Although common PTSD symptoms such as nightmares, disturbing memories, hyperarousal and insomnia do uniquely affect the service member, these symptoms can also negatively impact the spouse or significant other. This can lead to a worsening of the service member’s PTSD. And in turn, it can lead to a cascade of other problems such as substance abuse, depression, shame, and guilt.
How PTSD Affects Couples
PTSD symptoms can cause tremendous strain on relationships. Unpredictability in mood, anger outbursts, emotional withdrawal, and irritability are just a few ways PTSD can drive a wedge between the service member and his loved one.
If left unchecked, the spouse or significant other may develop their own emotional difficulties leading to increased fighting, resentment, and overall dissatisfaction with the relationship. In extreme cases, domestic violence may occur. Other downstream effects can include divorce, and the development of behavioral and emotional problems in children.
Historically, service members suffering from PTSD have been treated with individual methods such as exposure therapy, cognitive therapy, and medication. Any relationship problems were either referred for couple counseling, assumed to improve once the service member improved, or flat out neglected.
Fortunately, the tide has shifted and new methods for addressing relationship problems associated with PTSD are available.
Cognitive Behavioral Conjoint Therapy (CBCT) For PTSD
Cognitive Behavioral Conjoint Therapy—simply known as CBCT—is a relatively new talk therapy that addresses PTSD symptoms as well as improves relationship satisfaction. Developed by psychologist Candice Monson, CBCT is a time-limited couples therapy in which the primary goal of treatment is to reduce the service member’s PTSD symptoms while simultaneously improving the relationship.
Through a series of activities geared toward understanding the effects of PTSD, improving interpersonal communication and problem solving skills, and making sense of the traumatic event, the couple confronts the many challenges associated with this often disabling condition and learns how to manage future problems once therapy is over.
The Three Phases of CBCT
CBCT can be conceptualized as a three phase process.
Phase 1: In Phase 1, the therapist provides psychoeducation about PTSD. The simple process of explaining the common symptoms of the disorder and how they impact relationship functioning can be highly therapeutic for the couple, especially the loved one. This phase also teaches conflict resolution, effective communication, and promotes adaptive feelings and behaviors. The latter is accomplished through a variety of exercises.
Phase 2: Different behavioral techniques are employed in Phase 2. Specifically, through education and practical exercises, couples learn the importance of confronting feared situations, thoughts, and feelings. This is a key component of CBCT, as the hallmark of PTSD is avoidance of feared thoughts, feelings, situations, and other reminders of the past trauma, which in turn, maintains the symptoms. Avoidance applies to people as well, particularly loved ones. Instead of avoiding for the purpose of minimizing reminders of the trauma, the person avoids the spouse or significant other as a way to protect him or her from the details of the trauma. The avoidance also manifests as a result of a reduced inability to effectively communicate with the loved one.
Phase 3: Lastly, Phase 3 addresses cognitive appraisals—many of which are dysfunctional—that reinforce PTSD and the associated relationship discord.
What the Evidence Shows
CBCT has been shown to be effective in several research studies with civilians and veterans and their significant others. Anecdotal reports also indicate that it is well tolerated by those who receive the therapy.
This is important, as some treatments for PTSD can be distressing to the point where the individual drops out of treatment prematurely. This is a significant concern for prolonged exposure, which is one of the more popular individual treatments for PTSD.
PTSD is far from being a disorder of the individual. The often detrimental impact it has on intimate relationships has been known for quite awhile. Fortunately, we now have an effective way to care not only for those who have served in harm’s way, but for those who have made it possible for them to serve.
For more information on CBCT, visit www.coupletherapyforptsd.com/therapy. You may also find the book Cognitive-Behavioral Conjoint Therapy for PTSD: Harnessing the Healing Power of Relationships a useful resource.
*This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”
photo courtesy of Ian D. Keating on flickr