1. 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

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

3. 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 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. 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. 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. Partners of PTSD veterans report high levels of distress and demoralization.

4. Top 5 Referral Issues – U.S. Army Couple’s Issues51.9% Couple’s Issues51.9% Depression18.1% Depression18.1% Counseling11.9% Counseling11.9% Family Relations 9.2% Family Relations 9.2% Stress Management 9.0% Stress Management 9.0%

5. Top 5 Referral Issues – Louisiana National Guard Couple’s Issues47.5% Couple’s Issues47.5% Stress Management15.0% Stress Management15.0% War Issues15.0% War Issues15.0% Depression12.5% Depression12.5% Counseling10.0% Counseling10.0%

6. 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.

7. 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. 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 couple’s treatment. The spouses and family members of OEF/OIF veterans may encourage them to accept family or couple’s treatment. OEF/OIF veterans may be assured that a goal of family and couple’s treatments will be to provide them with a more supportive and understanding family environment. OEF/OIF veterans may be assured that a goal of family and couple’s treatments will be to provide them with a more supportive and understanding family environment.

8. What empirically-based treatments are appropriate for traumatized OEF/OIF veterans and their families? 1.Family psychoeducation 2.Couple’s therapy a.Behavioral Couple’s Therapy b.Couple’s Cognitive Behavior Therapy

9. Family psychoeducation was developed to reduce “expressed emotion” in families of schizophrenics. “Expressed emotion” is defined as… Critical attitude toward the patient. Critical attitude toward the patient. Hostile attitude toward the patient. Hostile attitude toward the patient. Emotional overinvolvement Emotional overinvolvement (e.g. dramatic, highly reactive)

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

11. Exactly what does family psychoeducation programs provide? Education about mental illness Education about mental illness Improves communication Improves communication Improves problem-solving Improves problem-solving

12. Cognitive-Behavioral Couple’s Therapy (Monson) Targets dysfunctional attitudes and beliefs that traumatized people often have about relationships. Targets dysfunctional attitudes and beliefs that traumatized people often have about relationships. Addresses issues about trust, power and control, esteem, safety, and intimacy. 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. Data show significant reductions in PTSD symptoms as rated by the clinician and partner.

13. Structured Approach Therapy (Sautter and Glynn) Combines behavioral couple’s therapy and acceptance-based treatments. Combines behavioral couple’s therapy and acceptance-based treatments. Targets emotional numbing. Targets emotional numbing. Improves dyadic coping with anxiety. Improves dyadic coping with anxiety. Reduces PTSD symptoms. Reduces PTSD symptoms.

14. SAT Treatment Components PTSD Problem SAT Treatment Component Outcome Emotional Numbing Behavior Exchange Emotion Management Acceptance–Based 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

15. 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 Total20.0(2.8)10.7(3.3)10.16.0002** Partner- Reported Total 11.5(2.5)7.3(1.9)4.41.007*

16. 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*