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Couple Therapy for PTSD

  • Post-Traumatic Stress Disorders (K Chard and T Geracioti, Section Editors)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Opinion statement

Research has consistently documented a bidirectional association between posttraumatic stress disorder (PTSD) symptoms and intimate relationship functioning. PTSD symptoms are associated with greater relationship distress, higher likelihood of divorce, decreased emotional intimacy, and increased sexual dysfunction. Conversely, specific relational factors and interaction patterns (e.g., hostility, partner accommodation of PTSD symptoms) can serve to maintain or exacerbate PTSD symptoms. Given this reciprocal relationship, several couple therapies for PTSD have been created and empirically examined. Therapies that have been empirically studied include behavioral family therapy, emotionally focused couple therapy, strategic approach therapy, and cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD). To date, CBCT for PTSD has accumulated the most supporting evidence in the most diverse samples. Collectively, these empirical studies suggest that CBCT for PTSD is associated with improvements in PTSD, comorbid mental health symptoms, some partners’ mental health symptoms, and relationship satisfaction. CBCT for PTSD is a 15-session, trauma-focused PTSD treatment that occurs within a conjoint context. The therapy includes three phases: (1) psychoeducation and safety building, (2) communication skills and dyadic approach tasks to undermine avoidance, and (3) cognitive change regarding historical trauma appraisals and here-and-now maladaptive cognitions that maintain PTSD symptoms and/or relationship problems. Given the evidence supporting conjoint therapies for PTSD, clinicians should consider systematically involving partners in PTSD treatments to facilitate treatment by targeting both individual and relationship factors maintaining PTSD symptoms, as well as cultivate the strength within the couple’s relationship to encourage them to confront PTSD as a team.

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Author information

Authors and Affiliations

  1. Trauma Recovery Center, Cincinnati VAMC (Ft. Thomas Division), 1000 S. Ft. Thomas Ave., Ft. Thomas, KY, 41075, USA

    Nicole D. Pukay-Martin Ph.D.

  2. Psychology Department, The Citadel, Military College of South Carolina, 171 Moultrie Street, Charleston, SC, 29409, USA

    Alexandra Macdonald Ph.D.

  3. Department of Human Development and Family Studies, The Pennsylvania State University, 119 Health and Human Development Building, University Park, PA, 16802, USA

    Steffany J. Fredman Ph.D.

  4. Psychology Department, Ryerson University, 350 Victoria Ave., Toronto, Ontario, M5B 2K3, Canada

    Candice M. Monson Ph.D.

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  1. Nicole D. Pukay-Martin Ph.D.
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  2. Alexandra Macdonald Ph.D.
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  3. Steffany J. Fredman Ph.D.
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  4. Candice M. Monson Ph.D.
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Correspondence to Nicole D. Pukay-Martin Ph.D..

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Conflict of Interest

Nicole Pukay-Martin declares that she has no conflict of interest.

Alexandra Macdonald declares that she has no conflict of interest.

Steffany Fredman and Candice Monson declare that they receive royalties related to the publication of Cognitive-Behavioral Conjoint Therapy for PTSD: Harnessing the Healing Power of Relationships (Guilford Press).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Post-Traumatic Stress Disorders

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Pukay-Martin, N.D., Macdonald, A., Fredman, S.J. et al. Couple Therapy for PTSD. Curr Treat Options Psych 3, 37–47 (2016). https://doi.org/10.1007/s40501-016-0070-0

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  • DOI: https://doi.org/10.1007/s40501-016-0070-0

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