Effect Of Couple Cognitive-Behavioral Intervention When One Partner Suffers From Post-Traumatic Stress Disorder On Post-Traumatic Symptoms, Emotional Distress, Relationship Satisfaction and Violence

Many studies in Israel and worldwide point to the long-term effects of Post-Traumatic Stress Disorder (PTSD) on the individual, their relationships, and their immediate environment. These studies show that PTSD has a significant impact on couple's relationship, which is expressed, among other things, in a decrease in marital satisfaction and intimacy, alongside an increase in expressions of anger, criticism, and even violence toward the partner.

The current study focused on the effect of Cognitive Behavioral Conjoint Therapy (CBCT) (Monson et al., 2010) on post-traumatic symptoms, psychological distress, violence, and marital satisfaction among couples in which one partner suffers from PTSD. The basic premise of this intervention is that there are intrapersonal behavioral, cognitive, and emotional processes operating at the individual level, involving the trauma survivor, alongside dyadic-marital processes. These intrapersonal processes and dyadic-marital processes influence each other and shape individual and marital functioning. Therefore, this intervention aims to reduce the post-traumatic distress of the person with PTSD, the associated distress of the partner, and marital violence, and to improve marital relationships.

According to the research hypotheses, CBCT was expected to lead to a reduction in post-traumatic symptoms in the patient dealing with PTSD and in mental distress (somatization, depression, and anxiety) in both partners. It was also hypothesized that CBCT would lead to a decrease in the use of violence indicators by the patient dealing with PTSD toward the partner and result in an improvement in relationship satisfaction in both partners.

As part of a prospective, quantitative, Randomized Controlled Trial (RCT), 19 couples participated in the current study, with one partner diagnosed with PTSD. A total of 38 participants were included: 19 patients and 19 partners who were treated at the Cognitive Behavioral Therapy (CBT) Clinic for PTSD at Bar-Ilan University. Of the patients, 63.2% were male and 36.8% female (and their partners, respectively).

Participants completed self-report questionnaires during their participation in the study and underwent a clinical assessment that included structured interviews and physiological assessment. The treatment protocol consisted of 15 weekly sessions of 75-90 minutes and three assessment sessions (a total of 18 sessions). Data were collected at two time points: time point T1 - before the intervention began during the assessment phase, and time point T2 - at the end of the intervention after 15 therapy sessions. Each partner completed self-report questionnaires regarding psychological distress, violence, and relationship satisfaction, and the patient with PTSD also completed a questionnaire to examine post-traumatic symptoms.

The main findings showed that after participating in CBCT, there was a significant decrease in post-traumatic symptoms and psychological distress among patients dealing with PTSD, but no significant reduction in psychological distress among the partners. Contrary to expectations, no significant reduction was found in the violence index among patients dealing with PTSD toward their partners. Finally, a significant improvement was found in relationship satisfaction among the patients. However, a significant decrease in relationship satisfaction was found among the partners.

These findings shed light on the effects of CBCT as a couple intervention with the potential to improve personal, interpersonal, and marital functioning among couples, one of whom is dealing with PTSD. Nevertheless, the study findings mainly emphasized the potential contribution to the person dealing with PTSD themselves, while the benefits for the couple as a unit remain less clear. Hence, the study contributes to a deeper understanding of the relationships between the variables examined in light of participation in CBCT and the distinction between patients with PTSD and their partners. Additionally, it highlights aspects of the intervention that must be refined in order to lead to significant improvement among both partners in coping with the consequences of PTSD on daily life and on the personal, marital, and family functioning.