Pretreatment relationship characteristics predict outcomes from an uncontrolled trial of intensive, multicouple group PTSD treatment

Cognitive behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is associated with improvements in patients' and partners' mental health and relationship satisfaction. Some pretreatment relationship characteristics have predicted CBCT for PTSD outcomes for patients, but findings were limited to a single community sample consisting primarily of female patients with male partners. A better understanding of whether pretreatment relationship characteristics predict outcomes in other patient populations and whether there are partners who may be particularly responsive to couple therapy for PTSD could optimize treatment matching. This study investigated whether pretreatment partner accommodation and relationship satisfaction predicted patient and partner treatment outcomes from an uncontrolled trial of an abbreviated, intensive, multicouple group version of CBCT for PTSD conducted with 24 active-duty military or veteran couples (96% male patients/female partners). In general, changes in patients' PTSD and comorbid symptoms and relationship satisfaction did not vary by pretreatment partner accommodation or patients' own pretreatment relationship satisfaction. In contrast, pretreatment relationship characteristics predicted partner outcomes. Partners who engaged in higher levels of accommodation pretreatment and partners who reported lower levels of pretreatment relationship satisfaction experienced greater declines in psychological distress following treatment. Also, partners who began the study relationally distressed exhibited significant increases in relationship satisfaction following treatment, whereas those who were not relationally distressed did not. Findings suggest that improvements generally do not vary by pretreatment relationship characteristics for patients, whereas partners who begin treatment with elevated relationship risk factors may be especially likely to experience improvement across outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans

We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.

Love, health, and the 'hood: An examination of romantic relationship adjustment and perceived neighborhood quality as predictors of partnered Black Americans' long-term psychological health

Existing disparities regarding Black Americans' psychological health warrant further investigation of socioecological factors that may be associated with negative and positive dimensions of psychological health in this population. Romantic relationship functioning and neighborhood context are two domains relevant to Black Americans' mental health. However, less is known about how they may serve as independent and interactive prospective predictors of Black Americans' psychological health and potentially in distinctive ways for Black men and women. Using data from 333 partnered Black Americans who participated in the Midlife in the United States study, we investigated relationship adjustment and neighborhood quality as independent and interactive predictors of negative and positive affect 10 years later and examined gender differences in these linkages. Higher neighborhood quality predicted lower levels of negative affect and higher levels of positive affect for both men and women a decade later. Additionally, for Black men, the longitudinal association between relationship adjustment and negative affect differed by neighborhood quality such that better relationship adjustment predicted higher subsequent negative affect only for men in lower quality neighborhoods. Findings demonstrate the connections among romantic relationship functioning, ecological resources, and gender in this population and highlight the importance of incorporating socioecological and intersectional perspectives for predicting Black Americans' long-term psychological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations among Financial Well-Being, Daily Relationship Tension, and Daily Affect in Two Adult Cohorts Separated by the Great Recession

Financial well-being may be an important context for daily emotional reactivity to relationship tension (e.g., arguments) whose salience varies across historical time or as a function of exposure to economic downturns. This study investigated how emotional reactivity, operationalized as daily fluctuations in negative and positive affect associated with the occurrence of daily relationship tension, varied by financial well-being among those who were and were not exposed to the Great Recession of 2008. Two matched, independent subsamples of partnered individuals from the National Study of Daily Experiences completed identical 8-day diary protocols, one before the Great Recession (n = 587) and one after (n = 351). Individuals reported higher negative affect and lower positive affect on days when relationship tension occurred. Further, results indicated that negative affect reactivity, but not positive affect reactivity, was moderated by both financial well-being and cohort status. For the pre-recession cohort, negative affect reactivity was stronger among those with lower financial well-being. However, among the post-recession cohort, financial well-being did not moderate negative affect reactivity to relationship tension. Findings highlight the utility of considering major societal events, such as economic downturns, to understand variability in emotional reactivity to day-to-day relationship tension in the context of financial well-being, as the salience of financial well-being in the ways relationship tension and negative affect are related on a daily basis appears to vary by historical context.

PTSD Symptom Cluster Severity Predicts Momentary Emotion Dynamics During Couple Conversations

This study investigated the associations between momentary emotion dynamics and posttraumatic stress disorder (PTSD) symptoms. Using a sample of 61 couples (N = 122 individuals) in which all individuals were trauma exposed and at least one partner screened positive for PTSD, we examined the intra- and interpersonal regulation of vocally encoded emotional arousal (fundamental frequency [f0]) and how these momentary emotion regulatory patterns relate to specific PTSD symptoms during two couple conversations: one designed to elicit conflict and one to elicit intimacy. PTSD symptoms were assessed using a gold standard clinical interview. In both conversations, higher reexperiencing symptoms were associated with greater emotional inertia (i.e., more resistance to change in emotional state following deviation from one's emotional equilibrium), and higher avoidance symptoms were associated with less emotional inertia (i.e., quicker return to emotional equilibrium). In the intimacy conversations, individuals also responded to their partners' arousal. Furthermore, individuals whose partners exhibited higher emotional numbing symptoms exhibited more emotional inertia, suggesting that emotion regulation may be a function of both one's own and one's partner's PTSD symptoms. Attending to the interpersonal context of emotion dynamics during PTSD treatment may enhance outcomes.

An exploration of potential pressures to engage in parenting accommodation of PTSD symptoms for military couples

In the context of service member posttraumatic stress disorder (PTSD) symptoms, intimate partners may experience pressure to take over parenting roles and run interference between the service member and the children; that is, to engage in partner accommodation focal to parenting. The current study quantitatively assessed potential pressures to engage in parenting accommodation (PPEPA) in a sample of 207 female partners married to male service members with at least one child in the home and the convergence of PPEPA with service member PTSD symptoms, general partner accommodation, couple functioning, parenting, and child functioning. Partners' reports of PPEPA were associated with higher levels of service member PTSD symptoms and partners' general accommodation of PTSD symptoms. When controlling for service member PTSD symptoms and general partner accommodation, partner reports of PPEPA still accounted for unique variance in lower parenting alliance (as reported by both service member and partner), lower levels of service members' reports of closeness with children in the home, higher levels of harsh parenting by both the service member and partner, and greater child behavioral difficulties. Findings support PPEPA as related to partners' accommodative responses to PTSD but demonstrating unique associations with parenting alliance, parenting, and child outcomes. Parenting interventions in the context of PTSD may benefit from conjoint or family approaches that attend to the intersection of PTSD and broader family functioning, including pressures to engage in accommodation focal to the parenting domain.

A systematic review and meta-analysis of individual and couple therapies for posttraumatic stress disorder: Clinical and intimate relationship outcomes

The association between symptoms of posttraumatic stress disorder (PTSD) in adults and difficulties in intimate relationships is well documented. Growing literature suggests that interpersonally-oriented therapies, such as couple and family interventions, may lead to improvements in both PTSD symptoms and intimate relationship functioning. However, it is unknown how individual PTSD treatments compare to couple/family interventions in relational outcomes. The present study was a systematic review and meta-analysis of individual and couple/family treatments to examine changes in PTSD symptoms and intimate relationship functioning. Twelve couple treatment studies with 13 unique samples and 7 individual treatment studies with 9 unique samples met inclusion criteria. No family-based treatments were identified. Meta-analytic findings indicated moderate to large reductions in PTSD symptoms for both couple and individual studies. Small but significant improvements in intimate relationship functioning across individual and couple studies were observed. Moderation analysis suggested that across both individual and couple treatment formats, trauma-focused treatments had larger effects on PTSD symptoms. Trauma-focused treatments had larger effects on intimate relationship functioning for individual studies. Military status did not moderate outcomes. This study supports the utility of both individual and couple treatment formats for treating PTSD and provides preliminary support for these modalities for also enhancing intimate relationship functioning.

Effectiveness of cognitive behavioral conjoint therapy for posttraumatic stress disorder (PTSD) in a U.S. Veterans Affairs PTSD clinic

Cognitive behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) is a 15-session conjoint treatment for PTSD designed to improve PTSD symptoms and enhance intimate relationship functioning. Numerous studies of CBCT for PTSD document improvements in patient PTSD and comorbid symptoms, partner mental health, and relationship adjustment. However, little is known about its effectiveness in real-world clinical settings. Using an intention-to-treat sample of couples who participated in CBCT for PTSD in an outpatient U.S. Veterans Affairs (VA) PTSD clinic (N = 113), trajectories of session-by-session reports of veterans' PTSD symptoms and both partners' relationship happiness were examined. Across sessions, there were significant reductions in veteran-rated PTSD symptoms, d = -0.69, and significant increases in veteran- and partner-rated relationship happiness, ds = 0.36 and 0.35, respectively. Partner ratings of veterans' PTSD symptoms increased before significantly decreasing, d = -0.24. Secondary outcomes of veteran and partner relationship satisfaction, ds = 0.30 and 0.42, respectively; veteran and partner depressive symptoms, ds = -0.75 and -0.29, respectively; and partner accommodation of PTSD symptoms, d = -0.44, also significantly improved from pre- to posttreatment. The findings suggest that CBCT for PTSD was effective for decreasing PTSD and comorbid symptoms in veterans, as well as for improving relationship functioning and partners' mental health, among a sample of real-world couples seeking treatment in a VA PTSD specialty clinic.

Religious Coping and Gender Moderate Trajectories of Marital Love among Black Couples

An increasing body of work documents the roles of religion and spirituality in Black American marriages. We built on this research to examine religious coping as a potential cultural resource for Black marriages using a dyadic analytic approach with longitudinal data. Specifically, we investigated the effects of positive (i.e., sense of spiritual connectedness) and negative (i.e., spiritual tension or struggle) religious coping on trajectories of marital love reported by wives and husbands in 161 Black, married, mixed-gender couples, and we tested the potential moderating role of spouse gender. At baseline, spouses reported on their religious coping, and they rated their marital love at baseline and during two additional home interviews conducted annually. Data were analyzed using growth curve modeling within an Actor-Partner Interdependence Modeling framework. Husbands who reported more positive religious coping at baseline exhibited relatively high and stable marital love over time, whereas those who reported less positive religious coping reported less love at baseline and exhibited declines in love over time. Wives who reported less negative religious coping at baseline were higher in marital love initially but showed declines over time, whereas those who reported more negative religious coping at baseline were lower in marital love initially but showed increases in love over time. Results highlight the importance of further research on the role of religion and religious coping in Black couples' marital experiences and suggest differential roles of positive and negative religious coping for men's and women's marital love. Clinical and policy implications are discussed.

Secondary individual outcomes following multicouple group therapy for posttraumatic stress disorder: An uncontrolled pilot study with military dyads

Cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) has demonstrated efficacy for improving PTSD and comorbid symptoms and relationship adjustment. To enhance treatment efficiency and scalability, we developed a 2-day, abbreviated, intensive, multicouple group version of CBCT for PTSD (AIM-CBCT for PTSD). Prior work demonstrated that AIM-CBCT for PTSD wasassociated with reductions in PTSD and comorbid symptoms in a sample of 24 post-9/11 active duty military or veteran couples who received the treatment in a retreat format over a single weekend. The current study investigated secondary outcomes regarding trauma-related cognitions, psychosocial impairment, and insomnia. For trauma-related cognitions, reductions were nonsignificant and small at 1-month follow-up, ds = -0.14 to -0.32. However, by 3-month follow-up, there were significant, medium effect size reductions in total trauma-related cognitions, d = -0.68, and negative views of self and others, ds = -0.64 and -0.57, respectively, relative to baseline. There was also a nonsignificant, small-to-medium effect-size reduction in self-blame, d = -0.43, p = .053, by 3-month follow-up. For psychosocial impairment, there were significant and medium-to-large and large effect size reductions by 1- and 3-month follow-ups, ds = -0.73 and -0.81, respectively. There were nonsignificant, small effect size reductions in insomnia at both 1- and 3-month follow-ups relative to baseline, ds = -0.30 and -0.34, respectively. These findings suggest that AIM-CBCT for PTSD is associated with reductions in maladaptive posttraumatic cognitions and psychosocial impairment but that adjunctive interventions may be needed to address insomnia.

Relational impacts of capitalization in early parenthood

Relationship difficulties are common during the transition to parenthood and may persist for years. Strategies that enhance couples' daily relational experiences early in the parenting years may serve a protective role. In general, engaging in a capitalization attempt (i.e., sharing personal good news) with one's romantic partner and perceiving the partner to be responsive are associated with better relationship outcomes among committed couples. However, it is unknown whether these relational benefits extend to the early parenting years or to other relational domains such as coparenting, which plays a central role in family functioning. The current study examined same-day associations between couples' capitalization process and relationship closeness and perceived coparenting support in a dyadic context during the first year of parenthood. A subsample of primarily non-Hispanic White coresident mixed-gender couples who participated in a randomized controlled trial of a transition to parenthood program (N = 141) completed daily diaries at 10 months postpartum for 8 consecutive days. On days when mothers shared, both partners reported greater closeness. On days when fathers shared, mothers reported greater closeness and perceived coparenting support. Furthermore, perceived partner responsiveness was associated with greater closeness for both partners and greater coparenting support for fathers. Fathers also perceived greater closeness and coparenting support on days when mothers shared about the child. Findings highlight the potential benefits of capitalization in early parenthood for both closeness and perceived coparenting support and suggest that capitalization may be a low cost, high yield strategy for enhancing new parents' daily relational experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

STRONG STAR and the Consortium to Alleviate PTSD: Shaping the future of combat PTSD and related conditions in military and veteran populations

The STRONG STAR Consortium (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) and the Consortium to Alleviate PTSD are interdisciplinary and multi-institutional research consortia focused on the detection, diagnosis, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) and comorbid conditions in military personnel and veterans. This manuscript outlines the consortia's state-of-the-science collaborative research model and how this can be used as a roadmap for future trauma-related research. STRONG STAR was initially funded for 5 years in 2008 by the U.S. Department of Defense's (DoD) Psychological Health and Traumatic Brain Injury Research Program. Since the initial funding of STRONG STAR, almost 50 additional peer-reviewed STRONG STAR-affiliated projects have been funded through the DoD, the U.S. Department of Veterans Affairs (VA), the National Institutes of Health, and private organizations. In 2013, STRONG STAR investigators partnered with the VA's National Center for PTSD and were selected for joint DoD/VA funding to establish the Consortium to Alleviate PTSD. STRONG STAR and the Consortium to Alleviate PTSD have assembled a critical mass of investigators and institutions with the synergy required to make major scientific and public health advances in the prevention and treatment of combat PTSD and related conditions. This manuscript provides an overview of the establishment of these two research consortia, including their history, vision, mission, goals, and accomplishments. Comprehensive tables provide descriptions of over 70 projects supported by the consortia. Examples are provided of collaborations among over 50 worldwide academic research institutions and over 150 investigators.

Quality of coparenting and infant-mother attachment: The mediating role of maternal emotional availability

Increasing attention has been paid to the influence of family contextual factors in predicting infant attachment security. However, little is known about the influence of coparenting quality on attachment. The goal of the present study was to examine the associations among parental perceptions of coparenting quality, quality of mothering (as indexed by maternal emotional availability), and infant-mother attachment. Parental reports of positive and negative coparenting quality, maternal emotional availability, and infant-mother attachment were assessed in 152 infants and their parents at 1, 3, 6, 9, and 12 months postpartum. Direct and indirect effects were assessed within a structural equation modeling framework to examine: (a) direct effects of mother-reported coparenting on infant-mother attachment, (b) indirect effects of mother-reported coparenting on infant-mother attachment through maternal emotional availability, and (c) indirect effects of father-reported coparenting on infant-mother attachment through maternal emotional availability. Results indicated that there was an indirect, but not direct, association between mother-reported coparenting quality across the first year of life and infant-mother attachment at 1 year through maternal emotional availability across the first year. Father-reported coparenting across infants' first year was not associated with infant-mother attachment at 1 year. Post hoc analyses revealed that mothers' perceptions of coparenting at 1 month were indirectly linked to attachment at 1 year through maternal emotional availability across the first year. Findings highlight the importance of coparenting quality, especially in the early postpartum, in organizing quality of parenting and infant attachment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Closer Examination of Relational Outcomes from a Pilot Study of Abbreviated, Intensive, Multi-Couple Group Cognitive-Behavioral Conjoint Therapy for PTSD with Military Dyads

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is associated with improvements in patients' PTSD symptoms, partners' psychological distress, and relationship satisfaction. However, little is known about whether CBCT for PTSD is associated with changes in other relationship domains that have theoretical and clinical relevance to the relational context of PTSD. The current study is a secondary analysis of relational outcomes from an uncontrolled, within-group trial designed to examine whether an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered in a retreat during a single weekend was associated with improvements in PTSD symptoms and relationship satisfaction. In this investigation, we examined whether AIM-CBCT for PTSD is also associated with improvements in ineffective arguing, supportive dyadic coping by partner, joint dyadic coping, and partners' accommodation of patients' PTSD symptoms. Participants were 24 couples who included a post-9/11 U.S. service member or veteran with PTSD. At 1- and 3-month follow-up, patients reported significant reductions in couples' ineffective arguing (ds = -.71 and -.78, respectively) and increases in supportive dyadic coping by partners relative to baseline (ds = .50 and .44, respectively). By 3-month follow-up, patients also reported significant increases in couples' joint dyadic coping (d = .57), and partners reported significant reductions in their accommodation of patients' PTSD symptoms (d = -.44). Findings suggest that AIM-CBCT for PTSD is associated with improvements in multiple relationship domains beyond relationship satisfaction but that these may be differentially salient for patients and partners.

Associations Between Service Members' Posttraumatic Stress Disorder Symptoms and Partner Accommodation Over Time

When service members manifest symptoms of posttraumatic stress disorder (PTSD), intimate partners may engage in behaviors to accommodate their partners' experiences (e.g., helping service members avoid situations that could make them uncomfortable, not expressing own thoughts and feelings to minimize PTSD-related conflict), which may inadvertently serve to maintain or increase PTSD symptoms over time. In a sample of 274 male service member/female civilian couples, we evaluated hypothesized bidirectional pathways between self-reported service member PTSD symptoms and partner accommodation, assessed four times over an approximately 18-month period. A random-intercept cross-lagged panel model disaggregating between and within effects revealed that, on average, couples in which the service member had higher levels of total PTSD symptoms also scored higher in partner accommodation, between-couple correlation, r = .40. In addition, at time points when service members' PTSD symptoms were higher relative to their own average symptom level, their partners' level of accommodation was also higher than their personal average, within-couple correlation r = .22. Longitudinally, service member PTSD symptom scores higher than their personal average predicted subsequent increases in partner accommodation, β = .19, but not vice versa, β = .03. Overall, the findings indicate both stable and time-specific significant associations between service member PTSD symptoms and partner accommodation and suggest that higher levels of PTSD symptoms are a significant driver of later increases in partner accommodation. These findings add further support for treating PTSD in an interpersonal context to address the disorder and concomitant relational processes that can adversely impact individual and relational well-being.

Intensive, Multi-Couple Group Therapy for PTSD: A Nonrandomized Pilot Study With Military and Veteran Dyads

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients' self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients' PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD.

Partners' motivations for accommodating posttraumatic stress disorder symptoms in service members: The reasons for accommodation of PTSD scale

Emerging research reinforces the importance of partner accommodation in the interpersonal context of posttraumatic stress disorder (PTSD). A better understanding of partners' motivations for accommodation is needed to help refine or design interventions that target accommodation. To explore partners' motivations, we created the Reasons for Accommodation of PTSD Scale (RAPS) and evaluated it in 263 female partners of male Army soldiers who had returned from a deployment within the past 2 years. Soldiers completed a measure of military-related PTSD, and partners completed a measure of accommodation and the newly created RAPS. Factor analysis of the RAPS yielded a clear, 3-factor solution suggesting the following reasons for accommodating: (1) Relationship & Obligation, or a desire for positive relationship outcomes and a sense of duty or responsibility; (2) Helping Recovery, or a belief that avoidance was helpful for the service member; and (3) Conflict Avoidance/Helplessness, or a desire to avoid conflict or simply not knowing what else to do. Analyses of these factors in relation to soldiers' PTSD clusters indicated that hyperarousal symptoms were uniquely associated with relationship and obligation motivations, re-experiencing symptoms were uniquely associated with helping recovery motivations, and emotional numbing symptoms were uniquely associated with conflict avoidance and helplessness motivations. Furthermore, conflict avoidance and helplessness accounted for the greatest variance in partners' accommodation frequency and distress. Assessment of partners' accommodative behaviors, as well as their motivations for engaging in accommodation, may aid in treatment planning and enhance outcomes for couples in which one individual has PTSD.

Prospective associations between depressive symptoms and marital satisfaction in Black couples

Associations between depressive symptoms and relationship distress are well-established, but little is known about these linkages among Black couples, or about the role of sociocultural factors in these processes. In this study, we applied a dyadic analytic approach, Actor-Partner Interdependence Modeling (APIM), to address 2 goals: to assess the prospective, bidirectional associations between depressive symptoms and marital satisfaction over a 1-year period in a racially homogenous sample of 168 heterosexual Black couples, and to explore whether these associations were moderated by husbands' and wives' experiences of racial discrimination and/or the centrality of race in their personal identities. Findings revealed that depressive symptoms predicted relative declines in marital satisfaction reported by both self and partner for both husbands and wives. Moderation analyses indicated that, when wives reported greater racial centrality, their depressive symptoms predicted relative declines in husbands' marital satisfaction. In contrast, when wives reported lower racial centrality, their depressive symptoms were not associated with husbands' satisfaction. Together, the findings highlight the interdependence between spouses' mental health and relationship satisfaction and the role of sociocultural factors in these linkages. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Prospective, dyadic links between posttraumatic stress disorder symptoms and family violence in the early years of parenthood

Cross-sectional research has suggested that posttraumatic stress disorder (PTSD) symptom severity may be an important predictor of family violence perpetration; however, causal inference is limited by the absence of studies designed to prospectively predict family violence by PTSD symptoms. In the current study, PTSD symptoms were assessed among 250 trauma-exposed heterosexual couples 10 months after having their 1st child. The number of acts of psychological and physical intimate partner aggression (IPA) and parent-to-child aggression (PCA) that occurred during the past year was assessed at 10 and 24 months postpartum to account for stability in family violence perpetration when prospectively predicting perpetration. Longitudinal actor-partner interdependence models revealed that women's and men's PTSD symptoms positively predicted increases in the frequency of their own perpetration of psychological and physical IPA as well as psychological PCA. Additionally, partners' PTSD symptoms prospectively predicted psychological and physical IPA perpetration but not psychological or physical PCA perpetration, suggesting that partners' PTSD symptoms may directly impact dyadic processes during incidents of IPA but may not generally affect the family environment in a way that potentiates all forms of aggression. No significant gender differences were revealed. Overall, results of the current study largely support existing research and theory while clarifying inconsistencies that have emerged when examining cross-sectional associations. Further, the current results highlight the potential utility of PTSD treatment as an avenue for aggression prevention and intervention efforts during the early parenting years. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parents' PTSD symptoms and child abuse potential during the perinatal period: Direct associations and mediation via relationship conflict

BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms are associated with parental aggression towards children, but little is known about the relation between parents' PTSD symptoms and their risk for perpetrating child physical abuse during the early parenting years, when the potential for prevention of abuse may be highest.

OBJECTIVE

To examine direct associations between mothers' and fathers' PTSD symptoms and child abuse potential, as well as indirect effects through couple relationship adjustment (i.e., conflict and love) in a high-risk sample of parents during the perinatal period, most of whom were first-time parents.

PARTICIPANTS AND SETTING

From March 2013 to August 2016, data were collected from 150 expecting or new parental dyads in which the mother was participating in a home visiting program.

METHODS

Data were analyzed using the Actor-Partner Interdependence Mediation Model.

RESULTS

For mothers and fathers, there were direct associations between PTSD symptom severity and child abuse potential (βs = .51, ps <.001), and this association for fathers was stronger at higher levels of mothers' PTSD symptoms (β = .15, p =  .03). In addition, parents' own and their partners' PTSD symptoms were each indirectly associated with parents' own child abuse potential through parents' report of interparental conflict (standardized indirect effects = .052-.069, ps = .004) but not love.

CONCLUSIONS

Addressing parents' PTSD symptoms and relationship conflict during the perinatal period using both systemic and developmental perspectives may uniquely serve to decrease the risk of child physical abuse and its myriad adverse consequences.

Cross-day influences between couple closeness and coparenting support among new parents

The couple and coparenting relationships are demonstrated to be prospectively and bidirectionally associated over months to years during the early parenting years. However, little is known about these associations at the daily level within the first year of parenthood, when coparenting first emerges. The goal of the current study was to examine the association between couples' daily feelings of relationship closeness and coparenting support in first-time parents and determine directionality of these effects using a dyadic daily diary design. At 10 months postpartum, heterosexual couples (N = 141 dyads) completed daily diaries for 8 consecutive days. An autoregressive cross-lagged model was incorporated within an Actor Partner Interdependence Modeling framework to examine at the daily level: (a) within-person cross-day associations between relationship closeness and coparenting support, (b) cross-partner cross-day associations within relationship closeness and coparenting support, (c) cross-partner cross-day associations between relationship closeness and coparenting support, and (d) gender differences in these associations. Results revealed a prospective, within person bidirectional link between daily relationship closeness and perceived coparenting support for both mothers and fathers. Additionally, an indirect effect from mothers' experiences of coparenting support to fathers' relationship closeness through fathers' experiences of coparenting support was found at the daily level. Findings highlight the interdependent nature of the couple and coparenting relationship at the daily level during the first year of parenthood and suggest that mothers' feeling supported by their coparenting partners may facilitate a "virtuous cycle" between coparenting support and relationship closeness early in the coparenting relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relationship Quality with Parents: Implications for Own and Partner Well-Being in Middle-Aged Couples

Relationships with parents have significant implications for well-being throughout the lifespan. At midlife, these ties are situated within both developmental and family contexts that often involve the adult offspring's spouse. Yet, it is not known how ties with aging parents are related to psychological well-being within middle-aged couples. This study examined how middle-aged wives' and husbands' views of the current quality of relationships with their own parents (positive and negative) are linked to their own and their partner's psychological well-being. Using a sample of 132 middle-aged couples from Wave 1 of the Family Exchanges Study, we estimated actor-partner interdependence models to evaluate these dyadic associations while controlling for each spouse's marital satisfaction. Both actor and partner effects were observed. With respect to actor effects, wives who reported more negative relationship quality with their own parents had elevated depressive symptoms and lower life satisfaction. Husbands who reported more negative relationship quality with their own parents had lower life satisfaction. In terms of partner effects, husbands had lower depressive symptoms and greater life satisfaction when wives reported more positive relationship quality with their own parents. Finally, the link between wives' positive ties with parents and husbands' lower depressive symptoms was intensified when husbands had less positive relationships with their own parents. Findings suggest that relationship quality with wives' aging parents has implications for both spouses' well-being and may serve as a critical social resource for husbands.

Parenting stress mediates the association between negative affectivity and harsh parenting: A longitudinal dyadic analysis

The current study examined parenting stress (disaggregated into personal distress and child rearing stress) at 12 months postpartum as a mediator of the longitudinal association between parental negative affectivity at 6 months postpartum and harsh parenting at 3 years postpartum for first-time parents with a child transitioning from late toddlerhood to the early preschool years. Analyses were conducted using Mediation for Actor Partner Interdependence Modeling in a sample of 164 couples who participated in a randomized controlled trial of a universal, couple-based transition to parenthood program. There were indirect actor effects of negative affect on a parent's own harsh parenting through both dimensions of parenting stress, with a stronger mediating effect for personal distress than child rearing stress. There were also indirect partner effects of negative affect on one's partner's harsh parenting through the partner's parenting stress, with a stronger indirect partner effect from mothers' negative affect to fathers' harsh parenting than vice versa. Specifically, the mediating effect of personal distress was found for both mothers and fathers, whereas the mediating effect of child rearing stress was found from mothers' negative affect to fathers' harsh parenting only. Findings highlight the importance of a dyadic approach in examining the longitudinal association between negative affect and harsh parenting and suggest that reducing parenting stress in the first year postpartum may decrease the risk of future harsh parenting among couples in which one or both partners experience negative affectivity. (PsycINFO Database Record

A Dyadic Perspective on PTSD Symptoms' Associations with Couple Functioning and Parenting Stress in First-Time Parents

Posttraumatic stress disorder (PTSD) symptoms are associated with disruptions in both couple functioning and parenting, and limited research suggests that, among military couples, perceptions of couple functioning and parenting stress are a function of both one's own and one's partner's mental health symptoms. However, this work has not been generalized to civilian couples, and little is known about the associations between PTSD symptoms and family adjustment in specific family developmental contexts. We examined PTSD symptoms' associations with perceived couple functioning and parenting stress within a dyadic context in civilian couples who had participated in a randomized controlled trial of a universal, couple-based transition to parenthood program and at least one member of the couple reported having experienced a Criterion A1 traumatic event. Results of actor-partner interdependence models revealed that parents' own and partners' PTSD symptoms were negatively associated with perceived couple functioning; contrary to expectation, the association of partners' PTSD symptoms with perceived couple functioning was strongest among men who received the intervention. A parent's own PTSD symptoms were positively associated with parenting stress for both men and women and were unexpectedly strongest for men who received the intervention. Partner PTSD symptoms were also positively associated with increased parenting stress for both men and women. Findings support a dyadic conceptualization of the associations between spouses' PTSD symptoms and family outcomes during the transition to parenthood and suggest that participating in a couple-based, psychoeducational program during this phase in the family life cycle may be particularly salient for men.

Longitudinal Associations Between PTSD Symptoms and Dyadic Conflict Communication Following a Severe Motor Vehicle Accident

There are well-documented associations between posttraumatic stress disorder (PTSD) symptoms and intimate relationship impairments, including dysfunctional communication at times of relationship conflict. To date, the extant research on the associations between PTSD symptom severity and conflict communication has been cross-sectional and focused on military and veteran couples. No published work has evaluated the extent to which PTSD symptom severity and communication at times of relationship conflict influence each other over time or in civilian samples. The current study examined the prospective bidirectional associations between PTSD symptom severity and dyadic conflict communication in a sample of 114 severe motor vehicle accident (MVA) survivors in a committed intimate relationship at the time of the accident. PTSD symptom severity and dyadic conflict communication were assessed at 4 and 16weeks post-MVA, and prospective associations were examined using path analysis. Total PTSD symptom severity at 4weeks prospectively predicted greater dysfunctional communication at 16weeks post-MVA but not vice versa. Examination at the level of PTSD symptom clusters revealed that effortful avoidance at 4weeks prospectively predicted greater dysfunctional communication at 16weeks, whereas dysfunctional communication 4weeks after the MVA predicted more severe emotional numbing at 16weeks. Findings highlight the role of PTSD symptoms in contributing to dysfunctional communication and the importance of considering PTSD symptom clusters separately when investigating the dynamic interplay between PTSD symptoms and relationship functioning over time, particularly during the early posttrauma period. Clinical implications for the prevention of chronic PTSD and associated relationship problems are discussed.

The Role of Posttraumatic Growth in a Randomized Controlled Trial of Cognitive-Behavioral Conjoint Therapy for PTSD

Posttraumatic growth (PTG) is defined as a positive psychological change that can emerge following a traumatic life event. Although documented in noninterventional studies of traumatized individuals, there are scant data on the potential for therapy to induce or improve PTG. Thus, the primary goal of this study was to examine changes in PTG in a controlled trial of cognitive-behavioral conjoint therapy for posttraumatic stress disorder versus waitlist (CBCT for PTSD; Monson & Fredman, 2012). We also examined whether pretreatment relationship satisfaction and PTSD symptomatology moderated change in PTG. There were 40 couples (75% with a female partner with PTSD) who were randomized to either immediate CBCT for PTSD or a 3-month waitlist (WL). Compared to WL, individuals who received treatment immediately demonstrated a significant increase in PTG. There was a moderate effect size between-group difference (Hedge's g = 0.45). There was a nonsignificant relationship with a moderate effect size (Hedge's g = 0.65) for the positive effect of pretreatment relationship satisfaction on the trajectory of PTG, but no effect of pretreatment PTSD symptoms. Results suggested that CBCT for PTSD facilitated PTG, even with a limited focus on PTG in this conjoint intervention. Future research should target PTG as a treatment goal and further examine the role of close others in facilitating development of PTG.

Cognitive-behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial

Numerous studies document an association between posttraumatic stress disorder (PTSD) and impairments in intimate relationship functioning, and there is evidence that PTSD symptoms and associated impairments are improved by cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012). The present study investigated changes across treatment in clinician-rated PTSD symptom clusters and patient-rated trauma-related cognitions in a randomized controlled trial comparing CBCT for PTSD with waitlist in a sample of 40 individuals with PTSD and their partners (N = 40; Monson et al., 2012). Compared with waitlist, patients who received CBCT for PTSD immediately demonstrated greater improvements in all PTSD symptom clusters, trauma-related beliefs, and guilt cognitions (Hedge's gs -.33 to -1.51). Results suggest that CBCT for PTSD improves all PTSD symptom clusters and trauma-related cognitions among individuals with PTSD and further supports the value of utilizing a couple-based approach to the treatment of PTSD.

A Preliminary Examination of the Effects of Pretreatment Relationship Satisfaction on Treatment Outcomes in Cognitive-Behavioral Conjoint Therapy for PTSD

OBJECTIVE

The primary goal of the present study was to investigate whether pre-treatment relationship satisfaction predicted treatment drop-out and posttraumatic stress disorder (PTSD) symptom outcomes within a trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012). Additionally, we examined the influence of pre-treatment relationship distress on relationship outcomes.

METHOD

Thirty-seven patients and their intimate partners who participated in a course of CBCT for PTSD were assessed for PTSD symptoms with the Clinician-Administered PTSD Scale and PTSD Checklist, and for intimate relationship functioning with the Dyadic Adjustment Scale. CBCT for PTSD is a conjoint therapy designed to improve PTSD symptoms and enhance relationship functioning. Patients had to meet diagnostic criteria for PTSD to be included in the study; however, couples were not required to be in distressed relationships to receive treatment.

RESULTS

Neither patients' nor partners' pre-treatment relationship satisfaction, nor their interaction, predicted treatment drop-out (ORs = .97-1.01) or completing patients' post-treatment PTSD symptom severity (sr² ≤ .03). However, participants who were in distressed relationships prior to treatment made greater gains in relationship satisfaction compared with those who began treatment in more satisfied relationships (g = 1.02).

CONCLUSIONS

Among patients receiving CBCT for PTSD, treatment drop-out and improvements in PTSD symptoms may be independent of pre-treatment relationship functioning, whereas improvements in relational functioning may be greater among those distressed prior to treatment.

Partner accommodation moderates treatment outcomes for couple therapy for posttraumatic stress disorder

OBJECTIVE

Partner accommodation of posttraumatic stress disorder (PTSD) symptoms (i.e., altering one's own behaviors to minimize patient distress and/or relationship conflict due to patients' PTSD symptoms) has been shown to be positively associated with patient and partner psychopathology and negatively associated with patient and partner relationship satisfaction cross-sectionally. However, the prognostic value of partner accommodation in treatment outcomes is unknown. The goals of the present study were to determine if partner accommodation decreases as a function of couple therapy for PTSD and if pretreatment partner accommodation moderates the efficacy of couple therapy for PTSD.

METHOD

Thirty-nine patients with PTSD and their intimate partners (n = 39) were enrolled in a randomized controlled trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012) and received CBCT for PTSD immediately or after 3 months of waiting. Blinded assessors determined clinician-rated PTSD symptoms and patient-rated PTSD and depressive symptoms and relationship satisfaction at baseline, midtreatment/4 weeks of waiting, and posttreatment/12 weeks of waiting.

RESULTS

Contrary to expectation, partner accommodation levels did not change over time for either treatment condition. However, baseline partner accommodation significantly moderated treatment outcomes. Higher levels of partner accommodation were associated with greater improvements in PTSD, depressive symptoms, and relationship satisfaction among patients receiving CBCT for PTSD compared with waiting list. At lower levels of partner accommodation, patients in both groups improved or remained at low levels of these outcomes.

CONCLUSIONS

Individuals with PTSD who have more accommodating partners may be particularly well-suited for couple therapy for PTSD.

Relatives' emotional involvement moderates the effects of family therapy for bipolar disorder

OBJECTIVE

The "critical comments" dimension of the expressed emotion (EE) construct has been found to predict the illness course of patients with bipolar disorder, but less is known about the "emotional overinvolvement" component. The goal of this study was to evaluate whether relatives' observed appropriate and inappropriate emotional involvement (intrusiveness, self-sacrifice, and distress about patients' well-being) moderated the effectiveness of a family-based intervention for bipolar disorder.

METHOD

108 patients with bipolar disorder (mean age = 35.61 years, SD = 10.07; 57% female) and their relatives (62% spouses) from 2 clinical trials completed 10-min problem-solving interactions prior to being treated with pharmacotherapy plus family-based therapy (FBT) or brief psychoeducation (crisis management [CM]). Patients were interviewed every 3-6 months over 2 years to assess mood symptoms.

RESULTS

When relatives showed low levels of inappropriate self-sacrifice, CM and FBT were both associated with improvements in patients' manic symptoms over 2 years. When relatives showed high levels, patients in CM became more manic over time, whereas patients in FBT became less manic. Group differences in mania trajectories were also observed at high levels of inappropriate emotional response but not at low. When relatives showed high levels of appropriate self-sacrifice, patients in both groups became less depressed. At low levels of appropriate self-sacrifice, patients in CM did not improve, whereas patients in FBT became less depressed.

CONCLUSIONS

Future studies of bipolar disorder should consider the prognostic value of the amount and appropriateness of relatives' emotional involvement with patients in addition to their critical behaviors.

Partner accommodation in posttraumatic stress disorder: initial testing of the Significant Others' Responses to Trauma Scale (SORTS)

Posttraumatic stress disorder (PTSD) is associated with myriad relationship problems and psychological distress in partners of individuals with PTSD. This study sought to develop a self-report measure of partner accommodation to PTSD (i.e., ways in which partners alter their behavior in response to patient PTSD symptoms), the Significant Others' Responses to Trauma Scale (SORTS), and to investigate its reliability and construct validity in 46 treatment-seeking couples. The SORTS demonstrated strong internal consistency and associations with individual and relationship distress. Accommodation was positively correlated with partners' ratings of patients' PTSD symptoms, patient self-reported depressive and trait anger severity, and partner self-reported depressive and state anger severity. Accommodation was negatively correlated with patient and partner relationship satisfaction and partners' perceived social support received from patients. Findings suggest that accommodation may be an attempt to adapt to living with a partner with PTSD but may have negative implications for patient and partner well-being.

Effects of cognitive-behavioral conjoint therapy for PTSD on partners' psychological functioning

A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in "one" partner are negatively associated with their intimate partner's psychological functioning. The present study investigated intimate partners' mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive-behavioral conjoint therapy for PTSD (Monson & Fredman, 2012). There were no significant differences between active treatment and waitlist in intimate partners' psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive-behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress.

Effect of cognitive-behavioral couple therapy for PTSD: a randomized controlled trial

CONTEXT

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.

OBJECTIVE

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.

INTERVENTION

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.

RESULTS

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.

CONCLUSION

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.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00669981.

Concordance between physiological arousal and subjective distress among Vietnam combat veterans undergoing challenge testing for PTSD

This study examined concordance between physiological arousal and subjective distress during a laboratory challenge task. Data were collected during the multisite VA Cooperative Study 334 in the early 1990s examining psychophysiological arousal among combat-exposed Vietnam veterans with (n = 775) and without (n = 369) posttraumatic stress disorder (PTSD). Study participants were presented with 6 standardized neutral scenes and 6 standardized combat scenes. Participants provided a subjective rating of distress after each slide. During the presentation, levels of heart rate (HR) and skin conductance (SC) were recorded. Using linear mixed effects modeling, both HR level and SC level exhibited significant positive associations with subjective distress ratings (pr = .33, p < .001 and pr = .19, p < .001, respectively). Individuals with PTSD demonstrated greater concordance between their distress ratings and SC level during exposure to combat slides than participants without PTSD (pr = .28, p < .001 vs. pr = .18, p < .001). Although a significant association was found between subjective distress and HR reactivity and SC reactivity, these findings were not moderated by PTSD status. The results of these analyses suggest that patients' reports of distress during exposure-based treatments might serve as approximate measures of actual physiological arousal.

Men's psychological functioning in the context of women's breast cancer

Previous research indicates that men are affected when their female partners have breast cancer. However, little is known about what predicts men's psychological well-being in this context. The current investigation involved couples in which the woman had early stage breast cancer and explored the degree to which men's positive and negative well-being was related to women's well-being, women's physical symptoms, relationship functioning, and relationship duration. The findings indicate that all of these factors play a role and interact in predicting men's well-being. In particular, when women have a high level of physical symptoms, the typical associations between men's well-being with women's well-being and relationship adjustment no longer persist. Implications for working with couples addressing health problems are provided.

Cognitive-behavioral conjoint therapy for PTSD: pilot results from a community sample

Seven couples participated in an uncontrolled trial of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Among the 6 couples who completed treatment, 5 of the patients no longer met criteria for PTSD and there were across-treatment effect size improvements in patients' total PTSD symptoms according to independent clinician assessment, patient report, and partner report (d = 1.32-1.69). Three of the 4 couples relationally distressed at pretreatment were satisfied at posttreatment. Partners reported statistically significant and large effect size improvements in relationship satisfaction; patients reported nonsignificant moderate to large improvements in relationship satisfaction. Patients also reported nonsignificant, but large effect size improvements in depression and state anger symptoms. Future directions for research and treatment of traumatized individuals and close others are offered.

Associations among disaster exposure, intimate relationship adjustment, and PTSD symptoms: can disaster exposure enhance a relationship?

This study examined associations among disaster characteristics, relationship adjustment, and posttraumatic stress disorder (PTSD) symptomatology 9 months postdisaster in 205 women exposed to extensive flooding. Bivariately, threat/harm and loss exposure dimensions were related to each other but differentially related to relationship adjustment and PTSD symptoms. Results from structural equation modeling revealed a positive and significant direct association between threat/harm and PTSD symptoms. Conversely, loss was not significantly associated with PTSD symptoms, but was positively and significantly associated with relationship adjustment. Relationship adjustment was negatively and significantly related to PTSD symptoms. These data suggest that some aspects of disaster exposure can have a mobilizing and positive effect on intimate relationships. In turn, positive intimate relationships may buffer individuals against PTSD symptoms.

Military-related PTSD and intimate relationships: from description to theory-driven research and intervention development

Military operations in Iraq and Afghanistan have brought heightened awareness of military related PTSD, as well as the intimate relationship problems that accompany the disorder and can influence the course of veterans' trauma recovery. In this paper, we review recent research that documents the association between PTSD and intimate relationship problems in the most recent cohort of returning veterans and also synthesize research on prior eras of veterans and their intimate relationships in order to inform future research and treatment efforts with recently returned veterans and their families. We highlight the need for more theoretically-driven research that can account for the likely reciprocally causal association between PTSD and intimate relationship problems to advance understanding and inform prevention and treatment efforts for veterans and their families. Future research directions are offered to advance this field of study.

Quantifying the recruitment challenges with couple-based interventions for cancer: applications to early-stage breast cancer

OBJECTIVE

Despite mounting evidence supporting the use of psychosocial interventions to promote adaptation to cancer, enrolling participants into these interventions is challenging. This is particularly salient for couple-based interventions, and newer, more targeted recruitment strategies to increase enrollment are needed. However, there have been few published empirical studies focused specifically on recruitment-related variables associated with enrollment into these types of interventions. To better understand how to encourage participation in couple-based psychosocial interventions for cancer, we examined facilitating and impeding factors to enrollment into a couple-based intervention for women with early-stage breast cancer.

METHOD

In this sample of 99 women diagnosed with early-stage breast cancer, patient demographic variables and method of approaching eligible patients were examined as predictors of enrollment into a randomized controlled trial comparing couple-based relationship enhancement with treatment as usual.

RESULTS

Results indicated that women were more likely to enroll if they were contacted at home or at a follow-up medical appointment rather than when first diagnosed at a busy multidisciplinary clinic; they were also more likely to enroll the closer they lived to the research facility.

CONCLUSIONS

In addition to decreasing participant burden, timing and setting of recruitment efforts may have important implications for enhancing participation rates in couple-based intervention studies for cancer.

A couple-based intervention for female breast cancer

OBJECTIVE

Although women's breast cancer affects both women and their male partners, as well as their relationships, few interventions have been developed to work with couples confronting breast cancer. The current investigation presents the pilot results from a new couple-based intervention program for breast cancer that teaches couples how to minimize negative effects and maximize positive functioning during this difficult time.

METHOD

In this pilot study, 14 couples in which the wife had early stage breast cancer were randomly assigned to one of the two treatment conditions: Couple-based relationship enhancement (RE) or treatment-as-usual (TAU).

RESULTS

The results from this study suggest that compared with couples receiving treatment-as-usual, both women and men in the RE condition experienced improved functioning on individual psychological variables as well as relationship functioning at posttest and 1-year follow-up. In addition, women in RE show fewer medical symptoms at both time periods.

CONCLUSIONS

In this pilot study, the couple-based intervention, RE, has shown promise in improving individual, medical, and relationship functioning for couples in which the woman is facing breast cancer, and therefore merits further investigation on a larger scale.

Observed emotional involvement and overinvolvement in families of patients with bipolar disorder

Many studies have examined the construct validity of the criticism component of expressed emotion, but little work has been done on clarifying the emotional overinvolvement (EOI) construct. In a sample of 115 recently episodic patients with bipolar disorder, the authors of the present study examined the construct validity of an observational coding system for both appropriate and inappropriate emotional involvement that permitted separate ratings for relatives' intrusiveness, self-sacrificing behaviors, and distress related to the patient's well-being. Findings support the measure's reliability and convergent validity and are moderately supportive of the measure's discriminant validity. Results also suggest that Camberwell Family Interview (C. E. Vaughn & J. P. Leff, 1976) EOI ratings do not discriminate among the different dimensions of the emotional involvement construct (or their appropriateness or inappropriateness) as revealed in laboratory-based interactions. The findings suggest that clinicians working with such families might consider differentiating among the various ways in which family members are involved with the patient and helping them learn to judge under what circumstances such involvement is appropriate and inappropriate.

Development and validation of an observational coding system for emotional overinvolvement

The present study investigated the reliability and construct validity of a behavioral observation coding system of emotional overinvolvement (EOI), an index of intrusive, excessively self-sacrificing, or exaggeratedly emotional behavior displayed by the relative of a psychiatric patient. Separate behavioral ratings of relatives' intrusiveness, excessive self-sacrifice, and exaggerated emotional response were generated from 10-min problem-solving interactions between adult outpatients with obsessive-compulsive disorder or panic disorder with agoraphobia and their relatives. The interrater reliability for the 3 scales was adequate to excellent, and the scales appeared to tap related, but distinct, aspects of the EOI construct. Results from a multitrait-multimethod matrix and a confirmatory factor analysis supported the measure's convergent validity but were equivocal with respect to its discriminant validity.

Partial response, nonresponse, and relapse with selective serotonin reuptake inhibitors in major depression: a survey of current "next-step" practices

BACKGROUND

Many patients treated for major depression require more than one antidepressant trial to achieve or sustain response. However, the literature provides few treatment algorithms or effectiveness studies that empirically support "next-step" options available to clinicians. We conducted a survey of psychiatrists and other medical specialists who treat depression to ascertain what clinicians actually do when faced with patients who suboptimally respond to an adequate course of selective serotonin reuptake inhibitor (SSRI) therapy.

METHOD

Attendees at a psychopharmacology course (N = 801) were queried about their top choices for antidepressant-treatment nonresponders: a minimal responder after 4 weeks of adequate SSRI treatment, a partial responder after 8 weeks of adequate SSRI therapy, a nonresponder after 8 weeks of adequate SSRI therapy, and a relapser on long-term SSRI maintenance therapy. Choices included raising the dose, augmenting or combining with another agent, switching to a second SSRI. or switching to a non-SSRI agent.

RESULTS

432 (54%) of the surveys were returned. Raising the dose was the most frequently reported next-step strategy for a patient with minimal response after 4 weeks of adequate SSRI therapy, partial response after 8 weeks of adequate SSRI therapy, and relapse on long-term SSRI therapy. Switching to a non-SSRI agent was the most frequently chosen option for nonresponders to an adequate trial of SSRI therapy.

CONCLUSION

Our findings suggest that clinicians select different next-step strategies when patients are nonresponders versus when patients are partial responders or relapsers.