A Case Study of Cognitive-Behavioral Conjoint Therapy for Combat-Related PTSD in a Same-Sex Military Couple

Military deployments to Iraq and Afghanistan are associated with increased risk for posttraumatic stress disorder (PTSD), depression, and relationship impairment. Unfortunately, the perceived stigma associated with seeking deployment-related behavioral health care in military settings has been a significant barrier to care. Historically, active-duty military service members involved in same-sex intimate relationships have experienced further stressors and barriers to care related to additional stigma and lack of social support. Prior federal regulations excluded sexual minorities from openly serving in the military, thereby limiting the available behavioral health services for same-sex couples. Since this ban was lifted after the repeal of the U.S. policy known as "Don’t Ask, Don’t Tell" in 2010, gay and lesbian service members have increased opportunities to obtain behavioral health care. One therapy that is newly available to sexual minority military couples is Cognitive-Behavioral Conjoint Therapy (CBCT), which effectively addresses co-occurring PTSD and relationship dysfunction. This case study illustrates the use of CBCT for the treatment of deployment-related PTSD in a same-sex active-duty military couple. After completing all 15 CBCT sessions, the couple reported clinically meaningful changes in the service member’s PTSD symptoms, which was maintained at the 2-month follow-up. The results of this case study indicate that CBCT for PTSD can have positive treatment outcomes with military same-sex couples. Further clinical implications are discussed.     

Mindfulness-Based Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder: A Case Study

With as many as 1.9 million men and women deployed as part of the wars in Iraq and Afghanistan, increased recognition is being placed on the effect of returning Veterans’ combat experiences on their adjustment and mental health, particularly those with symptoms of posttraumatic stress disorder (PTSD) and associated effects on families and relationships. Cognitive-behavioral conjoint therapy (CBCT) for PTSD is a manualized intervention with demonstrated efficacy in clinical trials with Veterans who have experienced trauma and their intimate partners. This case study involves the successful application of Mindfulness-based CBCT for PTSD to treat an operation Iraqi freedom male Veteran and his wife referred for PTSD and relationship dissatisfaction. In the current study, mindfulness interventions were integrated into the existing CBCT for PTSD protocol and treatment duration was shortened by including a weekend group retreat for couples. Baseline and post-treatment data from self- and partner-report measures demonstrates symptom reduction in posttraumatic stress symptoms as well as an increase in relationship satisfaction. The advantages of incorporating mindfulness strategies into this treatment protocol and recommendations for future work are discussed.     

Assessing Family Coordination in Divorced Families

Posttraumatic stress disorder (PTSD) and partner relationship difficulties commonly co-occur among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF). This study reports upon results for six male OEF-OIF Veterans with PTSD and their female relationship partners who completed cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD), which is a treatment that targets reductions in PTSD and couple distress. Case- and group-level data supported reductions in Veterans' PTSD symptoms and female partners' relationship distress. These findings suggest that CBCT for PTSD may be a promising intervention for OEF-OIF Veterans' PTSD and their partners.     

Impact of Treatment Setting and Format on Symptom Severity Following Cognitive Processing Therapy for Posttraumatic Stress Disorder

Preliminary data suggest cognitive processing therapy (CPT) significantly reduces posttraumatic stress disorder (PTSD) symptom severity among military personnel and veterans when delivered over 12 days and combined with daily recreational activities (Bryan et al., 2018). The present study aimed to examine how therapy pace (i.e., daily vs. weekly sessions) and setting (i.e., clinic vs. recreational) impacts change in PTSD symptom severity. Forty-five military personnel and veterans diagnosed with PTSD chose to receive CPT (a) daily at a recreational facility with recreational programming, (b) daily on a university campus without recreational programming, and (c) weekly on a university campus without recreational programming. PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Reductions in CAPS-5 and PCL-5 scores were large and statistically significant across all three settings (Cohen’s ds > 2.1). As compared to reductions in CAPS-5 and PCL-5 scores in daily therapy at a recreational facility (CAPS-5: d = 1.63–2.40; PCL-5: d = 1.99–2.17), reductions in CAPS-5 and PCL-5 scores were significantly larger in daily therapy on campus, CAPS-5: t(80) = –2.9, p = .005, d = 2.23–2.69; PCL-5: t(78) = 2.6, p = .010, d = 2.54–4.43, but not weekly therapy on campus, CAPS-5: t(80) = 0.2, p = .883, d = 1.04–2.47; PCL-5: t(78) = 1.0, p = .310, d = 1.77–3.44. Participants receiving daily therapy on campus and weekly therapy on campus also had higher rates of clinically significant improvement and good end-state functioning. Results support the effectiveness of CPT across multiple treatment settings and formats and suggest that daily CPT may be less effective when delivered in combination with recreational activities.     

Standardized assessment of relationship functioning in OEF/OIF Veterans with and without PTSD

Posttraumatic Stress Disorder (PTSD) is associated with difficulties in intimate relationships, with most prior research examining associations with continuous, single-dimension, and often-unstandardized measures of general relationship quality or aggression. Standardized, well-normed assessments that include multiple couple problem areas could provide more precise information about the presence and specific nature of clinically significant concerns in patient care settings. This investigation aimed to replicate findings regarding increased difficulties in relationship functioning among Operations Enduring and Iraqi Freedom Veterans with PTSD and their romantic partners, specifically using a standardized assessment that permits identification of cases of clinically significant general couple distress and difficulties across multiple problem areas. We compared 32 male Veterans with PTSD and 33 without PTSD, and their romantic partners on reports of several problem areas using the revised Marital Satisfaction Inventory (MSI-R). All participants underwent structured diagnostic interviewing. PTSD couples reported clinically significant levels of relationship distress several times more frequently than comparison couples, both for general distress and across all specific problem areas (e.g., aggressive behavior, quality of leisure time together, sexual functioning, conflicts about finances and child rearing). The most notable problem areas for PTSD couples were affective and problem-solving communication. These results replicate associations of PTSD with general couple discord and multiple specific areas of couple difficulties and extend them by documenting the clinical severity of these problems. Mental health providers may consider incorporating standardized couple assessments into their evaluations of Veterans’ functioning. Couple therapies may consider using such measures to prioritize targets for treatment.     

父母协同教养与学前儿童社会行为的关系:亲子关系和同胞关系的链式中介作用

以河南省某市四所幼儿园大、中、小班共196名学前儿童及其父母和教师为研究对象,基于家庭系统理论,采用父、母填写的父母感知协同教养量表和亲子关系量表、母亲填写的儿童早期同胞关系质量问卷和幼儿教师报告的儿童行为量表探讨亲子关系、同胞关系在父母感知协同教养与学前儿童社会行为之间的中介作用。结果发现：（1）母子冲突和母子亲密分别在母亲感知协同教养与同胞冲突和同胞温暖间起部分中介作用;父子冲突和父子亲密分别在父亲感知协同教养与同胞冲突和同胞温暖间起完全中介作用;（2）父/母子冲突和同胞冲突在母亲感知协同教养和儿童攻击行为间起链式中介作用;父子冲突和同胞冲突在父亲感知协同教养和儿童攻击行为间起链式中介作用。     

A Pilot Study of the Effects of Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder on Parenting

Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties. Cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD) improves PTSD symptoms, relationship adjustment, and partners’ mental health functioning. However, the impact of CBCT for PTSD on parenting competency is unknown. In this pilot study, the effects of CBCT for PTSD on parenting competency were investigated in 14 individuals (6 patients with PTSD and 8 partners) who had children under age 18. Results suggested that most participants perceived themselves as competent in their parenting prior to treatment, and some enhancements in competency occurred following CBCT for PTSD. Moreover, changes in parenting competency were associated with improvements in patient-rated PTSD. Adjunctive interventions targeting parenting and goals for future research are discussed.     

Treating an HIV/AIDS Patient’s PTSD and Medication Nonadherence With Cognitive-Behavioral Therapy: A Principle-Based Approach

HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a patient with HIV/AIDS who was unable to adhere to his antiretroviral medication regimen primarily because of PTSD and depressive symptoms resulting from a sexual assault that had caused his seroconversion. Exposure-based cognitive-behavioral therapy was instrumental in helping the patient overcome his PTSD and depressive symptoms so that he could tolerate his HIV medications. The patient’s symptom relief was evidenced by improved scores on the Impact of Event Scale and Beck Depression Inventory. The article discusses the importance of accurate assessment, therapist flexibility, and principle-based treatment versus strict adherence to manual-based protocols.     

Cognitive Processing Therapy for Concurrent Posttraumatic Stress Disorder and Psychogenic Nonepileptic Seizures: A Case Study

Psychogenic nonepileptic seizures (PNES) are the number-one medically unexplained symptom encountered by neurologists (Brown & Reuber, 2016) and account for approximately 30% of patients referred to epilepsy centers (Leu et al., 2020). Episodes of PNES physically resemble epileptic seizures; however, electrical activity within the brain appears to be within normal limits. Currently, there are no medications available to specifically manage PNES (Hingray et al., 2017). Although studies focused on the impact of psychological interventions for PNES are limited, cognitive behavioral therapy (CBT) approaches appear to be effective (LaFrance et al., 2014). Prior exposure to a traumatic event is common for patients with PNES (Brown & Reuber, 2016; Myers et al., 2017). Cognitive Processing Therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). CPT is effective for a variety of traumatic experiences, and asks patients to address avoidance (e.g., of situations, emotions) and challenge maladaptive thought patterns (Resick et al., 2017). In this case study, a 29-year-old Caucasian female patient presented for treatment with comorbid PTSD and PNES. Current PTSD diagnosis was indicated by self-reported and clinician-administered assessment, which included the Clinician Administered PTSD Scale for DSM-5 (CAPS-5 = 52 out of 80) and the PTSD Checklist for DSM-5 (PCL-5 = 59 out of 80). This patient’s Criterion A trauma involved repeated domestic sexual assault as an adult, which occurred for several years. PNES was diagnosed approximately 1 year prior by a neuropsychologist. At the start of treatment, the patient endorsed PNES almost daily, which prevented her from maintaining a job or driving a vehicle. The patient was an early and successful responder to CPT, as she participated in 8 of 12 sessions. In addition to significantly lower self-reported PTSD and depressive symptom severity (PCL-5 = 5; PHQ-9 = 2), she did not experience PNES in the 17 days leading up to her final session. As the patient’s avoidance of distressing trauma-related thoughts and emotions decreased, so too did her PNES. This case study provides neurologists with a promising treatment approach for patients with PNES and PTSD.     

Effectiveness of an Educational and Support Program for Family Members of a Substance Abuser

Abstract

This paper investigates the relationship between marital adjustment and congruency of couple preference regarding wife employment. Implications for marriage and family therapists are emphasized. Husband, wife, and couple scores were obtained on the Marital Status Inventory and Dyadic Adjustment Scale for eight work pattern categories. The first four (Dual-Career, Dual-Work, Pre-Dual-Career, Traditional Single-Career) were current couple work patterns perceived as desirable by both spouses. The last four categories (Incongruent Dual-Career, Incongruent Dual-Work, Incongruent Pre-Dual-Career, Incongruent Traditional Single-Career) were current couple work patterns that one spouse, in conflict with the other spouse, perceived as undesirable. In addition, number and ages of children and number of wife work hours were analyzed for their effects on marital adjustment in these couples. The results of this study indicate that marital adjustment is negatively influenced only when the wife wants to work in her career, is not employed, and her husband does not want her to be employed now or in the future. Possible reasons for these findings and suggestions for further research are included.     

Predictors and Moderators of Provoked Vestibulodynia Treatment Outcome Following a Randomized Trial Comparing Cognitive-Behavioral Couple Therapy to Overnight Lidocaine

Provoked vestibulodynia is a vulvar pain condition causing sexual dysfunction, affecting 8% to 10% of women. Our recently published randomized clinical trial (N = 108 couples) found that cognitive behavioral couple therapy (CBCT) and topical lidocaine reduced women’s pain and associated sexual symptoms, with CBCT showing more benefits. Little is known about pretreatment predictors of treatment outcomes in couples sex therapy. In the current study, we examined women and their partners’ pretreatment demographic (age, relationship length), clinical (pain duration, anxiety) and interpersonal (partner responses to pain, sexual goals) predictors/moderators of women’s pain intensity, pain unpleasantness, and sexual function at posttreatment and 6-month follow-up. Longer relationship duration, lower anxiety in women, partner higher solicitousness and partner higher approach sexual goals predicted better pain outcomes for women with PVD irrespective of treatment condition. CBCT was more effective than lidocaine for improving women’s sexual function at posttreatment when, at pretreatment, women had partners with higher anxiety and women reported lower approach sexual goals, whereas lidocaine was more effective for improving women’s sexual function at follow-up when partners had higher approach sexual goals. Findings can assist clinicians in determining what treatment will be most beneficial for whom.     

Rousseau on Sex-Roles,Education and Happiness

Over the last decade, philosophers of education have begun taking a renewed interest in Rousseau’s educational thought. This is a welcome development as his ideas are rich with educational insights. His philosophy is not without its flaws, however. One significant flaw is his educational project for females, which is sexist in the highest degree. Rousseau argues that females should be taught to “please men…and make [men’s] lives agreeable and sweet.” The question becomes how could Rousseau make such strident claims, especially in light of his far more insightful ideas concerning the education of males. This paper attempts to make sense of Rousseau’s ideas on the education of females. While I maintain that Rousseau’s project for Sophie ought to be rejected, I argue that we should try to understand how this otherwise insightful thinker could make such surprising claims. Is it a bizarre inconsistency in his philosophical reasoning or an expression of his unabashed misogyny, as so many have claimed? I argue that it is neither. Rather, it is a product of his conception of human happiness and his belief in the irreducible role human sexual relations has in achieving and prolonging that happiness. For Rousseau, sex, love and happiness are inextricably connected, and he believes that men and women will be happiest when they inhabit certain sex roles—not because sex roles are valuable in themselves, but because only through them can either men or women hope to be happy.     

Relationship quality of persons with obstructive sleep apnoea syndrome

In the field of sleep disorders, the quality of couple relationship is arousing increasing attention, given its implications for quality of life and treatment adherence. The aim of the present study was to evaluate relationship quality in a sample of treated or untreated patients with Obstructive Sleep Apnoea Syndrome. Eighty-seven patients were recruited in a hospital-based Centre for Sleep Medicine. Subjects were administered the Dyadic Adjustment Scale (DAS) to evaluate relationship quality, and the Epworth Sleepiness Scale (ESS). Apnoea-hypopnoea indexes (AHI) were collected through nocturnal polysomnography or home testing with a portable monitoring device. Although the DAS average scores were similar to local normative values, relationship quality was significantly lower in the untreated patients when compared with the ones treated. The ESS scores showed a negative correlation with many DAS scores, whereas no significant correlation emerged for AHI. Such data suggest a significant impact of perceived sleep apnoea symptoms on marital satisfaction, even though in the absence of striking differences between the whole sample and the general population.     

Partnerschaften von Sexualstraftätern

Intimate relationships of convicted and released sexual offenders have hardly been the topic of systematic research. This article presents a systematic review of this topic. Only nine articles were found in a systematic literature search which investigated this topic with qualitative and quantitative methods. These studies were dominated by the determination of multiple deficits in the sexual offenders, such as intimacy and empathy problems, high frequencies of conflicts and aggression in the relationships as well as social isolation of the female partners. The female partners of sexual offenders also showed a high tendency to denial and minimization similar to the offenders and blamed the victims for the offence. The women seemed to like their status as a “martyred wife” and gave their husbands a “second chance in life”. However, the currently available studies have barely investigated the “sexual offender couple” and the dynamics of their relationship to elucidate stabilizing factors. In a pilot study on the topic of “partnerships of sexual offenders” 17 “sex offender couples” were questioned by interviews and questionnaires to collate the dynamics of the partnership, which was published in the Journal of Sex and Marital Therapy. In the quantitative results it was found that the female partners of sex offenders predominantly demonstrated an insecure preoccupied attachment style and this influence on the relationship stability is discussed. Further studies are needed in this field of research to gain detailed data of “sex offender couples” for relapse prevention and therapeutic implications.     

Please May I Have a Bike? Better Yet, May I Have a Hug? An Examination of Children’s and Adolescents’ Happiness

Academic research on children’s and adolescents’ happiness has been slow to develop. This research provides an empirical investigation to answer the question, “What makes children and adolescents happy?” We explore this question in two studies with a total of 300 participants ages 8–18. Study 1 asks participants to answer the open-ended question, “What makes me happy?” There were five emergent themes—“people and pets,” “achievements,” “material things,” “hobbies,” and “sports”. Study 2 also asks participants to answer the question, “What makes me happy?”, but uses two different measures (a semi-structured thought listing task and a collage task). Using three different happiness measures, we found consistent age differences in what children perceive to make them happy.     

Intensive,Multi-Couple Group Therapy for PTSD: A Nonrandomized Pilot Study With Military and Veteran Dyads

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients’ self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients’ PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD.     

Improving Young Male Couples’ Sexual and Relationship Health in the 2GETHER Program: Intervention Techniques,Environments of Care,and Societal Considerations

Young male couples are at high risk for acquiring human immunodeficiency virus (HIV). However, few HIV prevention programs meet the needs of young male couples that express an interest in how to maintain healthy relationships. As such, we developed 2GETHER, a couple-based program that integrates HIV risk reduction and sexual health information into a relationship education program specific to young male couples. 2GETHER was guided by cognitive-behavioral theories of HIV risk reduction and relationship functioning and was informed by a social–ecological perspective to address factors within and outside the couple that can impact sexual and relationship health. As a micro-level intervention, 2GETHER intervenes directly with couples via psychoeducation and cognitive-behavioral strategies to change couples’ communication patterns, sexual health behaviors, and relationship satisfaction. Successful implementation of 2GETHER requires mezzo-level interventions that create an affirming environment of care for sexual minority individuals and facilitators who are culturally competent in working with young male couples. Although macro-level interventions to change societal acceptance of and policies germane to sexual minority couples are beyond the scope of 2GETHER, we discuss how clinicians can advocate for systemic changes to improve sexual minority couples’ health, and how 2GETHER addresses the impact of such macro-level factors on the couple’s relationship. Our experience developing and testing 2GETHER indicates that HIV prevention programs for young male couples should reflect the unique contexts shaping sexual minority individuals’ relationships and lives, and that programs should intervene within and across multiple levels when possible to improve health for sexual minority men.     

Characters named Charles or Charley in novels by Charles Dickens

12 fictional characters named Charles or Charley are contained in eight of the 14 completed novels by Charles Dickens. Most of the author's namesakes have humorous attributes, an unusually close relationship with one or more other characters, and a happy subsequent life. Three stages of the author's adult life are youthful, mature, and after separation from his wife. The fictional namesakes are most humorous in the author's youthful stage and least humorous after separation from his wife. The 12 fictional namesakes of Charles Dickens are compared with the two fictional namesakes of Jane Austen.     

Improving Personal Happiness Through Couple Intervention: A Randomized Controlled Trial of a Self-directed Couple Enhancement Program

Although personal happiness is highly associated with social relationships, basic questions remain regarding the causal effect of improved social relationships on happiness. The main aim of this study was to test whether emotional and cognitive dimensions of personal happiness can be increased by means of a self-directed relationship enhancement program, which aims to increase relationship-relevant skills such as dyadic coping, communication, and conflict resolution. N = 220 couples were randomly assigned either to an intervention or to a waiting list control group (survey: pre-, post-, 3- and 6-month follow-ups). Multi-group latent change score models reveal that (1) personal happiness can be increased through a couple intervention; (2) change in personal happiness was predicted by an increase in skills and relationship satisfaction through the intervention; (3) the least happy participants benefited most from the intervention. Improving spousal interactions may help people become and stay happier. Participants in this study did not relapse to their set point of personal happiness as could be expected by adaptation theory. Thus, not treating individuals directly, but rather the dynamic system of spousal interactions as a whole, offers a potentially very powerful area for happiness research.