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, 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 the proposed grant is to examine the effects of a Mindfulness-Based Cognitive-Behavioral Conjoint Therapy for PTSD (MB-CBCT for PTSD) on PTSD symptoms and intimate relationship functioning of veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF-OIF). The proposed project involves two phases. In Phase 1, mindfulness interventions will be integrated within the Cognitive Behavioral Conjoint Therapy for PTSD treatment manual. The integrated intervention, MB-CBCT for PTSD, will be delivered to 10 OIF- OEF veterans and their intimate partners in order to develop and test procedures to train and monitor therapists. During Phase 2, a randomized controlled trial with 40 OEF-OIF veteran couples will be conducted comparing the MB-CBCT for PTSD with a control condition that teaches communication skills. We hypothesize that MB-CBCT for PTSD will lead to greater improvement in: 1) veterans'PTSD symptoms;2) veterans'and partners'relationship functioning;and 3) anxiety and depression symptoms. 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.
Project Narrative and Relevance to Veterans'Health PTSD constitutes a substantial proportion of the burden of illness among veterans. In a recent study of Operation Enduring and Iraqi Freedom (OEF-OIF) veterans seen at VA health care facilities between 2001 and 2005, PTSD was the most commonly diagnosed military service-related mental health diagnosis, accounting for more than half of the veterans receiving a mental health diagnosis and 13 percent of all OEF-OIF veterans in the study (Seal KH, et al., 2007). Although research has documented a relationship between PTSD and relationship functioning, few couples interventions have been developed and tested. Results of the proposed study will yield scientifically sound information for policy makers and clinicians, such as the kinds of clinical and rehabilitation benefits (reduced PTSD symptoms and improved relationship functioning) that can be expected from an integrated mindfulness and cognitive behavior therapy couples intervention. The proposed study will also produce procedures that may be exported to other settings, allowing for replication and further refinement.