrell, Gustin, & Chard, ), Structured Approach Therapy (SAT; n = 2, 13%; Sautter, Glynn, Cretu, Senturk, & Vaught, ), Strategic Approach Therapy (STRAT; n = 1, 6%; Sautter, Glynn, Thompson, Franklin, & Han, ), Emotionally Focused Couples Therapy (EFCT, n = 1, 6%; Johnson, ), and the Veteran Couples Integrative Intensive Retreat (VCIIR; n = 2, 13%; Monk, Ogolsky, & Bruner, ). Of the 16 articles reviewed, 11 (69%) were multisubject studies with quantitative data and five (31%) were case studies with quantitative data.…”

“…Two studies have been published utilizing SAT for PTSD, including one nonrandomized multisubject study (Sautter et al, ), and one RCT (Sautter et al, ). In both studies, self‐rated PTSD symptoms were assessed using the Posttraumatic Stress Disorder Checklist‐Military Version (PCL‐M; Weathers et al, ), and clinician‐rated PTSD symptoms were assessed using the CAPS (Blake et al, ).…”