Military deployment can be associated with increased risk of mental health problems for military service members and veterans as well as psychological distress in the spouses and children of the deployed, a risk that increases with longer deployment, according to research.
Part of the problem is that only a small number of military personnel and veterans receive treatment for post-traumatic stress disorder (PTSD) incurred during deployment, according to recent studies. And for those who do seek help, treatment options too often fail to accommodate the schedule constraints of service members, veterans and their families.
Steffany Fredman, assistant professor of human development and family studies and the Karl R. Fink and Diane Wendle Fink Early Career Professor for the Study of Families at Penn State, and fellow researchers are working to find a treatment solution for service members and veterans with PTSD and their spouses that is both feasible for couples and effective.
"Post-traumatic stress disorder is a life-disrupting, frequently chronic condition that can cause devastating relationship problems," Fredman said. "Numerous studies have documented an association between PTSD symptoms and impaired intimate relationship functioning in active military and veteran couples, including relationship distress, physical and psychological aggression, and partner psychological distress. We also know that the quality of a trauma survivor's intimate relationships can promote or impede recovery from PTSD."
With Candice Monson of Ryerson University in Ontario, Canada, Fredman co-developed Cognitive-Behavioral Conjoint Therapy (CBCT) for PTSD. CBCT for PTSD is a 15-session couple therapy for PTSD that is also designed to enhance intimate relationship functioning.
In prior work, Fredman and colleagues have found that this program is helpful in both treating PTSD symptoms and enhancing couples' relationships. However, the format of 15 sessions over 15 weeks presented challenges—such as time and schedule conflicts—which could interfere with patients receiving the full course of treatment.
To alleviate these problems, Fredman and colleagues began developing intensive weekend retreats for active duty service members and veterans with PTSD and their partners.
The retreats are currently being evaluated as part of a research study being conducted under the auspices of the Consortium to Alleviate PTSD. Jointly funded by the Department of Defense (DoD) and the Department of Veterans Affairs (VA), the Consortium to Alleviate PTSD is a national research group led by the University of Texas Health Science Center at San Antonio and the VA's National Center for PTSD, with a network of co-investigators from across the country, working together to find the best ways to diagnose, prevent and treat combat-related PTSD and related conditions.
Held in Central Texas near the U.S. Army's Fort Hood, the retreats deliver months' worth of PTSD treatment condensed into one weekend that is taught in a multi-couple, group format.
"The rationale for the intensive weekend retreat format is that it's sometimes logistically challenging for both members of a couple to attend treatment during the typical 8 to 4:30 hours at the VA or DoD clinics and for them to attend all 15 weekly treatment sessions, which is typically preceded by three or four sessions of assessment to determine if the treatment might be a good fit in the first place," Fredman said. "This format has the potential for rapid dissemination and implementation, while capturing the majority of the benefits of the original therapy format."
The pilot study involves the recruitment of 24 couples to attend 12-hour, retreat-style workshops over the course of a weekend at a hotel in Austin, Texas, about an hour away from Fort Hood. The study includes seven weekend retreats in total, with two to six couples treated at each workshop.
Following the retreats, Fredman and colleagues will evaluate whether the intervention is effective in decreasing PTSD and associated symptoms, such as depression, anxiety and anger; improving partners' psychological distress; and increasing both partners' relationship satisfaction.
Investigators believe that providing the therapy in a non-military, non-VA setting helps reduce the stigma of seeking mental health care. An added expected benefit is that participating in a program with other couples will provide social support for couples coping with the effects of PTSD.
Therapists with extensive experience working with active duty service members and veterans with PTSD lead the workshops.
They provide couples with an understanding of how PTSD and intimate relationships affect one another, and guide the couples in ways to think, feel and behave differently in order to improve the service member or veteran's PTSD symptoms, the couples' relationship health, and the partners' psychological well-being.
Oftentimes, addressing a couple's problem and learning that it is treatable can improve a relationship.
"In short, the couple's relationship is the vehicle for change," Fredman said.
The study has been recruiting both active-duty service members and veterans who are diagnosed with PTSD and in committed, partnered relationships. To be eligible, both members of each couple must be available to participate in intensive treatment delivered over one weekend.
"A number of couples have said that, without this format, they would not have been able to participate in treatment due to work conflicts or the fact that some are geographically separated during the work week," Fredman said. "They have also found great support and comfort from interacting with the other couples attending the retreat, as it helps them to recognize that they are not the only ones grappling with the effects of PTSD on their relationship, and to learn vicariously as other couples describe how they are using the skills taught during the retreat over the course of the weekend."
Data analysis and interpretation will be conducted following the last cohort of couples. If the pilot study proves successful, the research team hopes to conduct a randomized controlled trial of accelerated, multi-couple CBCT for PTSD through a larger study funded by the U.S. Department of Defense and/or Department of Veterans Affairs.
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