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Randomized Controlled Trial
. 2012 Aug 15;308(7):700-9.
doi: 10.1001/jama.2012.9307.

Effect of cognitive-behavioral couple therapy for PTSD: a randomized controlled trial

Candice M Monson  1 , Steffany J Fredman, Alexandra Macdonald, Nicole D Pukay-Martin, Patricia A Resick, Paula P Schnurr
Affiliations
Randomized Controlled Trial

Effect of cognitive-behavioral couple therapy for PTSD: a randomized controlled trial

Candice M Monson et al. JAMA. .

Abstract

Context: Posttraumatic stress disorder (PTSD) is a prevalent condition associated with intimate relationship problems, and intimate relationship factors have been shown to affect individual PTSD treatment outcomes.

Objective: To compare cognitive-behavioral conjoint therapy for PTSD (a manualized couple therapy delivered to patients with PTSD and their significant others to simultaneously treat PTSD symptoms and enhance relationship satisfaction) with a wait-list condition.

Design, setting, and participants: Randomized controlled trial of heterosexual and same-sex couples (n = 40 couples; n = 80 individuals) in which one partner met criteria for PTSD according to the Clinician-Administered PTSD Scale, conducted from 2008 to 2012 in a Department of Veterans Affairs outpatient hospital setting in Boston, Massachusetts, and a university-based research center in Toronto, Ontario, Canada. Symptoms of PTSD, comorbid conditions, and relationship satisfaction were collected by blinded assessors at baseline, at mid treatment (median, 8.00 weeks [range, 1.71-20.43 weeks] after baseline), and at posttreatment (median, 15.86 weeks [range, 7.14-38.57 weeks] after baseline). An uncontrolled 3-month follow-up (median, 38.21 weeks [range, 28.43-50.57 weeks] after baseline) was also completed.

Intervention: Couples were randomly assigned to take part in the 15-session cognitive-behavioral conjoint therapy for PTSD protocol immediately (n = 20) or were placed on a wait list for the therapy (n = 20).

Main outcome measures: Clinician-rated PTSD symptom severity was the primary outcome and was assessed with the Clinician-Administered PTSD Scale. Intimate relationship satisfaction, assessed with the Dyadic Adjustment Scale, patient- and partner-rated PTSD symptoms, and comorbid symptoms were secondary outcomes.

Results: PTSD symptom severity (score range, 0-136) was significantly more improved in the couple therapy condition than in the wait-list condition (mean change difference, -23.21; 95% CI, -37.87 to -8.55). Similarly, patients' intimate relationship satisfaction (score range, 0-151) was significantly more improved in couple therapy than in the wait-list condition (mean change difference, 9.43; 95% CI, 0.04-18.83). The time × condition interaction effect in the multilevel model predicting PTSD symptoms (t37.5 = -3.09; P = .004) and patient-reported relationship satisfaction (t68.5 = 2.00; P = .049) revealed superiority of the couple therapy compared with the wait list. Treatment effects were maintained at 3-month follow-up.

Conclusion: Among couples in which one partner was diagnosed as having PTSD, a disorder-specific couple therapy, compared with a wait list for the therapy, resulted in decreased PTSD symptom severity and patient comorbid symptom severity and increased patient relationship satisfaction.

Trial registration: clinicaltrials.gov Identifier: NCT00669981.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Monson reports that she receives research funding from the Centers for Disease Control and Prevention, Department of Defense, Canadian Institute of Health Research, and National Institute of Mental Health. Drs Monson and Fredman report that they receive royalties for a published book describing CBCT for PTSD. Dr Resick reports that she receives research funding from the Department of Defense and US Department of Veterans Affairs. Dr Schnurr reports that she receives research funding from US Department of Veterans Affairs. Drs Resick and Schnurr report that they have published books on PTSD and its treatment for which they receive income. No other disclosures were reported.

Figures

Figure
Figure
Participant Flow CBCT indicates cognitive-behavioral conjoint therapy; PTSD, posttraumatic stress disorder.
See this image and copyright information in PMC

Comment in

References

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