Couple therapy decreases PTSD symptoms and improves relationship

A North American study led by a researcher at Ryerson University has discovered that treating a person with posttraumatic stress disorder (PTSD) and their partner using a specific couple therapy greatly decreases the severity of their symptoms -- and improves their relationship.

"Research consistently documents that PTSD is one of the mental health conditions most associated with intimate relationship problems. Although there are effective individual psychotherapies for the symptoms of PTSD, there is minimal evidence to show that these therapies improve intimate relationships," says Dr. Candice Monson, a professor at Ryerson University's Department of Psychology and the lead author of the study to be published in the Aug. 15 issue of the Journal of American Medical Association. "Now, there is increasing recognition that intimate relationships can play a vital role in the path to recovery for those with PTSD, and that relationships can improve along that path."

According to the Canadian Mental Health Association, PTSD affects approximately one in 10 Canadians, and is one of the most common mental health problems found among children and adults. In the U.S., 6.8 per cent of adults have experienced PTSD at some point in their life, according to the National Center for PTSD. This mental health disorder is usually caused by a psychologically traumatic event involving actual or threatened death or serious injury to oneself or others.

Dr. Monson collaborated on the four-year (2008-2012) study with her co-authors Dr. Steffany Fredman, Massachusetts General Hospital and Harvard Medical School; Dr. Alexandra Macdonald, VA Boston Healthcare System and Boston University School of Medicine; Nicole Pukay-Martin, Ryerson University, Toronto, Ontario; Dr. Patricia Resick of the VA National Center for PTSD, Women's Health Sciences Division and Boston University, Boston, Massachusetts; and Dr. Paula Schnurr, VA National Center for PTSD, Executive Division, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

Forty couples, in which one partner was diagnosed with PTSD, were enrolled in two sites: one in a Department of Veterans Affairs outpatient hospital setting in Boston, Massachusetts, and the other at the Ryerson University Psychology Research and Training Centre in Toronto, Ontario, Canada. Of the individuals diagnosed with PTSD who received CBCT, 30 percent of them were military veterans.

The couples were asked to refrain from receiving other forms of couple therapy for at least two months before the study. They also needed to be in remission from any substance dependence for a minimum of three months and have not been demonstrated any severe psychotic behaviour, suicide tendencies or extreme aggression towards their partner in the last year.

The couples, who ranged in age from 18 to 70 years, were then randomly assigned to two groups of 20 couples. The first group received cognitive-behavioural conjoint therapy for PTSD (CBCT), a pioneering treatment co-developed by Drs. Monson and Fredman, while the other 20 couples were put on a three-month wait list before receiving the treatment. All participants could continue to receive their stable psychopharmacological regimen and receive supportive psychotherapy not focused on PTSD. Those on the wait list received the therapy after three months of waiting.

CBCT is designed to simultaneously reduce PTSD symptoms and enhance relationship satisfaction, and consists of 15 sessions over three phases. Couples receiving CBCT met with a therapist twice per week for the first two phases and weekly during the third phase. The treatment manual was recently published by Guilford Press.

All of the participants were assessed at the start of the study, mid-treatment, and post-treatment. Couples who received the CBCT treatment were also assessed three months after they completed their treatment.

The researchers found that that 81 percent of couples who received CBCT experienced a significant improvement in their PTSD symptoms. Sixty-two percent of CBCT patients reported that their relationship with their partner had significantly improved. Those who received the therapy also reported fewer symptoms of depression, general anxiety and anger. Even after three months of completing the therapy sessions, couples reported the gains they made from their treatment were maintained.

A next step is to compare CBCT to individual therapy for PTSD, which is being tested in a study with active duty service members and their partners as part of the Strong Star Research Consortium funded by the U.S. Department of Defense (www.strongstar.org). Clinicians in the U.S. Air Force and Army are also currently receiving training in CBCT.

"Given how PTSD affects and is affected by intimate relationships, it is important to think beyond the individual to provide the most efficient and effective outcomes possible. In this case, a single therapy holds promise of providing multiple positive outcomes to trauma survivors and their loved ones," says Dr. Monson.