Couple Therapy for PTSD

Abstract

Research has consistently documented a bidirectional association between posttraumatic stress disorder (PTSD) symptoms and intimate relationship functioning. PTSD symptoms are associated with greater relationship distress, higher likelihood of divorce, decreased emotional intimacy, and increased sexual dysfunction. Conversely, specific relational factors and interaction patterns (e.g., hostility, partner accommodation of PTSD symptoms) can serve to maintain or exacerbate PTSD symptoms. Given this reciprocal relationship, several couple therapies for PTSD have been created and empirically examined. Therapies that have been empirically studied include behavioral family therapy, emotionally focused couple therapy, strategic approach therapy, and cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD). To date, CBCT for PTSD has accumulated the most supporting evidence in the most diverse samples. Collectively, these empirical studies suggest that CBCT for PTSD is associated with improvements in PTSD, comorbid mental health symptoms, some partners’ mental health symptoms, and relationship satisfaction. CBCT for PTSD is a 15-session, trauma-focused PTSD treatment that occurs within a conjoint context. The therapy includes three phases: (1) psychoeducation and safety building, (2) communication skills and dyadic approach tasks to undermine avoidance, and (3) cognitive change regarding historical trauma appraisals and here-and-now maladaptive cognitions that maintain PTSD symptoms and/or relationship problems. Given the evidence supporting conjoint therapies for PTSD, clinicians should consider systematically involving partners in PTSD treatments to facilitate treatment by targeting both individual and relationship factors maintaining PTSD symptoms, as well as cultivate the strength within the couple’s relationship to encourage them to confront PTSD as a team.