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.
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.
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.
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. Treatment effects were maintained at 3-month follow-up.
Among couples in which one partner was diagnosed as having PTSD, a disorder-specific couple therapy, compared with a wait list for the therapy, resulted in decreased PTSD symptom severity and patient comorbid symptom severity and increased patient relationship satisfaction.
clinicaltrials.gov Identifier: NCT00669981