Effects of Mindfulness-Based Cognitive-Behavioral Conjoint Therapy on PTSD and Relationship Function
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/3/2018 |
| Start Date: | July 1, 2010 |
| End Date: | December 31, 2014 |
The purpose of this study is to first adapt Cognitive Behavioral Conjoint Therapy for PTSD
for Operation Enduring Freedom and Operation Iraqi Freedom (OEF-OIF) Veterans diagnosed with
PTSD and their intimate partners by (1) reducing the overall length of treatment from 15
weeks to 10 weeks through the use of a weekend couple retreat to deliver the first two of
three phases of the three-phase protocol; and (2) by integrating mindfulness interventions as
a way to mitigate the short, more condensed treatment. Secondly, this study will examine the
effects of this adapted Mindfulness-Based Cognitive-Behavioral Conjoint Therapy on PTSD
symptoms and intimate relationship functioning.
for Operation Enduring Freedom and Operation Iraqi Freedom (OEF-OIF) Veterans diagnosed with
PTSD and their intimate partners by (1) reducing the overall length of treatment from 15
weeks to 10 weeks through the use of a weekend couple retreat to deliver the first two of
three phases of the three-phase protocol; and (2) by integrating mindfulness interventions as
a way to mitigate the short, more condensed treatment. Secondly, this study will examine the
effects of this adapted Mindfulness-Based Cognitive-Behavioral Conjoint Therapy on PTSD
symptoms and intimate relationship functioning.
Between 5 and 15 percent of Veterans return from deployment in Iraq and Afghanistan with PTSD
and the symptoms adversely affect many aspects of their lives, including intimate
relationships. Although research findings consistently suggest that the degree of intimate
relationship dysfunction correlates with the severity of Veteran's PTSD symptoms, few couples
interventions have been developed and systematically evaluated. Cognitive Behavioral Conjoint
Therapy for PTSD (CBCT for PTSD) is an intervention developed to treat both PTSD and
relationship dysfunction that has shown promising preliminary results. However, the
literature suggests that OEF-OIF Veterans prefer shorter time-limited treatments and CBCT for
PTSD requires as many as 15 sessions. CBCT for PTSD lacks specific interventions that train
meta-awareness, such as those taught in mindfulness-based stress reduction (MBSR).
Mindfulness practices have an emerging evidence base for improving both PTSD and relationship
functioning in several important ways. First, practicing mindfulness promotes the relaxation
response which counters hyperarousal and results in a calmer approach to difficulties and
challenges. Second, avoidance and numbing are countered by mindfully allowing one's
experience to be as it is while suspending judgment, which is associated with increased
compassion and empathy. Lastly, mindfulness supports a way of being with all life experiences
rather than providing techniques just for coping with specific difficulties, which enables
individuals to access inner strengths that are already available to them. Just as many
physical conditions require more than one rehabilitation approach, there may be a synergy
between CBCT for PTSD and mindfulness interventions. Mindfulness skills may assist
individuals in tolerating painful emotional reactions to their experiences which may in turn
enhance their awareness of associated feelings and thoughts. With enhanced meta-awareness the
beliefs that may maintain PTSD symptoms and relationship dysfunction become more amenable to
cognitive restructuring. Therefore, the goal of this study is to examine the effects of a
Mindfulness-Based adaptation of CBCT for PTSD. The study involves two phases over the course
of four years. In Phase 1, mindfulness interventions will be integrated within the Cognitive
Behavioral Conjoint Therapy for PTSD treatment manual and the content of the first 7 sessions
of CBCT will be adapted to be delivered during a weekend retreat. The integrated
intervention, MB-CBCT for PTSD, will be delivered to 10 OIF-OEF Veterans and each of their
intimate partners in order to develop and test procedures to train and monitor therapists.
During Phase 2, 40 OEF-OIF Veterans and each of their intimate partners will be consented and
a randomized controlled trial with be conducted comparing the MB-CBCT for PTSD with a control
condition that teaches communication skills drawn from the first 7 sessions of the CBCT
manual. We hypothesize that MB-CBCT for PTSD will lead to greater improvement in: 1)
Veterans' PTSD symptoms as measured by the Clinician Administered PTSD Scale (primary
outcome) and PTSD Checklist (secondary outcome); 2) Veterans' and partners' relationship
functioning (secondary outcome); and 3) anxiety and depression symptoms (secondary outcomes).
PTSD constitutes a substantial proportion of the burden of illness among Veterans. The longer
term goals of this project are to conduct a fully-powered randomized controlled clinical
trial of MB-CBCT to determine its effectiveness and to finalize the treatment manual.
and the symptoms adversely affect many aspects of their lives, including intimate
relationships. Although research findings consistently suggest that the degree of intimate
relationship dysfunction correlates with the severity of Veteran's PTSD symptoms, few couples
interventions have been developed and systematically evaluated. Cognitive Behavioral Conjoint
Therapy for PTSD (CBCT for PTSD) is an intervention developed to treat both PTSD and
relationship dysfunction that has shown promising preliminary results. However, the
literature suggests that OEF-OIF Veterans prefer shorter time-limited treatments and CBCT for
PTSD requires as many as 15 sessions. CBCT for PTSD lacks specific interventions that train
meta-awareness, such as those taught in mindfulness-based stress reduction (MBSR).
Mindfulness practices have an emerging evidence base for improving both PTSD and relationship
functioning in several important ways. First, practicing mindfulness promotes the relaxation
response which counters hyperarousal and results in a calmer approach to difficulties and
challenges. Second, avoidance and numbing are countered by mindfully allowing one's
experience to be as it is while suspending judgment, which is associated with increased
compassion and empathy. Lastly, mindfulness supports a way of being with all life experiences
rather than providing techniques just for coping with specific difficulties, which enables
individuals to access inner strengths that are already available to them. Just as many
physical conditions require more than one rehabilitation approach, there may be a synergy
between CBCT for PTSD and mindfulness interventions. Mindfulness skills may assist
individuals in tolerating painful emotional reactions to their experiences which may in turn
enhance their awareness of associated feelings and thoughts. With enhanced meta-awareness the
beliefs that may maintain PTSD symptoms and relationship dysfunction become more amenable to
cognitive restructuring. Therefore, the goal of this study is to examine the effects of a
Mindfulness-Based adaptation of CBCT for PTSD. The study involves two phases over the course
of four years. In Phase 1, mindfulness interventions will be integrated within the Cognitive
Behavioral Conjoint Therapy for PTSD treatment manual and the content of the first 7 sessions
of CBCT will be adapted to be delivered during a weekend retreat. The integrated
intervention, MB-CBCT for PTSD, will be delivered to 10 OIF-OEF Veterans and each of their
intimate partners in order to develop and test procedures to train and monitor therapists.
During Phase 2, 40 OEF-OIF Veterans and each of their intimate partners will be consented and
a randomized controlled trial with be conducted comparing the MB-CBCT for PTSD with a control
condition that teaches communication skills drawn from the first 7 sessions of the CBCT
manual. We hypothesize that MB-CBCT for PTSD will lead to greater improvement in: 1)
Veterans' PTSD symptoms as measured by the Clinician Administered PTSD Scale (primary
outcome) and PTSD Checklist (secondary outcome); 2) Veterans' and partners' relationship
functioning (secondary outcome); and 3) anxiety and depression symptoms (secondary outcomes).
PTSD constitutes a substantial proportion of the burden of illness among Veterans. The longer
term goals of this project are to conduct a fully-powered randomized controlled clinical
trial of MB-CBCT to determine its effectiveness and to finalize the treatment manual.
Inclusion Criteria:
Veteran must:
- be enrolled in outpatient treatment
- have a confirmed diagnosis of PTSD
- have no major change in psychiatric medication for at least 1 month
- have a partner mutually committed to maintaining the relationship for the duration of
the intervention
- willing to forgo initiating psychotherapy for PTSD or other conditions during the
study
Exclusion Criteria:
- severe physical or sexual relationship aggression in the past year
- current suicidal/homicidal intent (Veteran or partner)
- cognitive impairment that precludes understanding session content (either Veteran or
partner)
- current substance dependence of Veteran or partner
- uncontrolled psychotic or bipolar disorder in Veteran or partner
- PTSD diagnosis in the partner
- self-mutilation or self-injury within the previous 6 months by Veteran or partner
- unwilling to have therapy or CAPS sessions video or audio recorded
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