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

Candice M. Monson, Steffany J. Fredman, Alexandra Macdonald, Nicole D. Pukay-Martin, Patricia A. Resick, Paula P. Schnurr

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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 waitlist 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 X condition interaction effect in the multilevel model predicting PTSD symptoms (t 37.5=-3.09; P=.004) and patient-reported relationship satisfaction (t 68.5=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.

Original languageEnglish (US)
Pages (from-to)700-709
Number of pages10
JournalJAMA - Journal of the American Medical Association
Volume308
Issue number7
DOIs
StatePublished - Aug 15 2012

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Couples Therapy
Cognitive Therapy
Post-Traumatic Stress Disorders
Randomized Controlled Trials
Social Adjustment

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Monson, Candice M. ; Fredman, Steffany J. ; Macdonald, Alexandra ; Pukay-Martin, Nicole D. ; Resick, Patricia A. ; Schnurr, Paula P. / Effect of cognitive-behavioral couple therapy for PTSD : A randomized controlled trial. In: JAMA - Journal of the American Medical Association. 2012 ; Vol. 308, No. 7. pp. 700-709.
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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 waitlist 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 X condition interaction effect in the multilevel model predicting PTSD symptoms (t 37.5=-3.09; P=.004) and patient-reported relationship satisfaction (t 68.5=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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Effect of cognitive-behavioral couple therapy for PTSD : A randomized controlled trial. / Monson, Candice M.; Fredman, Steffany J.; Macdonald, Alexandra; Pukay-Martin, Nicole D.; Resick, Patricia A.; Schnurr, Paula P.

In: JAMA - Journal of the American Medical Association, Vol. 308, No. 7, 15.08.2012, p. 700-709.

Research output: Contribution to journalArticle

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AU - Monson, Candice M.

AU - Fredman, Steffany J.

AU - Macdonald, Alexandra

AU - Pukay-Martin, Nicole D.

AU - Resick, Patricia A.

AU - Schnurr, Paula P.

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N2 - 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 waitlist 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 X condition interaction effect in the multilevel model predicting PTSD symptoms (t 37.5=-3.09; P=.004) and patient-reported relationship satisfaction (t 68.5=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.

AB - 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 waitlist 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 X condition interaction effect in the multilevel model predicting PTSD symptoms (t 37.5=-3.09; P=.004) and patient-reported relationship satisfaction (t 68.5=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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