Strength at Home Couples Program (PTSD-Focused Relationship Enhancement Therapy for Returning Veterans)

The focus of this project is to produce a well-defined and standardized intervention, labeled
Strength at Home Couples Group, that can improve intimate relationship satisfaction, decrease
the likelihood of relationship aggression, increase the intimacy and closeness of the
relationship, and help with anger management. We hope to learn more about how to improve
relationships, how to prevent anger and violence, and about what factors help people
successfully complete treatment. Strength at Home Couples Group will incorporate components
of several interventions for PTSD and IPA and will target mechanisms implicated in the
PTSD-IPA association. The development of this type of integrated intervention is critical due
to high rates of PTSD-IPA co-occurrence and the pressing need to efficiently address both
problems among military veterans. Specific aims of this project are: (1) to develop and
standardize Strength at Home Couples Group for male combat veterans, including the
development of a clinician-friendly intervention manual detailing Strength at Home Couples
Group, along with intervention adherence measures and therapist training and certification
procedures; (2) to test the efficacy of Strength at Home Couples Group for OEF/OIF/OND
veterans by conducting a multiple site randomized trial comparing 10 sessions of Strength at
Home Couples Group to 10 sessions of a supportive group therapy (ST) condition; and (3) to
explore differences in compliance and process factors across conditions.

Inclusion Criteria:

- couples must have been in a committed relationship for at least six months

- veterans and their partners must be over the age of 18

- male members of the couple report no occurrence of physical aggression during the last
six months in their current relationship on the Revised Conflict Tactics Scale (CTS2;
Straus et al, 1996)

- female members of the couple may report that they have engaged in low level aggression
during the past six months in their current relationship on the Revised Conflict
Tactics Scale (CTS2; Straus et al., 1996)

- one partner of the couple averages at or below a score of 29 on the 6-item Quality of
Marriage Index (QMI; Norton, 1983) or a 100 or below on the Dyadic Adjustment Score
(DAS; Spanier, 1976), which are cutoff scores often used to distinguish distressed and
non-distressed couples (e.g., Slep, Heyman, Williams, Van Dyke, & O'Leary, 2006), or
one member of the couple endorses veteran-perpetrated psychological aggression
(defined as scoring above the 75%ile on the CTS2 minor psychological aggression
subscale, or any endorsement of items on the severe psychological aggression subscale
on the CTS2 or the Dominance/Intimidation scale of the Multidimensional Measure of
Emotional Abuse, MMEA; Murphy & Hoover, 1999;)

- both members of the couple provide research consent

Exclusion Criteria:

- reading difficulties prevent valid completion of the assessment instruments

- the participant evidences severe organicity or active psychosis

- the participant expresses prominent suicidal or homicidal ideation

- the participant meets diagnostic criteria for alcohol and/or drug dependence, if not
in early full remission or sustained partial remission

- female members of the couple report their violence includes the use of weapons during
the past six months in their current relationship on the Revised Conflict Tactics
Scale (CTS2; Straus et al., 1996)

- violence perpetrated by female members of the couple produces injuries in men

- male members of the couple indicate they are fearful of the female partner

- male members of the couple report they are physically violent in any way during the
past six months or severely violent in the past 12 months of their current
relationship on the Revised Conflict Tactics Scale (CTS2; Straus et al., 1996)

- male members of the couple have had any bruising or injuries inflicted by the female
partner during the past six months in their current relationship. Criteria b through d
will be assessed using the Mini-International Neuropsychiatric Interview (MINI;
Sheehan et al., 1998) and clinical interview