Family Interventions in the Treatment of PTSD in OEF/OIF Veterans Frederic Sautter, Ph.D. Family Mental Health Program Southeast Louisiana Veterans Health Care System

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Family Interventions in the Treatment of PTSD in
OEF/OIF VeteransFrederic Sautter,
Ph.D.Family Mental Health ProgramSoutheast
Louisiana Veterans Health Care System
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Why is it important to provide family treatment
to OEF/OIF veterans with PTSD?

• Reexperiencing Symptoms Creates psychological
  distance between the veteran and the family
  member.
• Avoidance/Emotional Numbing Contributes to
  isolation and a loss of emotional expression.
• Hyperarousal Contributes to conflict and
  aggression.

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Why is it important to provide family treatment
to OEF/OIF veterans with PTSD?

• Because PTSD is devastating to relationships
• Combat veterans with PTSD are twice as likely to
  be divorced as non-PTSD veterans, and three times
  as likely to have multiple divorces.
• Combat veterans with PTSD are more likely to have
  interpersonal problems than non-PTSD veterans.
• Veterans with PTSD are more likely to perpetrate
  verbal and physical aggression against partners
  and children, with rates as high as 63 over a
  one-year period.
• Partners of PTSD veterans report high levels of
  distress and demoralization.

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Top 5 Referral Issues U.S. Army

• Couples Issues 51.9
• Depression 18.1
• Counseling 11.9
• Family Relations 9.2
• Stress Management 9.0

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Top 5 Referral Issues Louisiana National Guard

• Couples Issues 47.5
• Stress Management 15.0
• War Issues 15.0
• Depression 12.5
• Counseling 10.0

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What are the benefits of providing family
intervention to traumatized OEF/OIF veterans?

1. Reduce family and marital distress.
2. Increase family and spousal support.
3. Reduce PTSD symptoms and problems.
4. Promote PTSD treatment engagement.

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Couples and family interventions may be used to
engage the OEF/OIF veteran in PTSD treatment
because

• OEF/OIF veterans who are reluctant to seek
  treatment for PTSD may accept help for their
  relationship problems.
• The spouses and family members of OEF/OIF
  veterans may encourage them to accept family or
  couples treatment.
• OEF/OIF veterans may be assured that a goal of
  family and couples treatments will be to provide
  them with a more supportive and understanding
  family environment.

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What empirically-based treatments are appropriate
for traumatized OEF/OIF veterans and their
families?

• Family psychoeducation
• Couples therapy
• Behavioral Couples Therapy
• Couples Cognitive Behavior Therapy

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Family psychoeducation was developed to reduce
expressed emotion in families of
schizophrenics. Expressed emotion is defined as

• Critical attitude toward the patient.
• Hostile attitude toward the patient.
• Emotional overinvolvement
• (e.g. dramatic, highly reactive)

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• Family psychoeducation has been shown to reduce
  expressed emotion in families and to reduce
  psychotic relapse by 30-50, controlling for
  medication effects.

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Exactly what does family psychoeducation programs
provide?

• Education about mental illness
• Improves communication
• Improves problem-solving

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Cognitive-Behavioral Couples Therapy (Monson)

• Targets dysfunctional attitudes and beliefs that
  traumatized people often have about
  relationships.
• Addresses issues about trust, power and control,
  esteem, safety, and intimacy.
• Data show significant reductions in PTSD symptoms
  as rated by the clinician and partner.

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Structured Approach Therapy(Sautter and Glynn)

• Combines behavioral couples therapy and
  acceptance-based treatments.
• Targets emotional numbing.
• Improves dyadic coping with anxiety.
• Reduces PTSD symptoms.

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SAT Treatment Components
PTSD Problem SAT Treatment Component Outcome
Emotional Numbing Behavior Exchange Emotion Management AcceptanceBased Interventions Increased Intimacy and Positive Emotions
Anxiety Anxiety Management Training Relaxation Training Structured Support Training Increased Control Over Anxiety
Relationship Disturbance Problem-Solving Communication Training Psychoeducation Increased Marital Satisfaction
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Emotional Numbing
Pre Test Post Test T Value p
Self-Report Total 12.7 (1.2) 9.3 (1.6) 5.42 .003
Clinician-Rated Total 20.0 (2.8) 10.7 (3.3) 10.16 .0002
Partner-Reported Total 11.5 (2.5) 7.3 (1.9) 4.41 .007
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Total PTSD Severity
Pre Test Post Test T Value p
Self-Report Total 65.3 (7.7) 50.2 (9.7) 6.72 .001
Clinician-Rated Total 90.8 (15.5) 57.5 (15.8) 4.69 .002
Partner-Reported Total 58.3 (14.7) 40.8 (6.1) 3.66 .015