Couples Therapy May Help Combat PTSD
TUESDAY Aug. 14, 2012 -- Although most treatments for post-traumatic stress disorder (PTSD) focus on the affected individual, researchers report that a new therapy that includes the patient's partner not only improved symptoms, but also increased the couples' satisfaction with their relationship.
"PTSD is a very treatable condition, and it's important to get help if you're struggling," said study author Candice Monson, a professor of psychology and director of clinical training at Ryerson University, in Toronto. "What our study shows is that allowing your loved ones to be a part of your mental health treatment -- if you're in a supportive relationship -- can be very important to treatment. We'd never advise someone with cancer to go through their treatment alone, would we?"
Results of the study are published in the Aug. 15 issue of the Journal of the American Medical Association.
PTSD is an anxiety disorder that follows a dangerous and frightening event or events, according to the U.S. National Institutes of Mental Health (NIMH). It can stem from situations such as fighting in a war, being the victim of a violent crime or being in a motor vehicle accident.
People with the disorder often relive the events over and over again, according to the NIMH. Another common symptom is avoiding the situation or the place where it occurred. For example, people suffering from PTSD after a car accident might avoid driving, Monson explained.
Loved ones of someone with PTSD may find that their relationship suffers. The person with PTSD might even become aggressive towards them. On the other hand, loved ones can also reinforce the fears of people with PTSD by allowing them to withdraw from family events or not drive the car.
The new study randomly assigned 40 couples to either a PTSD-specific couples therapy or to a waiting list for therapy. One person in each couple had been diagnosed with PTSD. Anyone who was taking psychiatric medications was allowed to continue those medications.
The 20 couples in the treatment group received 15 sessions of cognitive behavioral therapy for PTSD in a couples-therapy format. Once the study period was over, those on the waiting list were offered therapy, according to Monson.
On a PTSD-symptom severity scale that ranged from zero to 136, with higher scores indicating more severe symptoms, the couples therapy resulted in a 23-point drop over the wait-list group.
On a measure that indicates relationship satisfaction ranging from zero to 151, with higher scores indicated a more satisfying relationship, the couples therapy group improved their score by almost 9.5 points compared to the wait-list group.
"Couple treatment improved PTSD symptoms and relationship satisfaction. Those outcomes were maintained at the three-month follow-up," Monson said. "Most people think about couples therapy as an adjunct for mental health conditions, but we're trying to develop this treatment where there's a simultaneous focus on improving relationships."
Monson said the findings showed that couples therapy was similarly effective when compared to individual therapy. This research team plans on doing a study to compare prolonged exposure therapy, a form of cognitive behavioral therapy that's currently considered the gold standard in PTSD treatment, with the PTSD-specific couples therapy, according to Monson.
Some experts were skeptical, however.
"It's sort of like going to the hospital and having your gallbladder removed and a facelift at the same time. You'll feel better, but you won't know for sure what helped," said Dr. Michael Aronoff, a psychiatrist at Lenox Hill Hospital, in New York City.
"If you have a willing partner that can be enlisted while you're working through the trauma, all the better," he said, but "in general, you want to first focus on each issue you're trying to deal with on an individual basis though."
A second study in the same issue of the journal focused on people with PTSD who also have a substance dependence problem. Australian researchers combined a commonly used therapy for PTSD, called prolonged exposure therapy, and substance abuse treatment, and compared it to the usual treatment for substance dependence. Prolonged exposure therapy involves exposure to memories and reminders of past trauma, and the concern has been that these exposures to someone who's undergoing substance abuse therapy might trigger a relapse.
The study included 55 people on the integrated therapy with 48 people on the usual substance abuse therapy. Both groups had improvements in PTSD symptom scores, but the integrated group saw larger gains. There were no significant differences in relation to substance use, depression or anxiety between the two treatment groups.
Learn more about PTSD from the U.S. National Institute of Mental Health.
Posted: August 2012