Partner accommodation moderates treatment outcomes for couple therapy for posttraumatic stress disorder.

Abstract

Objective Partner accommodation of posttraumatic stress disorder (PTSD) symptoms (i.e., altering one’s own behaviors to minimize patient distress and/or relationship conflict due to patients’ PTSD symptoms) has been shown to be positively associated with patient and partner psychopathology and negatively associated with patient and partner relationship satisfaction cross-sectionally. However, the prognostic value of partner accommodation in treatment outcomes is unknown. The goals of the present study were to determine if partner accommodation decreases as a function of couple therapy for PTSD and if pretreatment partner accommodation moderates the efficacy of couple therapy for PTSD. Method Thirty-nine patients with PTSD and their intimate partners (n = 39) were enrolled in a randomized controlled trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012) and received CBCT for PTSD immediately or after three months of waiting. Blinded assessors determined clinician-rated PTSD symptoms and patient-rated PTSD and depressive symptoms and relationship satisfaction at baseline, mid-treatment/4 weeks of waiting, and posttreatment/12 weeks of waiting. Results Contrary to expectation, partner accommodation levels did not change over time for either treatment condition. However, baseline partner accommodation significantly moderated treatment outcomes. Higher levels of partner accommodation were associated with greater improvements in PTSD, depressive symptoms, and relationship satisfaction among patients receiving CBCT for PTSD compared with waiting list. At lower levels of partner accommodation, patients in both groups improved or remained at low levels of these outcomes. Conclusions Individuals with PTSD who have more accommodating partners may be particularly well-suited for couple therapy for PTSD.

A Daily Diary Study of Posttraumatic Stress Symptoms and Romantic Partner Accommodation

“…However, partner accommodation is linked with greater distress in both trauma survivors and partners (e.g., Fredman et al, 2014; Fredman et al, 2016), which also predicts worse outcomes for those with PTSD (e.g., Evans et al, 2009). Thus, individual and conjoint treatments for PTSD should clearly lay out a treatment rationale for both members of the couple and provide partners with psychoeducation about PTSD symptoms to stem potentially distressing, burdensome, or unhelpful accommodating behaviors.…”

“…Fredman, Vorstenbosch, Wagner, Macdonald, and Monson (2014) found that scores on a newly created measure of partner accommodation of PTSD were strongly associated with partners’ perceptions of trauma survivors’ PTSD symptom severity and with additional distress in romantic partners. Moreover, greater accommodation interfered with natural symptom remission in a sample of largely female, civilian trauma survivors (Fredman et al, 2016). However, prior work did not test the direction of effects over time, but rather looked at cross-sectional associations of PTSD and accommodation.…”

“…However, prior work did not test the direction of effects over time, but rather looked at cross-sectional associations of PTSD and accommodation. Moreover, past research on accommodation of PTSD symptoms (Fredman et al, 2014, 2016) has not addressed the precise associations of accommodation with PTSD symptom clusters, to better understand how accommodation may be implicated in a lack of natural symptom remission.…”

A preliminary examination of the effects of pretreatment relationship satisfaction on treatment outcomes in cognitive-behavioral conjoint therapy for PTSD.

“…For example, partners may engage in accommodating or other treatment-interfering behavior that contributes to the dyad's relationship distress and create impediments to recovery from PTSD (Fredman, Vorstenbosch, Wagner, Macdonald, & Monson, 2014), but including partners in CBCT for PTSD helps to blunt the impact of these maladaptive partner behaviors (Fredman, Pukay-Martin, Macdonald, Wagner, Vorstenbosch, & Monson, 2015). Additionally, maladaptive relationship-based behaviors, such as poor communication, may interfere with adaptive trauma disclosure, and poor conflict management may work to maintain the symptoms of the disorder.…”

The Role of Relationship Adjustment in an Integrated Individual Treatment for PTSD and Substance Use Disorders Among Veterans: An Exploratory Study

“…Interventions to aid communication skills and making more accurate attributions about symptoms (e.g., lack of engagement in family outings due to PTSD-related avoidance rather than disinterest in the family) might promote positive treatment outcome and prevent inadvertent interference with treatment (Fredman et al, 2016). Engaging partners in some aspects of individual treatment may be helpful among individuals who are unwilling or unable to engage effectively in dyadic interventions (Monson et al, 2009).…”