Accelerated Treatment for Co-occurring Insomnia, Nightmares, and PTSD

Aug 24, 2023

An estimated 20% of military service members suffer from clinically significant insomnia, 20% from nightmares, and 15% from posttraumatic stress disorder (PTSD). These disorders are highly interrelated, as they commonly occur together and can each worsen symptoms of the others and make them more difficult to treat.

When these conditions become chronic, they can impair both physical and psychological health and decrease quality of life. Therefore, effective and efficient treatments are sorely needed to help hundreds of thousands of affected service members. Fortunately, there are evidence-based treatments for all three conditions. Unfortunately, these treatments typically focus on one of the disorders and do not specifically address the interplay of vexing comorbidities. Addressing all three conditions, then, typically requires separate individual treatments in succession. That can take months to complete, causing discouragement, interfering with personal and military schedules, and otherwise leading to high patient drop-out rates.

Proposing a faster, three-pronged treatment approach

After previous success in using condensed approaches to deliver evidence-based therapy for PTSD, STRONG STAR investigators have developed a research study to evaluate an accelerated treatment method that integrates front-line therapies for co-occurring insomnia, nightmares, and PTSD.

The study is led by Carmen McLean, PhD, with the VA’s National Center for PTSD and Stanford University. It will begin with a pilot study in San Antonio involving service members at Wilford Hall Ambulatory Surgical Center and, based on the pilot study’s success, move on to a full-scale randomized clinical trial (RCT).

All participants will receive Written Exposure Therapy for PTSD, also known as WET. This brief, five-session treatment was shown in a previous STRONG STAR trial to be as effective as a longer, gold-standard treatment for PTSD in military service members.

Concurrently, participants will receive one of two sleep interventions. Half will receive education in good sleep hygiene, which involves establishing a sleep environment and sleep behaviors that are conducive to good sleep in both quantity and quality. The other half will receive an accelerated form of Cognitive-Behavioral Therapy for Insomnia and Nightmares, known as CBTi+n. CBTi+n was developed as a way to combine separate, evidence-based treatment approaches for insomnia and nightmares. The combined therapy has shown promise in initial clinical trials where it was delivered once weekly for six weeks.

The pilot study for this project will evaluate the conjoint delivery of WET and CBTi+n and the optimal schedule for an accelerated treatment format. Based on the success of the pilot study, investigators aim to develop a large RCT to determine the treatment’s efficacy. Their primary aim is to examine how well cognitive-behavioral treatment for insomnia and nightmares reduces sleep problems when integrated with PTSD treatment and delivered in an accelerated treatment format. They also want to explore the impact of the added sleep treatment on PTSD symptoms.

Expected benefits

If CBTi+n integrated with WET in an accelerated treatment format is found efficacious, it could be broadly disseminated throughout the military health system and make it easier for service members to seek and complete treatment for—and potentially recover from—co-occurring PTSD, insomnia, and nightmares. This could greatly benefit the mental and physical health and quality of life for individual military personnel and positively impact military readiness. The same treatment method likewise could be well utilized by VA and civilian providers to help veterans and members of the general public who suffer from the same conditions. In addition, this novel treatment approach could serve as an implementation model for addressing other psychological health disorders in service members, veterans, and civilian populations.

An Effectiveness-Implementation Trial of Functional Restoration for Chronic Pain Management in Active Duty Military Personnel

Aug 11, 2023

Chronic pain has a major detrimental effect on operational readiness across all branches of the U.S. military and is the single greatest condition related to medical disability within the U.S. Department of Veterans Affairs.

Although there are several effective, evidence-based treatments for acute pain such as medications, injections, devices, and surgeries, most of them are not similarly effective for chronic pain. In addition, the military has been seeking alternatives to opioid medications, a mainstay of treatment, due to increasing rates of addiction and negative side effects.

Interdisciplinary, multicomponent, functional restoration programs (FRPs) targeting the biological, behavioral, psychological, and social aspects of chronic pain are the evidence-based treatments with the strongest scientific support for chronic pain management. FRPs use a rehabilitation model designed to increase physical functioning, improve pain coping skills, and increase the opportunity to return to work.

However, it has been difficult to achieve widespread implementation of these programs in the Military Health System (MHS), because the establishment of an FRP is clinically and administratively complex and very different from routine chronic pain management practices.

Working to bring effective chronic pain management to military clinics

Addressing the need for effective chronic pain management, STRONG STAR investigators have launched a project to accelerate the implementation of FPRs across the MHS, doing so under the leadership of partnering principal investigators by Alan Peterson, PhD (Lt Col, USAF Ret.), of The University of Texas Health Science Center at San Antonio and Katherine Comtois, PhD, of the University of Washington.

The study is an extension of two successful randomized clinical trials (RCTs) conducted by STRONG STAR researchers to evaluate an FRP called Functional and Occupational Rehabilitation for Troops (FORT). Investigators will test the effectiveness of FORT with active duty military personnel with chronic pain at six MHS clinics nationwide, where they also will test a strategy designed to promote implementation of this treatment approach at the six clinics.

How the program works

FORT includes education about chronic pain, relaxation, and stress management; cognitive and behavioral therapies designed to improve pain coping and increase physical activity; individually tailored and gradually increasing physical and occupational therapy exercises; strategies for activity pacing and functional activation; and specialized modules for addressing pain-related concerns such as stigma, depression, and insomnia.

Some patients in the study will receive FORT plus the established treatment as usual for chronic pain. Their progress will be compared to another group that simply receives treatment as usual.

Aspects of FORT implementation that the team plans to develop at the military treatment facilities include establishment of support from clinical and administrative leadership, allocation of clinical space and personnel, use of effective criteria for screening patients, commitment of sufficient time for clinical treatment, and use of complementary and integrative medicine approaches. They later will assess for the extent that those elements have been adopted at the military clinics, along with the number of FORT programs offered per year.

Expected benefits

This research potentially could provide an effective way to implement improved treatment for chronic pain, help more affected service members maintain their careers, improve operational readiness, and decrease military and VA costs associated with military separation due to pain-related disability.

Project MARCH: Multisite Advancement of Research on Chronic Posttraumatic Headache

Jul 24, 2023

Nearly 3 million U.S. service members have deployed since 9/11, with up to 690,000 estimated to have suffered a traumatic brain injury (TBI). Posttraumatic headache (PTH), or headache onset or worsening after a head or neck injury, is the most common and disabling symptom from TBI. Other co-occurring conditions, such as posttraumatic stress disorder (PTSD), also can compound or even cause headaches. A national study showed chronic PTH (lasting more than 3 months) among 60%-65% of veterans with service-related TBI. Other studies have shown high unemployment rates and decreased activity levels in this population even 10 years after injury.

Non-medication treatments are needed
However, military PTH is poorly understood, with little guidance from research on how to manage it effectively. Due to its similarity to migraines, PTH is typically treated with the same types of medications. However, medication does not cure PTH, and overuse can worsen it, while side effects cause many to avoid or discontinue their use. And since medications do not address contributing factors like PTSD, there is great need for non-medication treatments for co-occurring psychological problems.

A promising non-medication intervention
In the first large, randomized clinical trial for military-related headache, a group of investigators showed success with a manualized, multi-component, cognitive-behavioral therapy for migraine headache adapted specifically for military PTH. The research team led by Donald McGeary, PhD, of The University of Texas Health Science Center at San Antonio, used a treatment called Combined Cognitive-Behavioral Therapy for PTH. It led to significant, lasting improvement in PTH and related disability in veterans who had PTH and PTSD symptoms and was as effective as a top PTSD therapy in reducing PTSD symptoms. By comparison, veterans receiving treatment as usual at a U.S. Department of Veterans Affairs (VA) polytrauma center showed no significant improvement in disability.

Building on success of previous trial
Dr. McGeary’s group has designed a STRONG STAR-affiliated study to build on that success. The group will enroll 525 participants from clinics at seven VA and U.S. Department of Defense sites nationwide. Military personnel and veterans who have chronic PTH with or without PTSD will be assigned randomly to one of three treatment arms: Combined Cognitive-Behavioral Therapy (CCBT), Telemedicine-Based Combined Cognitive-Behavioral Therapy (TCBT), or treatment as usual. That will allow investigators to compare CCBT and TCBT to treatment as usual among patients with diverse demographics, trauma and headache histories, and comorbidities and when delivered in different military and VA settings. It also will provide evidence about the therapy’s efficacy when delivered via telehealth, compared to in-person in a clinic. The research group will include Co-Principal Investigator Blessen Eapen, MD, chief of Physical Medicine & Rehabilitation at the Greater Los Angeles Veterans Health Care System, who has extensive experience in military trauma research.

Potential relief for thousands
If successful, this study will provide a needed evidence-based, non-medication treatment for reducing PTH and PTSD symptoms and disability that can be widely disseminated in military and VA facilities to a diversity of patients. Validation of the treatment via telehealth would further expand access at smaller or more remote locations. CCBT and TCBT potentially could improve the lives of hundreds of thousands of service members and veterans, boost military readiness, and reduce military and VA disability costs. With the high prevalence of PTH in civilians, the treatment also could benefit the general public.

Pilot Study of Brain Stimulation Combined with Writing Therapy for PTSD

Jul 01, 2023

Symptoms of posttraumatic stress disorder (PTSD) include intrusive memories about the event, physiological hyperarousal such as always being on edge, sleep problems, and negative effect on a person’s mood and thoughts. All of this can have significant, long-term effects on health and functioning.

Evidence-based psychotherapies can help many patients, but there remains room for improvement, as too many patients do not significantly improve following treatment.

New approaches to treatment could help more people to recover from trauma.

The field of non-invasive brain stimulation is rapidly gaining attention as a potential treatment for PTSD based on its ability to restore healthy activity in regions of the brain associated with PTSD and its treatment.

Research is needed to determine the safety, feasibility, and benefits of non-invasive brain stimulation for those with PTSD. Toward that end, a STRONG STAR-affiliated research team led by Casey Straud, PsyD, a faculty member at The University of Texas Health Science Center at San Antonio, will conduct a randomized controlled pilot study of transcranial direct current stimulation (tDCS) vs. a placebo.

How the study and treatment will work

The study will involve 40 adults with PTSD receiving five weekly sessions of Written Exposure Therapy (WET), an evidence-based, behavioral psychotherapy for PTSD. By random assignment, half also will receive tDCS, while half will receive a placebo treatment that only appears to be administering tDCS. Study participants will include military veterans and non-veteran civilians in the San Antonio area who are seeking treatment for PTSD.

WET involves patients writing about their trauma and then discussing the written narrative with a therapist. In this study, patients will receive tDCS or placebo during the writing part of the therapy session, via electrodes secured to the head with elastic bands. During stimulation, a mild current flows between the electrodes passing through the brain to complete the circuit. The current is believed to enhance the resting potential of neurons that typically are overly active in brains of PTSD patients.

The study team also will monitor physical responses to stress via devices placed on the non-writing hand to measure heart rate and sweat production.

Pilot study expectations

The investigators believe that the study will show that tDCS is safe and compatible with WET, and that WET plus tDCS will result in greater reductions in PTSD symptoms than WET plus placebo. If successful, the pilot study could provide rationale for a larger study in the effort to add more treatment options for individuals with PTSD.

Assessment and Treatment of Chronic Anger and Aggression Following Military-Related Interpersonal and Institutional Betrayal: A Pilot Investigation

Mar 20, 2023

Difficulty controlling anger is the most commonly reported problem that military service members and veterans report upon reintegration after deployment. Research shows that more than half of veterans using VA services report problems controlling anger. This results in legal, employment, social interaction, or relationship problems for many veterans. Chronic, unmanaged anger can lead to aggression, interpersonal violence, and suicidal thoughts.

Chronic hostility, anger, and aggression are common after a person experiences betrayal betrayal. More than one fourth of service members and combat veterans report experiencing events involving military-related betrayal, either by the military or individuals during military service, including loved ones.

Seeing a need for an intervention to address anger and aggression in active duty military personnel, STRONG STAR investigators have designed a pilot study to test a treatment that directly targets reducing chronic anger and aggression and improving interpersonal relationships. The treatment, Countering Chronic Anger and Aggression Related to Trauma and Transgressions (CART), will focus on helping service members heal after transgressions they have suffered.

How the program works

CART will combine evidence-based anger regulation and interpersonal effectiveness skills with betrayal-focused processing. This might include such things as making meaning of betrayal, letting go of ineffective resentment, and finding purpose after betrayal. The study will prominently include promotion of forgiveness and compassion for self and others as a way to reduce anger and improve interpersonal functioning. Forgiveness and compassion-focused interventions have been found to be effective in prior research, but this has not yet been tested in a military population.

The research team has worked to fine-tune the intervention by consulting with service members, military leaders, and key military-serving providers to ensure that the treatment approach aligns with military culture.

Led by Initiating Principal Investigator (PI) Vanessa Jacoby, PhD, and Partnering PI Alan Peterson, PhD (Lt Col, USAF, Ret.), of The University of Texas Health Science Center at San Antonio, the team will recruit participants from the Fort Hood area in Killeen, TX, including mental health clinics where STRONG STAR has ongoing and well-established relationships.

A four-phased approach

The CART intervention is heavily based on an approach called the Process Model of Forgiveness. Using this model, the intervention is divided into four phases to guide patients through the process of forgiveness:

Developing motivation for change by exploring the benefits of forgiveness and negative impact of holding onto anger or resentment
Making the decision to work toward forgiveness
Building skills of empathy and compassion to reduce anger and find peace, and
Exploring the emotional freedom one has gained by putting down the burden of chronic anger.

Expected benefits

The research team believes that participants will experience significant reductions in the frequency and intensity of distressing anger, psychological aggression, and physical aggression, as well as improvements in their interpersonal functioning.

Written Exposure Therapy for Suicide Prevention: A Randomized Clinical Trial

Feb 06, 2023

Military personnel admitted to inpatient psychiatry for self-injurious thoughts and behaviors (SITBs) represent an at-risk group for continued SITBs and rehospitalizations following discharge. However, there is an absence of evidence-based interventions designed to be delivered on inpatient psychiatric units to reduce the risk of post-discharge SITBs.

To address this need, STRONG STAR investigators have developed Written Exposure Therapy for Suicide Prevention (WET-SP), a brief, suicide-specific psychotherapy based on Written Exposure Therapy, in which an individual writes about a personally stressful experience and the related thoughts and feelings. WET has shown to be effective in improving mental and physical health, and data from pilot study research suggests that it also helps to reduce SITBs.

However, no study has adapted WET-SP specifically to target distress associated with suicidal crises and examined whether the intervention reduces risk of subsequent SITBs and suicide-related hospitalizations.

Testing the therapy at a military hospital

STRONG STAR investigators led by Brian Marx, PhD, with VA’s National Center for PTSD and Boston University School of Medicine, will address that research gap with a study involving 124 patients admitted for acute psychiatric care at Carl R. Darnall Army Medical Center at Fort Hood, TX. Half will be randomly assigned to receive WET-SP delivered by the study team, plus the psychiatric unit’s treatment as usual (TAU). The other half will be assigned simply to receive TAU, which includes daily contact and patient-centered care delivered by the acute psychiatric unit provider team. TAU also includes psychiatric assessment, initial stabilization, nurse case management, medication management, treatment of medical comorbidities, group and individual therapy, and discharge planning.

Assessments to measure the outcomes for both groups of patients will be administered at pretreatment, posttreatment, and 10-, 20-, and 30-week follow-ups. The investigators also will explore whether a computerized analysis of the narrative content of WET-SP can predict which patients will benefit from the treatment.

Expected benefits

If WET-SP demonstrates success, it will address a critical healthcare crisis by reducing suicidal ideation and preventing post-discharge suicidal behaviors and rehospitalization for suicide-related concerns.

Although WET-SP must be delivered by a clinician, it is easy to train, offering a relatively low-cost yet high-yield therapeutic approach for military settings.

Decreasing Suicide Risk among Service Members with Posttraumatic Stress Using Written Exposure Therapy

Mar 01, 2022

Military service members and veterans have high rates of posttraumatic stress disorder (PTSD) and suicidal behavior. And PTSD more than doubles the likelihood that they will attempt suicide, researchers have reported.

Although evidence-based treatments for PTSD have been shown to reduce suicidal thinking, it is challenging to provide these therapies to high-risk patients hospitalized for acute care in military facilities. That is because the treatments require more time and resources than are typically afforded during inpatient stays.

Evaluating a therapy delivered in five sessions

A new STRONG STAR-affiliated study will test a therapy that the study team believes will reduce severity of posttraumatic stress symptoms and decrease suicide risk with only five sessions. They will evaluate an intervention called Written Exposure Therapy for Suicide (WET-S), which involves the patient writing about the same trauma experience during multiple sessions.

Brian P. Marx, PhD, deputy director of the Behavioral Science Division of the National Center for PTSD at the VA Boston Healthcare System, will lead the study at the Carl R. Darnall Army Medical Center at Fort Hood, Texas. His research team will work with consenting patients who are hospitalized for suicidal thoughts, suicide plan, or suicide attempt, who also have PTSD or symptoms of posttraumatic stress. A total of 124 patients will be randomly assigned either to “treatment as usual (TAU)” or WET-S plus TAU.

TAU consists of daily contact and patient-centered care by an acute psychiatric inpatient unit provider team that includes psychiatrists, therapists, case managers, and behavioral health technicians. TAU also involves initial psychiatric stabilization, nurse case management, medication management, psychoeducation groups, and discharge planning.

Writing about the “index trauma”

WET-S consists of five private treatment sessions, each lasting approximately one hour. During the first session, the therapist educates the patient about common reactions to trauma and the rationale for WET-S as a treatment for PTSD. Then the patient receives instructions for completing the written trauma narratives and completes the first narrative writing session. For each of the five sessions, the patient writes about the “index trauma” – the traumatic event that is deemed to be the worst by the patient and an independent assessor. Patients will receive at least one session per day.

Benefits of the therapy and future impact

Previous research found Written Exposure Therapy (WET) for PTSD to be comparable to other evidence-based treatments, with data also indicating that it helped to reduce suicidal thinking. WET-S is a reformulation of WET that adds a suicide prevention strategy called Crisis Response Planning (CRS). WET-S addresses trauma-related symptoms that are both targets for PTSD treatment and warning signs for suicidal thoughts and behaviors.

The therapy is brief and easy to administer. It also requires fewer resources and less training for the mental health provider than treatments currently used with at-risk patients in military settings. If found to be effective, WET-S could be scaled up and disseminated easily across the Department of Defense to reduce suicidal behavior among service members and veterans.

Two-Armed Pilot Randomized Controlled Trial of Massed Prolonged Exposure Plus Cannabidiol or Placebo for Posttraumatic Stress Disorder

Feb 24, 2022

Up to 20 percent of U.S. military service members who have deployed since Sept. 11, 2001, suffer from posttraumatic stress disorder (PTSD). While evidence-based treatments for PTSD are available, combat-related PTSD is more difficult to treat than cases found in the civilian population. Because of the great need to heal the psychological traumatic injuries incurred by our war fighters, researchers are engaged in ongoing efforts to improve treatments.

Recent research suggests that cannabidiol (CBD), a substance derived from the cannabis plant, may help to regulate brain functions that have become dysregulated due to trauma exposure. CBD interacts with a brain component known as the endocannabinoid system and already is approved by the U.S. Food and Drug Administration (FDA) for treating seizure disorders.

Early evidence also suggests that CBD can help to relieve pain, reduce anxiety and depression, and enhance learning. CBD may also help individuals recover from traumatic events by reducing anxiety and increasing their ability to talk about and make sense of painful memories, two key components of Prolonged Exposure (PE), a leading therapy for PTSD.

Pilot study evaluates combined impact of CBD and behavior therapy

This STRONG STAR-affiliated pilot study led by principal investigator Casey Straud, PsyD, of The University of Texas Health Science Center at San Antonio, will evaluate the potential benefits of administering either CBD or a placebo to a group of 24 patients receiving PE. Their therapy will be in the form of Massed PE, which involves patients receiving daily therapy sessions for 10 days, rather than the standard PE, in which patients receive weekly sessions over the course of a few months.

Twelve of the patients will receive Epidiolex, an FDA-approved, pharmaceutical-grade medication with CBD as its only active component. The other 12 will receive a placebo.

Expected impact

The investigators hypothesize that those receiving CBD will have greater symptom reductions than those in the placebo condition. In addition, they expect that the patients taking CBD will have lower average heart rates during therapy sessions, higher levels of critical biomarkers associated with stress reduction and lower levels of cortisol, a hormone that increases in response to stress. They predict that those measurable physical differences will be associated with improved PTSD symptom reductions.

Any positive findings have the potential to improve PTSD outcomes for service members and veterans and expand understanding of the relationship between PTSD, CBD, and the endocannabinoid system.

Targeting Chronic Pain in Military Primary Care Settings Using Internal Behavioral Health Consultants

Feb 15, 2022

Chronic pain is one of the most common and disabling conditions in U.S. military service members and their beneficiaries, and it is the leading cause of discharge from military service. As in the civilian population, addictive opioid medications have become the most common treatment for chronic pain in service members. But heavy reliance on those drugs has led to a national opioid crisis in which tens of thousands of Americans annually die from overdoses, according to the Centers for Disease Control and Prevention.

STRONG STAR part of national response

In response to this crisis, the National Institutes of Health and the Departments of Defense (DoD) and Veterans Affairs (VA) jointly established a national Pain Management Collaboratory. This collaboratory includes 11 individually funded pragmatic clinical trials with a focus on drug-free approaches to pain management in health care organizations that serve military personnel and veterans. Pragmatic trials take place in real-world settings with typical patients and produce results readily applicable in routine medical practice.

One of the Pain Management Collaboratory trials is a STRONG STAR-affiliated study designed to support the military’s own efforts to reduce the use of opioids for managing pain, while providing alternatives so that patients whose prescriptions are discontinued do not turn to civilian providers or street drugs.

This two-phase pragmatic trial is led by Principal Investigators (PIs) Donald McGeary, PhD, of The University of Texas Health Science Center at San Antonio and Jeffrey Goodie, PhD, of the Uniformed Services University of the Health Sciences. The study will offer the first formal pain management training specifically targeting the internal behavioral health consultants (IBHCs) already at primary care clinics throughout the U.S. Military Health System (MHS). IBHCs, who manage mental health and health behavior issues among primary care patients, previously received no formal training in drug-free pain management.

Managing pain without opioids

Most military personnel and family members with chronic pain receive treatment through primary care services. To enhance delivery of chronic pain management in primary care, the U.S. Defense Health Agency (DHA) has teamed up with the VA to establish a “stepped care” model of pain management tailored to the needs of the MHS. Stepped care delivers the least resource-intensive treatment before “stepping up” to the use of specialists.

This stepped care model, called the “Pain Pathway,” will guide assessment, treatment, and referral of chronic pain patients in MHS primary care clinics. Pain Pathway emphasizes drug-free interventions to replace opioids as the No. 1 way to manage pain. It includes provider training and education, establishment of clinic “Pain Champions” to optimize pain management services, and use of the internal behavioral health consultants.

How the study will work, expected benefits

The research team led by Drs. McGeary and Goodie will work directly with the DHA to develop a brief manual for treatment based on the VA’s Brief Cognitive Behavioral Therapy for Chronic Pain. The intervention includes providing information about chronic pain, relaxation, and stress management; cognitive and behavioral therapies designed to improve pain coping and increase physical activity; strategies for activity pacing and functional activation; and specialized modules for addressing pain-related concerns such as stigma, depression, and insomnia.

Then, the team will establish a program for training IBHCs in this non-pharmacological pain management intervention and test its effectiveness among primary care patients with chronic musculoskeletal pain.

The first phase of the program included the development of materials for training and treatment, assessment of the work products by key stakeholders (DHA leadership, IBHCs, primary care clinicians, and patients), and a pilot test of the IBHC intervention with 42 patients at Fort Hood, TX.

The second phase includes a study of the intervention with IBHCs stationed at four military treatment facilities. The investigators plan to recruit about 700 patients with chronic pain at these sites.

If successful, this program will increase the number of military primary care clinics with staff trained to deliver a medication-free pain management program that improves quality of life for service members and dependents, prevents medical discharges, and reduces costs for healthcare, disability, and other expenses.

Multi-Couple Group Intervention for PTSD

Feb 10, 2022

Posttraumatic stress disorder (PTSD) is a life-disrupting, frequently chronic condition that can cause devastating relationship problems. Intimate relationship difficulties can also interfere with recovery from PTSD. Numerous studies have documented an association between PTSD symptoms and impaired intimate relationship functioning in military and veteran couples, including relationship distress, physical and psychological aggression, and partner psychological distress.

Previous research has demonstrated that cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD), a couple-based therapy designed specifically for PTSD, is efficacious in simultaneously treating PTSD and co-occurring symptoms and improving intimate relationship functioning. However, the standard format of fifteen 75-minute sessions over 15 weeks presents challenges for large-scale dissemination of the treatment for active duty service members and veterans.

In this pilot study conducted through the Consortium to Alleviate PTSD, principal investigator Steffany J. Fredman, PhD, of the Pennsylvania State University and her research team will deliver a version of CBCT for PTSD in which session content is taught in an accelerated, multi-couple group format over a weekend.

Participants in the pilot study will be recruited at and around the U.S. Army’s Fort Hood in Killeen, Texas, and must include an active-duty service member or veteran diagnosed with PTSD and in a committed, partnered relationship. Both members of the couple must be available to participate in intensive treatment delivered over one weekend.

How the study works

Twenty-four couples will attend 12-hour, retreat-style workshops over the course of a weekend at a hotel about an hour away from Fort Hood in Austin, Texas. There will be seven weekend retreats, and six couples will be treated at each retreat.

Therapists with extensive experience working with active duty service members and veterans with PTSD in the context of the STRONG STAR Consortium will lead the workshops. They will provide couples with an understanding of how PTSD and intimate relationships affect one another and guide the couples in ways to think, feel, and behave differently in order to improve the service member’s or veteran’s PTSD symptoms, the couples’ relationship health, and the partners’ psychological well-being.

If the pilot study proves successful, the research team hopes to conduct a randomized controlled trial of accelerated CBCT for PTSD through a larger study funded by the U.S. Department of Defense or Department of Veterans Affairs.

Expected benefits

The investigators believe that accelerated delivery of cognitive behavioral conjoint therapy has the potential for rapid dissemination and implementation, while capturing the majority of the benefits of the original therapy format. It is also expected that providing the therapy in a non-military, non-VA setting will reduce the stigma of seeking mental health care. An added expected benefit is that participating in a program with other couples will provide social support for couples coping with the effects of PTSD.