Category: Couples / Close Relationships
Keywords: PTSD Posttraumatic Stress Disorder | Families | Psychotherapy Process
Presentation Type: Symposium
Little is known about how families naturally influence trauma survivors’ experiences in individually-focused evidence based psychotherapies (EBPs) for PTSD. Two potential contributors include family behaviors members engage in to reduce PTSD-related distress, such as helping a Veteran avoid trauma reminders (i.e., symptom accommodation), and established social constraints around trauma disclosure within the family. We anticipate the influence of these family factors on treatment response is likely complex and may vary with patient gender and relationship distress. To learn more, we surveyed Veterans seeking Prolonged Exposure or Cognitive Processing Therapy for PTSD at four VA hospitals and their support persons (SPs) as they were beginning treatment (Time 1) and again four months later (Time 2; Veterans n = 352; SPs n = 230). We examined how Time 1 accommodation (SP reported) and social constraint (Veteran reported) predicted Time 2 symptoms of PTSD, controlling for Time 1 symptom severity. We also examined how associations between our predictors of interest and Time 2 PTSD symptom severity varied with Veteran gender and relationship distress. Preliminary multivariate regression analyses controlled for the number of sessions completed at Time 1 survey response, study site, and Veteran characteristics (combat era, gender, treatment credibility, self-efficacy, and perceived treatment barriers). Analyses indicated that, even after controlling for all other variables in the model, social constraints around trauma disclosure uniquely predicted greater Time 2 symptom severity (β = .60, p = .029). Findings also supported significant interactions between gender and social constraints (β = -.46, p = .045), gender and accommodation (β = .46, p = .039), and relationship stressors and accommodation (B = -.50, p = .027). Examinations of simple slopes indicated social constraints around trauma disclosure were associated with more severe symptoms of PTSD at Time 2 for men (β = .42), but with better treatment response for women (β = -.36). Additionally, associations between symptom accommodation and greater Time 2 symptoms of PTSD were stronger for men (β = .77) than women (β = .56). Finally, at the highest levels of relationship distress, findings suggest that accommodation may actually facilitate improved treatment response (at low relationship strain, β = -.23, at average relationship strain, β = -.38, at high relationship strain, β = -.53). No other predictors were uniquely associated with treatment response in the final model. Final analyses completed by the time of the conference will explore potential 3-way interactions, stratify findings by site of data collection, and further explore the implications of significant interactions. Initial analyses suggest that a family environment that is open to trauma disclosure with limited symptom accommodation may facilitate EBP treatment response, particularly for male Veterans. However, these findings may not hold true for Veterans experiencing strain in their close relationships or female Veterans.
Health Science Specialist
Friday, November 17
12:00 PM – 1:30 PM
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