Individual PE vs Couples' CBT for Combat-Related Posttraumatic Stress Disorder

The purpose of the proposed study is to examine the effects of Cognitive-Behavioral
treatments for PTSD on PTSD symptoms and relationship functioning in active duty military
personnel who have recently returned from combat deployment to Operation Enduring Freedom
(OEF), Operation Iraqi Freedom (OIF), or Operation New Dawn (OND) and their partners.
Research indicates that PTSD is associated with high levels of relationship distress [8-12].
We will compare a treatment specifically designed to incorporate partners,
Cognitive-Behavioral Couples Therapy (CBCT), with an established therapy that focuses on
treatment of the individual, Prolonged Exposure (PE). CBCT includes techniques designed both
to promote support for the traumatized individual and reduce relationship distress; whereas,
PE focuses solely on PTSD symptoms and treats only the patient with PTSD. Therefore, we
expect to see greater improvement in intimate relationship functioning with CBCT than with
PE, while remaining equally effective in reducing PTSD symptomatology. Our specific
hypotheses are as follows:

1. Cognitive-Behavioral Couples Therapy (CBCT) and Prolonged Exposure (PE) will be equally
effective in reducing PTSD symptoms in a sample of OEF/OIF/OND Veterans, as measured by
the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist -
Stressor Specific Version (PCL-S).

2. CBCT for PTSD will be more effective than PE in improving relationship distress in a
sample of OEF/OIF/OND Veterans and their partners, as measured by the Dyadic Adjustment
Scale.

3. CBCT for PTSD will have significantly greater impact than PE on measures of
relationship functioning (e.g., intimacy, conflict, aggression) in a sample of
OEF/OIF/OND Veterans and their partners.

Inclusion Criteria:

- • Married or cohabitating couples who have been together the past 3 months in which
one partner is an OEF/OIF/OND veteran with PTSD. Diagnosis of PTSD will be determined
by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). The veteran with PTSD
must have experienced a Criterion A event that is a specific combat-related event or
high magnitude operational experience that occurred during a military deployment in
support of OIF/OEF/OND. The diagnosis of PTSD may be indexed to that event or to
another Criterion A event.

- Both individuals must be willing to make a commitment to treatment as prescribed
by their randomization in this study.

- Speak and read English.

- Be stable for at least 6 weeks on any psychotropic medications either partner
may be taking. This criterion is established in order to minimize the likelihood
that significant outcome effects may be attributed to changes in psychotropic
medications rather than to the treatment protocol.

Exclusion Criteria:

- • Evidence or admission of severe intimate aggression as indicated by a "yes"
endorsement to the one-question screen for severe violence items by either member of
the couple occurring within the past 6-months.

- Partner with PTSD symptoms on the Life Events Checklist (LEC), Deployment Risk
and Resilience Inventory (DRRI) subscales (if active duty and is a Veteran of
deployment), and PTSD CheckList - Stressor Specific (PCL-S) warranting primary
treatment for him or herself.

- Recent initiation of other treatment (i.e., drug/alcohol treatment) or an
identified immediate need for other treatment (i.e., severe suicide risk,
current alcohol dependence).

- Current suicidal ideation severe enough to warrant immediate attention (as
determined by the Scale for Suicidal Ideation)

- Alcohol dependence as assessed using the Alcohol Use Disorders Identification
Test (AUDIT).

- Any severe cognitive impairment that precludes retention of session content
across sessions or an ongoing psychotic or bipolar disorder.