Posttraumatic stress disorder (PTSD) is highly prevalent in military and veteran populations, who also have a high dropout rate from individual PTSD therapy. PTSD also can contribute to difficulties within intimate relationships and to partner psychological distress. The state of intimate relationships can help or interfere with recovery from PTSD. Relationship problems also can contribute to attrition from the military and suicide risk.

Couple-based approaches to PTSD treatment offer the potential to address these complex problems as they strive to treat PTSD and enhance relationships at the same time. However, the length of existing couple-based PTSD treatments—15 sessions for up to five months—makes it difficult for many couples to get treatment; it also presents challenges for large-scale dissemination within the military and VA healthcare systems.

Early success with a creative approach to caring for couples

To address these limitations, investigators with the Consortium to Alleviate PTSD conducted a pilot study of a brief version of Cognitive-Behavioral Conjoint Therapy for PTSD (CBCT for PTSD) in which the treatment was delivered over two days to multiple couples at the same time using a retreat workshop format.

This compressed format decreased many of the logistical barriers that make it hard for couples to participate in and complete the 15-session version of CBCT for PTSD while capturing a majority of the benefits of the original therapy format. These included improvements in service members’ and veterans’ PTSD and related symptoms (depression, anxiety, anger), partners’ psychological well-being, and couples’ relationship adjustment.

Randomized trial will compare two treatments

STRONG STAR investigators led by Steffany Fredman, PhD, of The Pennsylvania State University will build on the success of that pilot study by testing the abbreviated, intensive, multi-couple group format of CBCT for PTSD (AIM-CBCT for PTSD) as a standalone treatment for PTSD in military and veteran couples in a larger sample (120 couples). AIM-CBCT will be compared to another intervention that also involves couples going away together to work on their relationships.

The comparison condition is the Prevention and Relationship Education Program (PREP), which research has shown to enhance couples’ psychological and relational well-being. This well-established, multi-couple, group-based, relationship education program has been adapted for military couples and widely disseminated in a weekend workshop format through the Army Chaplain Corps.

The study will test the efficacy of AIM-CBCT for PTSD in comparison to PREP in (1) treating PTSD, (2) treating co-occurring symptoms, (3) improving partner psychological distress, and (4) improving both partners’ relationship satisfaction.

The research team believes that if this study proves successful, AIM-CBCT for PTSD has the potential to be quickly scaled up within the Military Health System as a standalone treatment for PTSD with broad treatment effects, while improving access to care for PTSD and helping maintain a strong and effective military.