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Randomized Controlled Trial
. 2016 Jan;84(1):79-87.
doi: 10.1037/ccp0000061. Epub 2015 Oct 26.

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

Steffany J Fredman  1 , Nicole D Pukay-Martin  2 , Alexandra Macdonald  3 , Anne C Wagner  4 , Valerie Vorstenbosch  5 , Candice M Monson  4
Affiliations
Randomized Controlled Trial

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

Steffany J Fredman et al. J Consult Clin Psychol. 2016 Jan.

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 3 months of waiting. Blinded assessors determined clinician-rated PTSD symptoms and patient-rated PTSD and depressive symptoms and relationship satisfaction at baseline, midtreatment/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.

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Figures

Figure 1
Figure 1
Clinician-rated PTSD symptom severity as a function of treatment (CBCT for PTSD versus WL) and baseline partner accommodation (high versus low). Note. PTSD = posttraumatic stress disorder; CAPS = Clinician-Administered PTSD Scale; WL = waitlist; CBCT = cognitive-behavioral couple therapy.
Figure 2
Figure 2
Patient-rated PTSD symptom severity as a function of treatment (CBCT for PTSD versus WL) and baseline partner accommodation (high versus low). Note. PTSD = posttraumatic stress disorder; PCL = PTSD Checklist; WL = waitlist; CBCT = cognitive-behavioral couple therapy.
Figure 3
Figure 3
Patient-rated depressive symptom severity as a function of treatment (CBCT for PTSD versus WL) and baseline partner accommodation (high versus low). Note. BDI-II = Beck Depression Inventory-II; WL = waitlist; CBCT = cognitive-behavioral couple therapy.
Figure 4
Figure 4
Patient-rated relationship satisfaction as a function of treatment (CBCT for PTSD versus WL) and baseline partner accommodation (high versus low). Note. DAS = Dyadic Adjustment Scale; WL = waitlist; CBCT = cognitive-behavioral couple therapy.
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