Advertisement

Distress in Spouses of Combat Veterans with PTSD: The Importance of Interpersonally Based Cognitions and Behaviors

  • Keith D. Renshaw
  • Rebecca K. Blais
  • Catherine M. Caska
Chapter

Abstract

Despite considerable research indicating that spouses of veterans with posttraumatic stress disorder (PTSD) experience appreciable levels of psychological and marital distress, there is little empirical information about the mechanisms by which this distress develops. Given the ongoing military conflicts in Iraq and Afghanistan, and the fact that spouses form a primary support for combat veterans who return from deployments with symptoms of PTSD, a more comprehensive understanding of such mechanisms is critical. In this chapter, we review research that helps explain spouses’ distress from a cognitive-behavioral framework. Relevant veteran behaviors include internalizing behaviors (e.g., emotional withdrawal and avoidance) and externalizing behaviors (e.g., verbal and physical aggression). Although less research exists regarding spousal factors that may contribute to their distress, we review existing knowledge about spouse behaviors (e.g., accommodation of veterans’ symptoms) and cognitions (e.g., perceptions of burden and attributions for veterans’ symptoms). Finally, we provide recommendations for future research in this area.

Keywords

Anxiety Disorder Ptsd Symptom Relationship Satisfaction Service Member Combat Veteran 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Barrowclough, C., & Hooley, J. M. (2003). Attributions and expressed emotion: A review. Clinical Psychology Review, 23, 849–880.CrossRefPubMedGoogle Scholar
  2. Beckham, J. C., Lytle, B. L., & Feldman, M. E. (1996). Caregiver burden in partners of Vietnam War veterans with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 64, 1068–1072.CrossRefPubMedGoogle Scholar
  3. Biegel, D. E., Ishler, K. J., Katz, S., & Johnson, P. (2007). Predictors of burden of family caregivers of women with substance use disorders or co-occurring substance and mental disorders. Journal of Social Work Practice in the Addictions, 7, 25–49.CrossRefGoogle Scholar
  4. Breslau, N., Davis, G. C., & Schultz, L. R. (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry, 60, 289–294.CrossRefPubMedGoogle Scholar
  5. Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–766.CrossRefPubMedGoogle Scholar
  6. Byrne, C. A., & Riggs, D. S. (1996). The cycle of trauma: Relationship aggression in male Vietnam veterans with symptoms of posttraumatic stress disorder. Violence and Victims, 11, 213–225.PubMedGoogle Scholar
  7. Calhoun, P. S., Beckham, J. C., & Bosworth, H. B. (2002). Caregiver burden and psychological distress in partners of veterans with chronic posttraumatic stress disorder. Journal of Traumatic Stress, 15, 205–212.CrossRefPubMedGoogle Scholar
  8. Carroll, E. M., Rueger, D. B., Foy, D. W., & Donahoe, C. P. (1985). Vietnam combat veterans with posttraumatic stress disorder: Analysis of marital and cohabitating adjustment. Journal of Abnormal Psychology, 94, 329–337.CrossRefPubMedGoogle Scholar
  9. Caska, C. M., & Renshaw, K. D. (in press). Caregiver burden in spouses of National Guard/Reserve service members. Poster session presented at the annual conference of the Association for Behavioral and Cognitive Therapies. New York.Google Scholar
  10. Caska, C. M., & Renshaw, K. D. (in press). Caregiver burden in spouses of National Guard/Reserve service members deployed during Operations Enduring Freedom and Iraqi Freedom. Journal of Anxiety Disorders.Google Scholar
  11. Cook, J. M., Riggs, D. S., Thompson, R., Coyne, J. C., & Sheikh, J. I. (2004). Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. Journal of Family Psychology, 18, 36–45.CrossRefPubMedGoogle Scholar
  12. Dekel, R. (2007). Posttraumatic distress and growth among wives of prisoners of war: The contribution of husbands’ posttraumatic stress disorder and wives’ own attachment. The American Journal of Orthopsychiatry, 77, 419–426.CrossRefPubMedGoogle Scholar
  13. Dekel, R., Solomon, Z., & Bleich, A. (2005). Emotional distress and marital adjustment of caregivers: contribution of level of impairment and appraised burden. Anxiety, Stress, and Coping, 18, 71–82.CrossRefGoogle Scholar
  14. Dirkzwager, A. J. E., Bramsen, I., Adèr, H., & van der Ploeg, H. M. (2005). Secondary traumatization in partners and parents of Dutch peacekeeping soldiers. Journal of Family Psychology, 19, 217–226.CrossRefPubMedGoogle Scholar
  15. Epstein, N., & Baucom, D. H. (2002). Enhanced cognitive-behavior therapy for couples: A contextual approach. Washington: American Psychological Association.CrossRefGoogle Scholar
  16. Evans, L., McHugh, T., Hopwood, M., & Watt, C. (2003). Chronic posttraumatic stress disorder and family functioning of Vietnam veterans and their partners. Australian and New Zealand Journal of Psychiatry, 37, 765–772.PubMedGoogle Scholar
  17. Fredman, S. J., Monson, C. M., & Adair, K. C. (in press). Implementing cognitive-behavioral conjoint therapy for PTSD with the newest generation of veterans and their partners. Cognitive and Behavioral Practice doi:10.1016/j.cbpra.2009.06.007.Google Scholar
  18. Gallagher, J. C., Riggs, D. S., Byrne, C. A., & Weathers, F. W. (1998). Female partners’ estimations of male veterans’ combat-related PTSD severity. Journal of Traumatic Stress, 11, 367–374.CrossRefPubMedGoogle Scholar
  19. Galovski, T., & Lyons, J. A. (2004). Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggression and Violent Behavior, 9, 477–501.CrossRefGoogle Scholar
  20. Glenn, M. D., Beckham, J. C., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., & Moore, S. D. (2002). Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder. Violence and Victims, 17, 473–489.CrossRefPubMedGoogle Scholar
  21. Hendrix, C. C., Erdmann, M. A., & Briggs, K. (1998). Impact of Vietnam veterans’ arousal and avoidance on spouses’ perceptions of family life. The American Journal of Family Therapy, 26, 115–128.CrossRefGoogle Scholar
  22. Hoge, C. W., Auchterlonie, J. L., & Milliken, C. S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295, 1023–1032.CrossRefPubMedGoogle Scholar
  23. Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine, 351, 13–22.CrossRefPubMedGoogle Scholar
  24. Jordan, B. K., Marmar, C. R., Fairbank, J. A., Schlenger, W. E., Kulka, R. A., Hough, R. L., et al. (1992). Problems in families of male Vietnam Veterans with posttraumatic stress disorder. Journal of Consulting and Counseling Psychology, 60, 916–926.Google Scholar
  25. Lev-Wiesel, R., & Amir, M. (2001). Secondary traumatic stress, psychological distress, sharing of traumatic reminisces, and marital quality among spouses of Holocaust child survivors. Journal of Marital and Family Therapy, 27, 433–444.CrossRefPubMedGoogle Scholar
  26. Majerovitz, S. D. (2007). Predictors of burden and depression among nursing home family caregivers. Aging & Mental Health, 11, 323–329.CrossRefGoogle Scholar
  27. Manguno-Mire, G., Sautter, F., Lyons, J., Perry, D., Glynn, S., Sullivan, G., et al. (2007). Psychological distress and burden among female partners of combat veterans With PTSD. The Journal of Nervous and Mental Disease, 195, 144–151.CrossRefPubMedGoogle Scholar
  28. Marshal, M. P. (2003). For better or worse? The effect of alcohol use on marital functioning. Clinical Psychology Review, 23, 959–997.CrossRefPubMedGoogle Scholar
  29. McDonell, M. G., Short, R. A., Berry, C. M., & Dyck, D. G. (2003). Burden in schizophrenia caregivers: Impact of family psychoeducation and awareness of patient suicidality. Family Process, 42, 91–103.CrossRefPubMedGoogle Scholar
  30. McKay, N., & Barrowclough, C. (2005). Accident and emergency staff’s perceptions of deliberate self-harm: Attributions, emotions, and willingness to help. The British Journal of Clinical Psychology, 44, 255–267.CrossRefGoogle Scholar
  31. Mikulincer, M., Florian, V., & Solomon, Z. (1995). Marital intimacy, family support, and secondary traumatization: A study of wives of veterans with combat stress reaction. Anxiety, Stress & Coping: An International Journal, 8, 203–213.CrossRefGoogle Scholar
  32. Miller, M. W., Fogler, J. M., Wolf, E. J., Kaloupek, D. G., & Keane, T. M. (2008). The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. Journal of Traumatic Stress, 21, 58–65.CrossRefPubMedGoogle Scholar
  33. Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. Journal of the American Medical Association, 298, 2141–2148.CrossRefPubMedGoogle Scholar
  34. Monson, C. M., Fredman, S. J., & Dekel, R. (2010). Posttraumatic stress disorder in an interpersonal context. In J. G. Beck (Ed.), Interpersonal processes in the anxiety disorders: Implications for understanding psychopathology and treatment (pp. 179–208). Washington: APA.Google Scholar
  35. Monson, C. M., Taft, C. T., & Fredman, S. J. (2009). Military-related PTSD and intimate relationships: From description to theory-driven data and intervention development. Clinical Psychology Review, 29, 707–714. Google Scholar
  36. Nelson Goff, B. S., Crow, J. R., Reisbig, A. M. J., & Hamilton, S. (2007). The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction. Journal of Family Psychology, 21, 344–353.CrossRefGoogle Scholar
  37. Nelson Goff, B. S., Crow, J. R., Reisbig, A. M. J., & Hamilton, S. (2009). The impact of soldiers’ deployments to Iraq and Afghanistan: Secondary traumatic stress in female partners. Journal of Couple and Relationship Therapy, 8, 291–305.Google Scholar
  38. Nelson Goff, B. S., & Smith, D. B. (2005). Systemic traumatic stress: The Couple Adaptation to Traumatic Stress model. Journal of Marital and Family Therapy, 31, 145–157.CrossRefGoogle Scholar
  39. Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52–73.CrossRefPubMedGoogle Scholar
  40. Renshaw, K. D. (2010, June). Spouses’ perceptions of combat veterans: Symptoms of PTSD and the association of those symptoms with spouses’ distress. Paper presented at the triannual meeting of the World Congress of Behavioral and Cognitive Therapies, Boston, MA.Google Scholar
  41. Renshaw, K. D., Chambless, D. L., & Steketee, G. (2006). The relationship of relatives’ attributions to their expressed emotion and to patients’ improvement in treatment for anxiety disorders. Behavior Therapy, 37, 159–169.CrossRefPubMedGoogle Scholar
  42. Renshaw, K. D., Rodebaugh, T. L., & Rodrigues, C. S. (2010). Psychological and marital distress in spouses of Vietnam veterans: Importance of spouses’ perceptions. Journal of Anxiety Disorders, 24, 743–750.Google Scholar
  43. Renshaw, K. D., Rodrigues, C. S., Caska, C. M., Owens, J. S., & Jones, D. H. (2008). Effects of Afghanistan (OEF)/Iraq (OIF) era deployments on spouses of National Guard/Reserve members. In K. D. Renshaw (Chair), Collateral damage: Effects of OEF/OIF deployments on military families and non-combat personnel. Paper presented at the annual meeting of the Association for Behavioral and Cognitive Therapies, Orlando.Google Scholar
  44. Renshaw, K. D., Rodrigues, C. S., & Jones, D. H. (2008). Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: Relationships with spouses’ perceptions of veterans’ experiences and symptoms. Journal of Family Psychology, 22, 586–594.CrossRefPubMedGoogle Scholar
  45. Renshaw, K. D., Steketee, G., Rodrigues, C. S., & Caska, C. M. (2010). Obsessive compulsive disorder. In J. G. Beck (Ed.), Interpersonal processes in the anxiety disorders: Implications for understanding psychopathology and treatment (pp. 153–178). Washington: APA.Google Scholar
  46. Riggs, D. S., Byrne, C. A., Weathers, F. W., & Litz, B. T. (1998). The quality of the intimate relationships of male Vietnam veterans: Problems associated with posttraumatic stress disorder. Journal of Traumatic Stress, 11, 87–101.CrossRefPubMedGoogle Scholar
  47. Roberts, W. R., Penk, W. E., Gearing, M. L., Robinowitz, R., Dolan, M. P., & Patterson, E. T. (1982). Interpersonal problems of Vietnam combat veterans with symptoms of posttraumatic stress disorder. Journal of Abnormal Psychology, 91, 444–450.CrossRefPubMedGoogle Scholar
  48. Rodrigues, C. S., & Renshaw, K. D. (2009a). Anger mediates the relationship between PTSD and marital satisfaction in National Guard veterans. Poster session presented at the annual meeting of the International Society for Traumatic Stress Studies, Atlanta.Google Scholar
  49. Rodrigues, C. S., & Renshaw, K. D. (2009b). Spouses’ perceptions and veteran self-report of anger and PTSD: Influence on marital satisfaction. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, Atlanta.Google Scholar
  50. Savarese, V. W., Suvak, M. K., King, L. A., & King, D. W. (2001). Relationships among alcohol use, hyperarousal, and marital abuse and violence in Vietnam veterans. Journal of Traumatic Stress, 14, 717–732.CrossRefPubMedGoogle Scholar
  51. Solomon, Z., Dekel, R., & Zerach, G. (2008). The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans. Journal of Family Psychology, 22, 659–666.CrossRefPubMedGoogle Scholar
  52. Solomon, Z., Waysman, M., Avitzur, E., & Enoch, D. (1991). Psychiatric symptomatology among wives of soldiers following combat stress reaction: The role of the social network and marital relations. Anxiety Research, 4, 213–223.Google Scholar
  53. Solomon, Z., Waysman, M., Belkin, R., Mikulincer, M., Enoch, D., & Levy, G. (1992). Marital relations and combat stress reaction: The wives’ perspective. Journal of Marriage & the Family, 54, 316–326.CrossRefGoogle Scholar
  54. Taft, C. T., Kaloupek, D. G., Schumm, J. A., Panuzio, J., Keane, T. M., King, D. W., et al. (2007). Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans. Journal of Abnormal Psychology, 116, 498–507.CrossRefPubMedGoogle Scholar
  55. Taft, C. T., Schumm, J. A., Panuzio, J., & Proctor, S. P. (2008). An examination of family adjustment among Operation Desert Storm veterans. Journal of Consulting and Clinical Psychology, 76, 648–656.CrossRefPubMedGoogle Scholar
  56. Taft, C. T., Street, A. E., Marshall, A. D., Dowdall, D. J., & Riggs, D. S. (2007). Posttraumatic stress disorder, anger, and partner abuse among Vietnam combat veterans. Journal of Family Psychology, 21, 270–277.CrossRefPubMedGoogle Scholar
  57. Tanielian, T., & Jaycox, L. H. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: RAND Corporation.Google Scholar
  58. Verbosky, S. J., & Ryan, D. A. (1988). Female partners of Vietnam veterans: Stress by proximity. Issues in Mental Health Nursing, 9, 95–104.CrossRefPubMedGoogle Scholar
  59. Weiner, B., Perry, R. P., & Magnusson, J. (1988). An attributional analysis of reactions to stigmas. Journal of Personality and Social Psychology, 5, 738–748.CrossRefGoogle Scholar
  60. Westerink, J., & Giarratano, L. (1999). The impact of posttraumatic stress disorder on partners and children of Australian Vietnam veterans. The Australian and New Zealand Journal of Psychiatry, 33, 841–847.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Keith D. Renshaw
    • 1
  • Rebecca K. Blais
  • Catherine M. Caska
  1. 1.Department of PsychologyUniversity of UtahSalt Lake CityUSA

Personalised recommendations