A Pilot Randomized Controlled Trial of Treatment for Trauma-Related Nightmares in Active Duty Military Personnel

Feb 10, 2022

Sleep disturbances, such as nightmares and insomnia, are some of the most frequently reported symptoms of posttraumatic stress disorder (PTSD), and they can exacerbate PTSD by interfering with the type of sleep needed for healing. Sleep disturbances also may be resistant to broader PTSD treatments. Data collected from over 4,000 service members indicate that approximately 22% of service members experience frequent nightmares. Additionally, 83% of service members seeking treatment for PTSD report nightmares. And nearly three-quarters of service members report that nightmares persist after treatment for PTSD, warranting specific interventions for nightmares in this population.

Insomnia and nightmares are such a problem in the military that the Department of Defense is disseminating cognitive-behavioral therapy of insomnia (CBT-I) and plans to disseminate a cognitive-behavioral therapy of nightmares called Exposure, Relaxation, and Rescripting Therapy (ERRT). Both treatments have been validated in civilian populations.

CBT-I also has been validated as a therapy in an active duty military population. But there is little research supporting behavioral therapy of nightmares in active duty military personnel, who face numerous circumstances that have a negative impact on sleep. No randomized studies have examined behavioral treatment for nightmares in active duty military personnel.

In order to obtain preliminary data on the efficacy of ERRT in active duty military, STRONG STAR clinical researcher Kristi Pruiksma, PhD, and her research team will conduct a pilot study at the U.S. Army’s Fort Hood in Killeen, Texas. The randomized clinical trial will compare a group of 20 Soldiers receiving ERRT with a control group of 20 receiving only minimal contact (MC). The primary aim is to determine if ERRT produces clinically significant decreases in nightmare frequency compared to MC. Secondary aims are to determine the impact of ERRT on nightmare disorder diagnosis, nightmare severity, insomnia, PTSD and depression.

The STRONG STAR-affiliated pilot study will include participants aged 18-65 who have experienced a traumatic event and who meet criteria for Chronic Nightmare Disorder with nightmares that caused awakening at least once per week in the past month. They will be assigned randomly to either five sessions of ERRT or to a five-week period of minimal contact. Participants randomized to MC will later be offered ERRT.

Collaborators include STRONG STAR Director Lt Col Alan Peterson, PhD, (USAF, Retired) of The University of Texas Health Science Center at San Antonio; LT COL Karin Nicholson, MD, chief of Pulmonary and Sleep Services and Medical Director of Respiratory Therapy for the Carl R. Darnall Army Medical Center at Fort Hood; and Daniel J. Taylor, PhD, an associate professor of Psychology and director of Clinical Training at the University of North Texas.

Expected results

This research group hypothesizes that ERRT will result in significant improvements in nightmare frequency and severity, sleep continuity, PTSD and depression compared to the control group. Results will provide useful data for development of clinical treatment guidelines and efforts to address sleep concerns that are highly prevalent in active duty populations and that are related to other indicators of distress, including mental and physical health problems.

This study will yield relevant data needed for larger trials examining physiological changes related to treatment of nightmares, such as changes in sleep stages, and could provide evidence supporting the dissemination of ERRT. It will also help develop the infrastructure for future studies combining ERRT and CBT-I with PTSD treatments in active duty military personnel and veterans.

Network Dysregulation Among Individuals with Comorbid Tinnitus and PTSD

Jan 22, 2022

Along with posttraumatic stress disorder (PTSD), one of the most common combat-related disorders is tinnitus, the illusory perception of noise or ringing in the ears when no actual external noise is present. Although these conditions are very different, they commonly occur together, and resting-state functional magnetic resonance imaging (rs-fMRI) shows that both are associated with abnormalities in similar brain networks.

It is anticipated, then, that the successful treatment of PTSD may also help alleviate the frequency, intensity, duration, and distress of chronic tinnitus. Likewise, a better understanding of the brain mechanisms involved in the cause and maintenance of both disorders, as well as in patient response to treatment, could guide efforts to cure them both, individually and jointly.

With these overarching goals in mind, this STRONG STAR-affiliated pilot study led by John Moring, PhD, of UT Health San Antonio will enroll 12 military veterans who deployed post-9/11 and who suffer from both PTSD and bothersome tinnitus. They will be assessed for tinnitus, tinnitus-related distress, and PTSD prior to undergoing Cognitive Processing Therapy (CPT), one of the gold-standard treatments for PTSD.

Each patient also will undergo rs-fMRI scans prior to starting treatment with CPT, midway through the six-week therapy period, and one month after completing treatment.

Through these assessments and neuroimaging scans, investigators have several aims. For one, they seek to identify symptoms that are shared and unique to PTSD and tinnitus-related distress. These findings could help clinicians better understand the distinct ways each disorder contributes to functional impairment as well as what it is like live with both disorders. That could improve their approach to patient care.

In addition, investigators want to test their hypothesis that, as CPT helps patients recover from PTSD, it also will help reduce tinnitus-related distress. This could provide support for the use of CPT for this purpose.

Importantly, with the neuroimaging scans, researchers also aim to identify the brain network dysregulation associated with tinnitus and PTSD, both in causing and maintaining the disorders, and gauge the impact of successful PTSD treatment with CPT, including whether and how it results in healthier activity within affected brain networks. These findings could be used to generate new and innovative treatments targeting specific brain regions to alleviate tinnitus and PTSD.

An Open Trial of Web-Prolonged Exposure (Web-PE) for PTSD among Active-Duty Military Personnel and Veterans

Feb 14, 2018

With the growing demand for effective, efficient treatments for posttraumatic stress disorder (PTSD), there is an urgent need to make evidence-based PTSD treatments readily accessible to military service members and veterans. While effective, evidence-based treatments are available, a host of barriers (e.g., availability, logistics, cost, stigma) can deter military personnel and veterans from seeking and receiving care. Internet-based treatments represent an innovative way to overcome these barriers, and they appear promising. However, previously developed Web treatments are not based on treatment protocols with strong empirical support for their efficacy. No study to date has examined Web treatment of PTSD using a well-established treatment program.

The purpose of this open trial is to examine the efficacy of a Web-based version of Prolonged Exposure (PE) therapy, “Web-PE,” for PTSD in active-duty service members and veterans who have had post-9/11 deployments. Treatment will involve 10 sessions delivered over eight weeks. Participants will be assessed at pre-treatment and at one and three months after treatment completion to determine if Web-PE effectively and significantly reduced PTSD symptoms and if those improvements were maintained over time.

About Web-PE
Web-PE is based on Prolonged Exposure, commonly called PE, which is the treatment with the most empirical support for its efficacy with civilians and veterans. The Web-PE program utilizes PE’s standard treatment elements and format while seeking to deliver this leading therapy in a way that is easier for patients than having to travel to a therapists’ office for a scheduled, in-person appointment.

Web-PE’s 10 sessions, designed to take approximately 60 minutes each, are completed through a secure and discreet online portal to the course, as are all self-report assessments and homework forms that are part of the program. Although Web-PE patients do not meet personally with a therapist, the program is therapist-facilitated. It also utilizes a variety of strategies to promote user engagement, practice of skills, and transfer of skills into daily life. For example, participants have access to media clips that demonstrate the treatment procedures.

Potential benefit
If Web-PE proves to be efficacious for combat-related PTSD, this highly accessible and convenient method of treatment could potentially expand access to evidence-based care to thousands of military service members and veterans who currently are deterred by treatment barriers. Given PTSD’s devastating effects on all aspects of a person’s functioning, this could have a hugely positive impact on our nation’s war fighters, helping them maintain or resume highly productive lives in continued military service or as civilians.

Project Remission: Maximizing Outcomes with Intensive Treatments for Combat-Related PTSD

Dec 22, 2017

This study by the Consortium to Alleviate PTSD aims to maximize improvements and, if possible, treat patients with combat-related PTSD into remission so they can return to full fitness for military duty or successfully integrate into civilian life.

The need for tailored, intensive treatment programs

Effective treatment of combat-related PTSD requires tailored and enhanced approaches that work quickly in getting PTSD into remission. The leading exposure therapies, in which patients confront traumatic memories and environmental triggers rather than avoid them, show 80 percent success rates with civilian victims of assault, accidents, and similar traumas. But the rate of remission with service members and veterans has been lower and often is less than 50 percent of those studied.

Reasons for the lower success rate with combat PTSD include the fact that service members in combat zones are more likely to experience multiple types of trauma and repeated exposure to trauma. That may require extra time and attention to address multiple, varied traumatic memories and more trauma-related issues. Also, military culture may increase concerns about the stigma of mental health care, perhaps making service members reluctant to seek treatment in the first place, while work schedules may interfere with patients’ ability to complete treatment.

How the CAP IOP study works

With those challenges in mind, Alan Peterson, PhD, of The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System leads a study for the Consortium to Alleviate PTSD to evaluate two versions of intensive outpatient treatment programs for military service members and veterans with PTSD. Patients involved in this study will participate in a three-week, fulltime treatment program at a designated treatment center. The aim with this approach is to both maximize improvements and streamline the treatment length.

The study will compare two intensive, enhanced forms of Prolonged Exposure (PE), the PTSD treatment with the most scientific support for efficacy with civilians.

Rather than the traditional PE treatment of 10 therapy sessions delivered over a period of three to four months, participants will receive more sessions in a shorter time period, three weeks. They will be randomly placed into one of two treatment arms with different levels of therapy enhancement:

Massed-PE format, with 15 daily sessions over three weeks, or
Intensive Outpatient PE (IOP-PE) format, also with 15 daily sessions over three weeks, but with additional enhancements to better tailor the treatment to those with combat-related PTSD or otherwise help improve treatment outcomes.

The researchers hypothesize that both formats will result in improved outcomes over standard PE delivery and that IOP-PE will provide maximum benefit. Participants in this randomized clinical trial will include 100 active duty military service members recruited worldwide and 100 veterans, treated at military and Department of Veterans Affairs sites in South and Central Texas.

Potential benefits

If the intensive outpatient format is found to be highly effective at reducing PTSD symptoms, it will offer the military and VA a valuable option that would increase access to care, boost patient retention, and improve treatment outcomes. It also could enable creation of specialized PTSD treatment centers to which service members could travel from around the world for short-term, state-of-the-art care. This would make it possible for more service members to stay on active duty and for veterans to reintegrate more quickly into civilian life, potentially saving the nation millions of dollars in long-term disability payments to veterans.

Image-guided Robotically Delivered Transcranial Magnetic Stimulation for Combat-Related PTSD: a Double-Blind, Randomized, Placebo-Controlled Clinical Trial

Jul 03, 2017

Service members and veterans with treatment-resistant posttraumatic stress disorder (PTSD) could get relief from a cutting-edge approach that uses electro-magnetic energy to help reset the brain’s functioning to a healthy state.

Novel therapies such as this for PTSD and other mental health disorders are highly sought because, despite the availability of treatments that help many people to recover, too many continue to suffer from the condition even after receiving care.

The promise of magnetic therapy

A promising new treatment approach with a variety of mental disorders involves rebalancing neural circuits in the brain with neuro-modulation, in which patients receive repetitive, magnetically induced electrical stimulations to specific brain networks. The purpose is to alter brain function by altering brain circuitry.

A non-invasive form of neuro-modulation, transcranial magnetic stimulation (TMS), delivers a series of brief, repetitive electro-magnetic pulses to the brain via an electromagnet placed on the scalp.

The U.S. Food and Drug Administration has approved TMS for treatment of drug-resistant depression disorder. TMS also is being tested as a treatment for PTSD and various other conditions, including obsessive-compulsive disorder, chronic pain, tinnitus (ringing of the ears), and auditory verbal hallucinations.

How the CAP study will work

In this study for the Consortium to Alleviate PTSD (CAP), a research team led by principal investigator Peter Fox, MD, of The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and the South Texas Veterans Health Care System, will test an enhanced form of TMS with PTSD patients in San Antonio.

The enhanced TMS in this study is “image-guided robotically delivered transcranial magnetic stimulation” (irTMS). It will be tested as an add-on treatment for patients also receiving one of the leading evidence-based psychotherapies for PTSD, either Prolonged Exposure or Cognitive Processing Therapy.

This study involves collaboration between:

UT Health San Antonio, one of the lead institutions for the CAP and development site of the irTMS system with which treatment will be delivered, and
The Laurel Ridge Treatment Center in San Antonio, the largest civilian provider of psychiatric care to the U.S. military.

Investigators will evaluate irTMS with patients at Laurel Ridge whose combat-related PTSD has shown resistance to treatment. The two-arm study will involve 100 participants, comparing outcomes with 50 patients selected randomly to receive irTMS therapy daily for 20 days, and 50 patients who receive a treatment placebo that does not actually deliver magnetic pulses for the same time period.

For those receiving irTMS, the stimulation will be directed to the brain’s right dorsolateral prefrontal cortex. Previous studies have shown that electromagnetic stimulation to that region yielded the best results for PTSD patients.

In this study, functional magnetic resonance imaging (fMRI) of each patient’s brain prior to the first treatment will yield a map for personalized, precise targeting of the location designated for receiving TMS. A medical robot will use the imaging data to deliver the electro-magnetic pulses.

Dr. Fox is a co-inventor of the irTMS treatment system, director of the UT Health San Antonio’s Research Imaging Institute, and a health science researcher in the South Texas Veterans Health Care System. He will personally compute each patient’s irTMS treatment plan.

The research team predicts that irTMS treatment will reduce PTSD symptoms, such as fear and social anxiety, by reducing neural hyperactivity and hyperconnectivity in the brain networks associated with PTSD symptoms. The team also believes that the positive effects will spread via well established neuronal network connections.

Potential benefits

If this study confirms prior estimates of the effectiveness of TMS in an active duty military population, it will support new treatment options in the military as well as civilian populations. Also, a brief treatment period of 20 days could make it feasible for active duty military personnel and civilians who otherwise may not have time for therapies that take longer. Success with this treatment would add to the body of scientific knowledge of the potential benefits of the use of image-guided, high-frequency TMS in treating PTSD. That would make it possible to relieve the suffering of people who do not respond to other forms of therapy, allowing them to lead healthy, productive military or civilian lives.

The Efficacy of 90-Minute vs. 60-Minute Sessions of Prolonged Exposure for PTSD: A Randomized Controlled Trial in Active Duty Military Personnel

May 26, 2017

With up to 20 percent of post-9/11 combat veterans suffering from posttraumatic stress disorder (PTSD) symptoms, our nation needs to provide effective treatments to the greatest number of people possible.

One form of therapy proven effective, Prolonged Exposure (PE), is recommended by the Institute of Medicine and being rolled out by the Departments of Defense (DoD) and Veterans Affairs (VA) to help service members and veterans recover from PTSD. A major barrier to that rollout, however, is that PE typically is delivered in 90-minute sessions. That makes it difficult for military and VA mental health clinicians to provide PE because, due to large patient loads and federal scheduling policies, they usually must limit therapy sessions to 60 minutes. But if PE could be shown to maintain high success rates with shorter sessions, more military and VA providers could offer this powerful therapy.

Testing shorter exposure sessions

A key element of PE is a procedure known as “imaginal exposure,” during which patients recall and recount their trauma memories. Preliminary evidence has suggested that patients may benefit greatly from PE even when the time spent in imaginal exposure is shortened to fit into a 60-minute session.

In this STRONG STAR-affiliated clinical study, Edna Foa, PhD, of the University of Pennsylvania and her research team will evaluate the delivery of PE in 60-minute sessions. They will enroll 160 San Antonio-area active duty service members, randomly assign them to receive PE treatment with 60- or 90-minute sessions, and compare outcomes of the two groups. All treatment sessions will be conducted at a non-military site. The cause of the PTSD may include various types of trauma (e.g., combat, attacks, sexual or physical assault, childhood trauma, abuse, accidents) and does not have to be service-related.

In addition to measuring progress based on patients’ subjective self-reporting and clinicians’ objective assessments, the investigators seek to gain insight on how PE works – and which components of the therapy are most beneficial – by observing changes in patients’ physical symptoms of stress. Physical symptoms to be monitored include heart rate, which accelerates during stress, and skin electrical conductivity, which increases as a result of stress-induced perspiration. Tracking of physical changes during different parts of the therapy could yield insight on how PE helps patients recover from PTSD and, based on that knowledge, ways of enhancing this and other PTSD treatments to increase their effectiveness.

Potential benefits

Data from this study showing high success rates from shortened PE sessions could lead to increased availability of this powerful therapy for hundreds of thousands of combat veterans. More military and VA clinicians could offer PE, because it would fit within the time constraints of their heavy workload and federal scheduling policies. The military and general public would benefit from enhanced readiness of our Armed Forces and reduced public costs of service members’ lost work time and veterans’ disability benefits. Civilian therapists also may be more likely to use PE therapy if they had available a 60-minute format compatible with insurance reimbursement requirements. Finally, study findings about how and why PE is such an effective treatment could provide insights on how to improve PTSD treatment even further.

Doxazosin in the Treatment of Co-Occurring PTSD and Alcohol Use Disorder (PATRIOT Study)

May 25, 2017

Post-911 deployments have left an increasing number of U.S. military personnel and veterans at risk of developing posttraumatic stress disorder (PTSD) and substance use disorders. The most common substance use problem among veterans is alcohol use disorder (AUD).

Co-occurring PTSD and alcohol/substance use disorder (AUD/SUD) complicates treatment of both conditions, but medical professionals have little scientific evidence to guide patient care.

Principal Investigator Sudie E. Back, PhD, of the Ralph H. Johnson VA in Charleston, South Carolina, and the Medical University of South Carolina, and her research team are addressing that knowledge gap with this study for the Consortium to Alleviate PTSD. They will test the efficacy of doxazosin, as compared to placebo, in reducing PTSD and alcohol/substance use severity.

Although doxazosin normally is prescribed to treat high blood pressure and enlarged prostate, the drug has shown promise in pilot studies in significantly reducing symptoms of PTSD and AUD.

Study participants will be selected randomly to receive either doxazosin or a placebo over a 12-week period, with periodic measurements of PTSD symptoms and substance use. All patients will have the option of receiving cognitive behavioral therapy to help reduce alcohol or drug use during the trial.

Assessments will include optional functional magnetic resonance imaging (fMRI) before and after the study to examine physical characteristics of comorbid PTSD and AUD/SUD in the brain, as well as changes over time that indicate positive response to treatment.

This study features a multidisciplinary team of investigators with nationally recognized expertise in combat-related PTSD, alcohol/substance use disorders, and neuroimaging who have successfully collaborated in the past. The investigators represent a collaboration of faculty at the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center in Charleston, SC.

Expected benefits

The findings from this study may open a new avenue for treatment of the common and complex comorbidity of PTSD and substance use disorder. It has the potential to significantly improve the standard of patient care, advance the science in this area, decrease public health expenditures, and improve the military readiness and overall health of U.S. military personnel, veterans, and their families.

Ketamine for Antidepressant-Resistant PTSD

Jan 23, 2017

Although hundreds of thousands of active duty military personnel and veterans suffer from posttraumatic stress disorder, there are only two U.S. Food and Drug Administration-approved medications for treating PTSD. Both of those medications are a type of drug called monoaminergic antidepressants. Unfortunately, approximately 45 percent of PTSD patients do not improve from treatment with antidepressants. Many of those who do respond to antidepressants only show a partial improvement and continue to suffer from significant PTSD symptoms.

Mounting evidence indicates that the anesthetic ketamine produces a rapid and potent improvement in up to 90 percent of patients with severe antidepressant-resistant depression. Pilot evidence and case reports also indicate that ketamine may be effective for treating PTSD, but it has not been tested in active duty military personnel or veterans.

To further understanding of this potential treatment, principal investigator John Krystal, MD, of Yale University School of Medicine has developed a study for the Consortium to Alleviate PTSD. Dr. Krystal and his team of investigators will examine the safety and effectiveness of ketamine in active duty military personnel and veterans with antidepressant-resistant PTSD.

The study also will evaluate:

Whether treatment benefits may be extended safely through repeated dosing,
Whether different dosage levels affect treatment, and
How long the benefit of treatment lasts for those who respond to ketamine treatment.

Dr. Krystal and his research team seek to determine in this multi-site, double-blind clinical trial whether ketamine produces a rapid and sustained reduction in PTSD and depression symptoms, as compared to placebo.

Investigators will conduct the study at the Clinical Neurosciences Division of the U.S. Department of Veterans Affairs’ National Center for PTSD at the VA Medical Center in West Haven, Conn.; at the Minneapolis VA Health Care System; and at the U.S. Army’s San Antonio Military Medical Center. They will randomly place nearly 200 study participants into one of three treatment conditions, consisting of either one of two dosage levels of ketamine administered intravenously or a placebo. After the dosage period ends, investigators will follow up with the study participants for four weeks. All study participants who do not experience significant clinical improvement in PTSD symptoms at the end of the 4-week trial will be given the option of receiving a single dose of ketamine.

The number of participants makes this the largest known clinical trial of ketamine in any population.

Expected benefits

Because many PTSD sufferers do not respond to treatment with antidepressants, other treatment options are needed. If successful, this study will provide valuable data on the potential of ketamine to help antidepressant-resistant PTSD patients.

Investigators also believe that it is the first test of the therapeutic effects of ketamine in the veteran and active duty military population, as well as the first placebo-controlled, multi-site trial to determine the dose-related effects of repeated ketamine on PTSD. That will yield valuable information on the efficacy of a drug that could bring relief to help active duty personnel to resume their military careers, and to help veterans transition to civilian lives without PTSD.

Establishing Efficacy of a Functional-restoration-based Pain Management Program

Jan 18, 2017

Those suffering from chronic pain after military trauma often have other chronic symptoms, including posttraumatic stress disorder (PTSD), traumatic brain injury, and depression. Such “polymorbidity” makes all of the conditions more difficult to treat. The multiple trauma symptoms also increase the risk of chronic use of opioid (narcotic) medications. Unfortunately, the opioids frequently prescribed to those with chronic pain can complicate all of the multiple conditions and actually worsen a person’s ability to function.

To help address these problems, Donald McGeary, PhD, of The University of Texas Health Science Center at San Antonio is leading a STRONG STAR-affiliated study evaluating an integrated program to improve physical function/reduce disability and decrease rates of chronic opioid use among veterans with military service-related injuries. The approach integrates relaxation, biofeedback, guided exercise, imagery, mindfulness meditation, cognitive-behavioral therapies, and weekly team meetings with physical therapy and medical care.

To evaluate its effectiveness, this complementary and integrative health approach named FORT-A for “Functional Orthopedic Rehabilitation Treatment” will be compared with the current “treatment as usual.”

Study rationale and objectives

This study arose from an urgent call from the National Institutes of Health for development of pain management programs that do not require medications to provide meaningful approaches to chronic pain management and opioid use.

If successful, Dr. McGeary believes this approach could have a profound impact by offering a non-medication alternative for pain management that decreases opioid use in veterans with pain and trauma symptoms. Elimination of opioid side effects would help them to be productive members of both the military and civilian workforces. It also could reduce their need to visit clinics and emergency rooms, resulting in cost savings for the government and improved access to limited health care resources for other patients.

Dr. McGeary, a clinical health psychologist and assistant professor in the Psychiatry Department, Division of Behavioral Medicine at UT Health San Antonio, says that published research shows that primary care doctors do not like to prescribe opioid medication for pain, but they do it because they do not know of alternatives.

A recent study in the San Antonio Veterans Integrated Service Network (VISN) found that the opioid hydrocodone is the single most commonly prescribed medication in the VISN. And 40 percent of veterans taking opioid medication use it for more than three months. Chronic opioid use among polymorbid veterans has been linked to poor rehabilitation outcomes, abuse of other substances, and death.

McGeary’s team of investigators will work with veterans at the Polytrauma Rehabilitation Center at San Antonio, one of five U.S. Department of Veterans Affairs facilities in the country designed to provide intensive rehabilitative care to veterans and service members who experienced severe injuries, including brain injuries, to more than one organ system. This program is a modification of a previous study McGeary conducted with active-duty Air Force, Army, and Navy personnel, in which half of them stopped using opioid pain medications, even though that program did not talk about the drugs.

An important part of the treatment involves teaching patients to accept and manage the pain, while staying committed to physical therapy and getting their bodies to function at full capacity.

Conjoint Therapy for Pain Management: A Pilot Study

May 19, 2016

Chronic pain:

Affects approximately 100 million Americans, resulting in more than $600 billion in direct and indirect costs, making it a significant national health care concern.
Increases risk for psychological problems, such as depression, anxiety, and substance use, as well as interpersonal distress, particularly within romantic relationships.
Can cause distress for family members.

Family members of chronic pain patients report elevated caregiver burden, lower relationship quality and satisfaction, and decreased physical and psychological health. Marital distress and partners’ psychological maladjustment are problematic in pain management. Partners with depression/anxiety are less able to help their significant other cope with pain. Erosion of the quality of the relationship creates additional stress for patients.

Although research has shown a reciprocal relationship between chronic pain and relationship satisfaction, little has been done to develop treatments that include family members. Principal Investigators Tabatha Blount, PhD, and Cindy McGeary, PhD, the developers of this pilot study affiliated with the STRONG STAR Consortium, believe that chronic pain sufferers who are in a committed relationship may benefit from a couple-based pain management treatment.

First study of its kind

In what is believed to be the first pilot study of a couple-based treatment for chronic pain, the research team will test a treatment program called Conjoint Therapy for Pain Management in couples in which a partner has suffered from chronic pain for more than 12 weeks. Drs. McGeary and Blount, both members of the Psychiatry Department faculty in the School of Medicine at The University of Texas Health Science Center at San Antonio, will work with the UT Medicine Pain Consultants Clinic to recruit 10 patients and their spouses or cohabitating partners for this study.

The investigators will incorporate proven pain management interventions into a program similar to Cognitive-Behavioral Conjoint Therapy (CBCT) for PTSD, previously developed by Candice Monson, PhD, of Ryerson University, Toronto, Canada, and Steffany Fredman, PhD, of Pennsylvania State University (also STRONG STAR-affiliated investigators). That therapy simultaneously targets posttraumatic stress disorder symptoms and relationship distress. For couples, dealing with PTSD requires skills similar to those needed for dealing with pain, including communication training and overcoming fear-based avoidance of certain situations and activities.

Treatment in the CBCT for pain program will focus on managing chronic pain through:

psychoeducation about chronic pain and related relationship problems
communication skills training
breathing techniques
imagery
cognitive/behavioral interventions
acceptance, progressive muscle relaxation
mindfulness

CBCT will emphasize helping patients realize their potential to make progress gaining physical function, such as walking, bending, and lifting.

Expected results

The research group hypothesizes that including intimate partners in the treatment of chronic pain may improve patients’ adherence to treatment, improve their physical and social functioning, and improve overall couple’s satisfaction for both partners. The investigators expect that this pilot study will yield data relevant for the development of the first randomized controlled trial to systematically examine the role that others play in patients’ pain management treatments. That will inform improved therapies to ease the suffering of the millions of Americans and others worldwide living with chronic pain.