Background, Rationale and Objectives: Posttraumatic stress disorder (PTSD) is highly prevalent in military and Veteran populations. Treatment engagement tends to be low due to perceived stigma and logistical barriers, and dropout rates with individual therapy are high. Importantly, effects of untreated or undertreated PTSD are not confined to the trauma survivor. PTSD can contribute to intimate relationship difficulties (e.g., relationship distress, intimate partner aggression, difficulties with conflict management and intimacy) and to partner psychological distress, the effects of which ripple outward to the larger family, negatively affecting parenting and military child adjustment. Aspects of trauma survivors’ intimate relationships can also help or interfere with recovery from PTSD. Besides its negative impact on PTSD recovery, relationship distress is also a leading contributor to both military attrition and suicide risk. Couple-based approaches to the treatment of PTSD offer great potential to better address these complex problems as they strive to treat PTSD and enhance relationships at the same time. However, the length of existing couple-based PTSD treatments (e.g., 15 sessions delivered weekly to individual couples over 4-5 months) makes it difficult for many couples to undertake and complete a full course of treatment; it also presents challenges for large-scale dissemination within the Military Health System and VA. To address these limitations, we piloted a brief version of cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD) in which the treatment was delivered over 2 days to multiple couples at the same time using a retreat workshop format. This compressed format decreased many of the logistical barriers that make it hard for couples to participate in and complete the 15-session version of CBCT for PTSD while capturing a majority of the benefits of the original therapy format. These included improvements in Service Members’ and Veterans’ PTSD and related symptoms (depression, anxiety, anger), partners’ psychological well-being, and couples’ relationship adjustment. The goal of the proposed study is to test the abbreviated, intensive, multi-couple group format of CBCT for PTSD (AIM-CBCT for PTSD) as a standalone treatment for PTSD in military and Veteran couples in a larger sample (120 couples) in which it is compared to another intervention that also involves couples going away together to work on their relationships. The comparison condition is the Prevention and Relationship Enhancement Program (PREP). PREP is a well-established, multi-couple, group- based general relationship education program that has been adapted for military couples and widely disseminated within the DoD in a weekend workshop format through the Army Chaplain Corps. Prior research with PREP has shown that it is associated with some improvements in participants’ mental health, in addition to improvements in their relationships. The current study will test the efficacy of AIM-CBCT for PTSD in comparison to PREP in (1) treating PTSD, (2) treating comorbid symptoms, (3) improving partner psychological distress, and (4) improving both partners’ relationship satisfaction.

FY21 TBIPHRP CTA Focus Area to Be Addressed: The proposed project is directly relevant to the Treat TBIPHRP Clinical Trial Award Focus Area. It will target immediate and long-term improvements in PTSD in active-duty military personnel and Veterans by addressing “access to and delivery of healthcare services, including length and durability of treatment.” The proposed intervention is designed to promote functional recovery and improve long-term outcomes by including family members – specifically, romantic partners – in an efficient treatment for PTSD that can be delivered over just 2 days.

Clinical Applications, Risks, and Benefits: Potential risks to participants are minimal and include mild, temporary increases in emotional distress related to discussing the impact of exposure to traumatic events and relationship difficulties. Anticipated benefits are tremendous. Participants are expected to experience improvements in both their individual and relational well-being resulting from reductions in Service Members’ and Veterans’ PTSD and related symptoms, decreases in partners’ psychological distress, and increases in couples’ relationship satisfaction. For clinicians, the therapy’s condensed, group-delivery format maximizes provider time and availability to serve a larger number of military and veteran families in need. If the proposed research proves successful, AIM-CBCT for PTSD has the potential to be quickly scaled up within the Military Health System as an alternative standalone treatment for PTSD with broader treatment effects, which in turn can improve access to care for PTSD and services for military families. Considering the impact of mental health problems and relationship distress on military families, on suicide risk, and on attrition from the military, an efficient, effective, and broadly accessible therapy that treats both problems simultaneously can be expected in the long term to support and help maintain a strong and effective military force.