Effect of Cognitive-Behavioral Couple Therapy for PTSD: A Randomized Controlled Trial

• Published in: JAMA : the journal of the American Medical Association 2012-08, Vol.308 (7), p.700-709
• Main Authors: Monson, Candice M, Fredman, Steffany J, Macdonald, Alexandra, Pukay-Martin, Nicole D, Resick, Patricia A, Schnurr, Paula P
• Format: Article
• Language: English
• Subjects: Adult; Behavior modification; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognitive Therapy; Couples Therapy; Female; General aspects; Humans; Interpersonal Relations; Male; Medical research; Medical sciences; Middle Aged; Outpatients; Post traumatic stress disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; Stress Disorders, Post-Traumatic - complications; Stress Disorders, Post-Traumatic - therapy; Treatment Outcome; Treatments; Waiting Lists
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2012.9307

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. Treatmen