Author Insights: Couples Therapy an Option for Patients With PTSD

Candice M. Monson, PhD, of Ryerson University in Toronto, and her colleagues found that providing couples therapy for patients with post-traumatic stress disorder and their partners improved patients’ symptoms and their satisfaction with their relationship. Image: Ryerson University

Couples therapy tailored for patients with post-traumatic stress disorder (PTSD) and their partners substantially improves patients’ symptoms and relationship satisfaction, according to a study published in JAMA today.

Patients with PTSD may develop symptoms that can inhibit their ability to function in many aspects of their lives, including in their intimate relationships. These symptoms may strain marriages and other relationships. Partners caring for a loved one with PTSD may experience caregiver burden and have an increased risk of depression or anxiety. They may also experience vicarious traumatization, because they empathize with what their loved one has gone through.

To determine whether a couples therapy approach might be able to help patients with their symptoms and strengthen their relationships, Candice M. Monson, PhD, of Ryerson University in Toronto, and her colleagues conducted a randomized multisite trial in which couples received joint therapy or were assigned to a wait list. They found that those who received the therapy had less-severe symptoms and greater relationship satisfaction.

Monson discussed the findings with news@JAMA.

news@JAMA: Why consider a couples approach for PTSD?

Dr Monson: There is a well-documented association between PTSD symptoms and relationship problems. So you are getting at least a 2 for 1 [benefit] by improving PTSD symptoms and resulting interrelationship issues, as well as improving symptoms in the partner. It may also be an option that is potentially less stigmatizing, especially for male patients who may be more reluctant to engage in therapy.

news@JAMA: Would couples therapy for PTSD be offered in lieu of individual treatment?

Dr Monson: It’s best to be thought of as a PTSD therapy delivered in a couples context. It’s not an adjunctive therapy.

news@JAMA: How is this therapy different than individual PTSD therapy?

Dr Monson: It doesn’t focus on the trauma. Everyone in the room needs to have a common understanding of the trauma, but therapy is about the “whys” of the trauma not the “whats” of it. One of the evidence-based individual therapies for PTSD is based on people having a phobic response. In that model, the individual retells the trauma until they become habituated. In [the couples therapy model], there is an understanding that the person made sense of the event in a way that doesn’t make sense. “If I wouldn’t have drank, this wouldn’t have happened to me,” or “If I went left instead of right….” But trying to change the outcome after the fact gets in the way of moving on. It’s how do you understand these whys [of the patient’s response] and not the whats of the trauma.

news@JAMA: Why does PTSD have effects on spouses or other partners?

Dr Monson: People who have PTSD may be more likely to partner with individuals with mental health issues, in addition to the burden of living with the symptoms. It’s less about what the person experienced and more about their symptoms. Living with someone who is chronically angry and avoiding activities that normally bring happiness changes the structure and function of the relationship. We’ve had partners who were woken to being strangled by the patient with PTSD or have slept in another bed because of the patient’s sleep disturbances, which has an effect on intimacy.

news@JAMA: How can involving the partner help the patient?

Dr Monson: The study revealed that the improvements [in couples PTSD therapy] are on par or better than results with individual PTSD therapy, with the added benefit of improved relationship satisfaction.

There have been other specific couples therapies for depression and substance abuse to improve the patient’s condition and their relationship. It’s important to get relationship improvement alongside symptom improvement. Sometimes loved ones can do things that are well-meaning but have adverse consequences. They’ll get groceries so the patient doesn’t have to go out in public, they’ll make explanations why the patient is not at a family gathering or encourage them to isolate in other ways. In the long run, this maintains or increases the problem and reinforces that the patient can’t handle these situations, so the patient doesn’t learn anything about the safety of these situations.

news@JAMA: Is this a widely available option?

Dr Monson: We are working with the US Department of Defense, specifically the Army and Air Force, on disseminating this therapy. We are also working with Canadian Forces. There is a possibility it will be available through the US Department of Veterans Affairs. We are working to get clinicians trained.

Categories: Post Traumatic Stress Disorder, Psychiatry, War