From Our 2012 Archives
PTSD Treatment and Couple Therapy Go Hand in Hand
New Study Finds Combined Treatment Effective
By Matt McMillen
Reviewed by Louise Chang, MD
Aug. 14, 2012 -- For people with posttraumatic stress disorder, going to couples counseling with their partner may ease their PTSD symptoms -- and help their relationship, a new study shows.
The study, published in the Journal of the American Medical Association, used a specialized form of couples therapy called cognitive-based conjoint therapy (CBCT). It showed positive results compared to no therapy at all.
The key may be having your partner there. "PTSD patients don't do as well in individualized therapy," says researcher Candice Monson, PhD, of Ryerson University in Toronto. "Social support emerges as the most robust factor that encourages recovery."
The study included 40 couples, each of which included one partner with PTSD. Half of the couples were put on a wait list for therapy, during which they were allowed to stay on any therapies they were currently undergoing as long as it was not for PTSD. The rest of the couples attended couples therapy once or twice per week, for a total of 15 sessions.
The therapy began with education about PTSD and its potential for harm, as well as strategies to cope with it.
"One of the most important things is giving them an understanding of PTSD so that they don't get the wrong sense of what the disorder is," Monson says.
PTSD is caused by traumatic experiences such as combat, natural disasters, serious car accidents, and sexual assaults. People with PTSD often become emotionally withdrawn or numb. They avoid circumstances and places that remind them of the original trauma. And they are prone to anger and irritability, and are often on edge.
About 5 million U.S. adults have the disorder in any given year. Women are twice as likely as men to experience the disorder at some time in their lives.
In addition to its impact on individuals who have it, PTSD can also harm families. Vietnam veterans with PTSD, for example, have more distressed partners and their children have more behavior problems compared to vets who don't have the disorder.
"PTSD can be very corrosive to a relationship," says UCLA psychologist Shirley Glynn, PhD, who reviewed the study for WebMD. "There's a robust literature that shows that emotional numbness is bad for marital relationships, and irritability and anger can also be corrosive."
Partners of People With PTSD
During the second phase of the therapy, couples learn how to switch from avoidance to approach. That is, with the help of the therapist, they drafted a list of things they have actively shied away from because of the disorder -- social gatherings, for example -- and then begin to integrate the items on their list back into their lives.
Monson says partners of people with PTSD often have the best intentions but can inadvertently maintain the disorder by agreeing to avoid situations that may cause discomfort.
"By agreeing not to go to family gatherings or out to dinner, for example, because her husband is too anxious, the wife simply reinforces the idea that the symptoms can't be managed," Monson says. "They shrink their lives to manage the anxiety ... We help them reexamine such unhelpful thoughts and behaviors."
The last phase of the therapy focuses on the problematic beliefs that each partner holds and that contributes to PTSD and their relationship problems. They address issues of trust, control, emotional closeness, and physical intimacy.
At the end of the study period, the couples that had gotten therapy showed significant improvements. Their satisfaction with their relationship increased more than four times as much as the couples who were not treated.
Meanwhile, the partners with PTSD reported an average 50% reduction in the severity of their symptoms, or about three times the improvement of those on the wait list. More than three quarters of them no longer met the criteria for PTSD.
The study shows that this therapeutic approach was better than no therapy -- but it doesn't show whether the therapy the researchers have developed is more or less effective than other types of therapy.
Also, an editorial published with the study points out that the people in Monson's study seemed "easier to treat" than couples who face similar problems. In general, writes editorial author Lisa M. Najavits, PhD, these couples were in highly stable and satisfying relationships, without accompanying issues such as alcoholism, drug addiction, or abusive behavior.
"Thus, the trial by Monson et al cannot be interpreted as being applicable to couples with these additional challenges, which may be the couples in greatest need of help," writes Najavits, a psychologist at the Veterans Affairs Boston Healthcare System.
Monson disagrees. She says that the study population is quite typical and that very few people were excluded from the study based on issues like substance dependence or relationship aggression.
She adds that such distress in a couple is often a motivator for change. Without such motivations, couples often maintain the status quo, making them more difficult to get into treatment.
"The fact that we found significant improvements in patients' relationship satisfaction, despite the relatively high baseline levels of satisfaction, further supports the notion that it is a powerful treatment with respect to improvements in couple functioning," Monson says.
Monson and Glynn, who've collaborated in the past, say that PTSD is a highly treatable disorder. If your partner has experienced trauma and exhibits PTSD symptoms, the best thing you can do is be supportive and be willing to seek help together. Glynn points to the VA's Coaching Into Care program as an excellent place to start.
"Be kind, be firm but not coercive when you discuss getting help, and be hopeful," says Glynn. "Having PTSD or living with someone who has it can be a very hard road, but there is hope."
SOURCES: Monson, C. JAMA, August 2012. Najavits, L. JAMA, August 2012. Candice Monson, PhD, professor of psychology, Ryerson University, Toronto. Shirley Glynn, PhD, research psychologist, Semel Institute, UCLA. Veterans Administration: "How Common Is PTSD?" American Academy of Family Physicians: "PTSD."