Implementing Behavioral Couples Therapy for Substance Use Disorders in Real-World Clinical Practice.

Behavioral couple therapy (BCT) is an evidence-based, manualized treatment that has been primarily developed to treat alcohol use disorder. The treatment model leverages the intimate partner relationship to support recovery. Although the efficacy of BCT is well-supported in randomized controlled trials, little attention has been given to the translation of BCT to everyday practice settings. This article presents recommendations for implementing BCT in such settings. We describe a stepwise approach for getting a couple into BCT and determining whether it is an appropriate treatment for the couple. In addition, we provide recommendations for broadening inclusion criteria for everyday practice settings, including the use of BCT with couples who have drug use disorders with couples where both members exhibit substance use disorders and with couples who choose controlled drinking or drug use versus abstinence. Whereas BCT has mostly been researched in speciality substance use disorder settings, we provide recommendations for its use in general couple therapy settings. Based upon the extant research, we suggest implementing BCT as a standalone treatment or as an add-on to individual counseling for substance use disorders. We provide guidance for delivering BCT through telehealth and encourage future research to investigate this delivery modality. Future research should prioritize investigating the effectiveness of various BCT dissemination strategies and seek to determine what dosage and components of BCT will result in the best outcomes.

La terapia conductual de pareja (TCP) es un tratamiento factual y estandarizado que se ha desarrollado principalmente para tratar el trastorno por consumo de alcohol. El modelo de tratamiento aprovecha la relación de pareja para ayudar a la recuperación. Aunque la eficacia de la TCP está bien respaldada en ensayos controlados aleatorizados, se ha prestado poca atención al traslado de la TCP a los entornos de la práctica diaria. Este artículo presenta recomendaciones para implementar la TCP en dichos entornos. Describimos un método gradual para introducir a una pareja en la TCP y determinar si es un tratamiento adecuado para ella. Además, ofrecemos recomendaciones para ampliar los criterios de inclusión para los entornos de la práctica diaria, incluido el uso de la TCP con parejas que tienen trastornos por consumo de sustancias, con parejas donde ambos miembros presentan trastornos por consumo de sustancias y con parejas que eligen beber o consumir drogas de manera controlada en lugar de la abstinencia. Si bien la TCP se ha investigado principalmente en entornos especializados en trastornos por consumo de sustancias, ofrecemos recomendaciones para su uso en entornos de terapia de pareja general. Sobre la base de las investigaciones existentes, sugerimos implementar la TCP como tratamiento autónomo o como complemento de la terapia individual para trastornos por consumo de sustancias. Brindamos orientación para implementar la TCP mediante telesalud e incentivamos futuras investigaciones para estudiar esta modalidad de atención. Las futuras investigaciones deben priorizar el estudio de la eficacia de diferentes estrategias de difusión de la TCP y determinar qué dosis y qué componentes de la TCP producirán mejores resultados.

Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature.

INTRODUCTION: Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a 'gold standard' treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT. AIMS: The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment. METHOD: A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators. RESULTS: The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender. CONCLUSIONS: The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.

Efficacy of Behavioral Couples Therapy Versus Individual Recovery Counseling for Addressing Posttraumatic Stress Disorder Among Women With Drug Use Disorders.

Behavioral couples therapy (BCT) for substance use disorder shares similar intervention strategies with empirically supported couples therapies for posttraumatic stress disorder (PTSD). Like couples-based PTSD therapies, BCT includes interventions that may help to improve PTSD, such as increasing positive behavioral exchanges and improving communication. Studies have yet to examine whether BCT, which has demonstrated efficacy for improving substance-related outcomes, is efficacious for reducing PTSD. We conducted a secondary analysis of a randomized clinical trial comparing individually based treatment (IBT) to BCT plus IBT (BCT+IBT) for women with drug use disorders. Women in both conditions received 26 therapy sessions over 13 weeks. Women completed the PTSD Diagnostic Scale at baseline, posttreatment, and quarterly during the 1-year follow-up. Of the 61 women who were randomized to treatment, 51 (83.6%) reported a lifetime traumatic event. Of the 50 women who endorsed a "worst traumatic event," 25 (50.0%) had a baseline PTSD diagnosis. The treatments did not differ on baseline PTSD severity or diagnosis. Women who received BCT+IBT had significant reductions in PTSD severity from baseline to each of four posttreatment follow-ups, ds = 0.34-0.80; there were no changes in the IBT group. Generalized estimating equation results showed that women who received BCT+IBT had significantly lower PTSD severity during follow-up versus those who received IBT, d = 0.35. There were no differences in the proportion of participants diagnosed with PTSD following treatment. This was the first study to show that BCT+IBT is efficacious for reducing PTSD among women with drug use disorders.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Eficacia de la Terapia conductual de pareja frente a la Consejería de recuperación individual para tratar el TEPT entre las mujeres con Trastornos de Uso de Drogas. ABUSO DE DROGAS EN MUJERES Y TEPT La terapia conductual de pareja (TCP) para el trastorno por consumo de sustancias comparte estrategias de intervención con apoyo empírico similares a la terapia de pareja para el trastorno de estrés postraumático (TEPT). Al igual que las terapias de pareja basadas en TEPT, la TCP incluye intervenciones que pueden ayudar a mejorar el TEPT, como el aumento de los intercambios conductuales positivos y la mejora de la comunicación. Los estudios aún no han examinado si la TCP, la cual ha demostrado ser eficaz para mejorar los resultados relacionados con sustancias, es eficaz para reducir el TEPT. Se realizó un análisis secundario de un ensayo clínico aleatorio que comparó el tratamiento individualizado (TI) con la TCP más la TI (TI+ TCP) para las mujeres con trastornos por el consumo de drogas. Las mujeres en ambas condiciones recibieron 26 sesiones de terapia durante 13 semanas. Las mujeres completaron la Escala de Diagnóstico del TEPT al inicio, después del tratamiento y trimestralmente durante el seguimiento de un año. De las 61 mujeres que fueron asignadas al azar al tratamiento, 51 (83.6%) reportaron un evento traumático en la vida. De las 50 mujeres que señalaron un "peor evento traumático", 25 (50.0%) tuvieron un diagnóstico inicial de TEPT. Los tratamientos no difirieron según la gravedad o el diagnóstico inicial del TEPT. Las mujeres que recibieron TCP +TI tuvieron reducciones significativas en la gravedad del TEPT desde el inicio hasta cada uno de los cuatro seguimientos posteriores al tratamiento, ds = 0.34 - 0.80; no hubo cambios en el grupo de TI. Los resultados de la ecuación de estimación generalizada mostraron que las mujeres que recibieron TCP+TI tuvieron una gravedad de TEPT significativamente menor durante el seguimiento en comparación con las que recibieron TI, d = 0.35. No hubo diferencias en la proporción de participantes diagnosticados con TEPT después del tratamiento. Este fue el primer estudio en mostrar que la TCP +TI es eficaz para reducir el TEPT entre las mujeres con trastornos por el uso de drogas.

Examination of the World Health Organization Disability Assessment System as a Measure of Disability Severity Among Veterans Receiving Cognitive Processing Therapy.

Cognitive processing therapy (CPT) is effective for reducing posttraumatic stress disorder (PTSD) and depression among military veterans. However, studies have not examined whether CPT is associated with reductions in disability severity. The current study examines the association between disability severity and PTSD and depression among U.S. veterans who are receiving CPT. Veterans completed measures at pre- and posttreatment and received CPT through a Veterans Affairs PTSD outpatient (n = 155) or residential (n = 177) program. The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 was used to assess disability severity. The WHODAS 2.0 scores were positively correlated with clinician- and veteran-rated PTSD and veteran-rated depression at pre- and posttreatment (r = .22 to. 60). Compared with outpatients, veterans in residential treatment had worse scores on the WHODAS Mobility scale (ηp2 = .03), but on no other WHODAS 2.0 scales. Pre- to posttreatment reductions were found on all WHODAS 2.0 subscales (ηp2 = .03 to .15). Reductions in PTSD and depression were positively associated with improvements on the WHODAS 2.0 Summary scale and most subscales (r = .22 to. 52). Findings suggest that the WHODAS 2.0 is a promising disability severity measure for veterans in PTSD treatment. Findings also suggest that CPT may help veterans to achieve reductions in disability severity.

Couple Treatment for Alcohol Use Disorder and Posttraumatic Stress Disorder: Pilot Results From U.S. Military Veterans and Their Partners.

We studied 13 U.S. male military veterans and their female partners who consented to participate in an uncontrolled trial of couple treatment for alcohol use disorder and posttraumatic stress disorder (CTAP). CTAP is a 15-session, manualized therapy, integrating behavioral couples therapy for alcohol use disorder (AUD) with cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Due to ineligibility (n = 1) and attrition (n = 3), 9 couples completed the study, and 7 completed 12 or more sessions. There were 8 veterans who showed clinically reliable pre- to posttreatment reduction of PTSD outcomes. There were also significant group-level reductions in clinician-, veteran-, and partner-rated PTSD symptoms (d = 0.94 to 1.71). Most veterans showed clinically reliable reductions in percentage days of heavy drinking. Group-level reduction in veterans' percentage days of heavy drinking was significant (d = 1.01). There were 4 veterans and 3 partners with clinically reliable reductions in depression, and group-level change was significant for veterans (d = 0.93) and partners (d = 1.06). On relationship satisfaction, 3 veterans and 4 partners had reliable improvements, and 2 veterans and 1 partner had reliable deterioration. Group-level findings were nonsignificant for veteran relationship satisfaction (d = 0.26) and for partners (d = 0.52). These findings indicate that CTAP may be a promising intervention for individuals with comorbid PTSD and AUD who have relationship partners.

Associations between perceived social reactions to trauma-related experiences with PTSD and depression among veterans seeking PTSD treatment.

The Social Acknowledgment Questionnaire (SAQ; Maercker & Mueller, ) is a measure of trauma survivors' perceptions of social acknowledgment and disapproval from others, and these factors are shown to be associated with posttraumatic stress disorder (PTSD) among civilian trauma survivors. This study seeks to validate the structure of the SAQ among U.S. military veterans and test the hypothesis that family and general disapproval are associated with PTSD and depression among veterans. Participants were 198 U.S. veterans who experienced military trauma and completed an intake evaluation through a Veterans Affairs PTSD treatment program. Structural equation modeling (SEM) results supported a well-fitting 3-factor model for the SAQ that was similar to prior studies in capturing the constructs of social acknowledgment, general disapproval, and family disapproval. SEM results also showed that all 3 of the SAQ factors were associated with veterans' depression (-.31, .22, and .39, respectively), whereas only general disapproval was related to veterans' PTSD. This is the first study of which we are aware to investigate the factor structure of the SAQ in a veteran sample and to investigate the relationship between SAQ factors and trauma survivors' depression. Results build upon prior findings by showing the importance of positive and negative social reactions to veterans' traumatic experiences.

Comparing response to cognitive processing therapy in military veterans with subthreshold and threshold posttraumatic stress disorder.

Research suggests that subthreshold posttraumatic stress disorder (PTSD) symptomatology is associated with increased risk for psychological and functional impairment, including increased risk for suicidal ideation. However, it does not appear that any studies to date have investigated whether subthreshold PTSD can effectively be treated with evidence-based, trauma-focused treatment. Accordingly, we tested response to cognitive processing therapy (CPT) in 2 groups of military veterans receiving care at a VA outpatient specialty clinic, 1 with subthreshold PTSD at pretreatment (n = 51) and the other with full, diagnostic PTSD (n = 483). Multilevel analysis revealed that both groups experienced a significant decrease in PTSD symptoms over the course of therapy (the full and subthreshold PTSD groups experienced an average decrease of 1.79 and 1.52 points, respectively, on the PTSD Checklist with each increment of time, which was coded from 0 at pretreatment to 13 at posttreatment). After controlling for pretreatment symptom severity, a between-groups difference was not found. These results suggest that CPT is an effective form of treatment among military veterans, and that its effectiveness does not differ between subthreshold and threshold groups.

Relationship-Oriented Recovery System for Youth (RORSY): Clinical Protocol for Transition-Age Youth with Opioid Use Disorders.

This article introduces the Relationship-Oriented Recovery System for Youth (RORSY) protocol, which is designed to increase uptake of Medications for Opioid Use Disorder (MOUD) and related services among adolescents and young adults. Youth exhibit alarmingly poor rates of MOUD initiation and adherence, OUD services involvement and long-term recovery success. RORSY attends to three developmentally unique recovery needs of this age group: assess and bolster youth recovery capital, prioritize involvement of concerned significant others, and use digital direct-to-consumer recovery supports. RORSY contains five evidence-informed intervention modules that can be flexibly tailored to meet the individual and relationship needs of a given youth: Relational Orientation, Youth Recovery Management Planning, Relational Recovery Management Planning, Relationship Skills Building, and Digital Recovery Support Planning. The article concludes with practice and policy recommendations for making relationship-building a top clinical priority for addressing youth OUD.

Actor and partner effects of PTSD and relationship functioning in a recently traumatized sample.

A robust negative association exists between self-reported posttraumatic stress disorder (PTSD) and self-reported interpersonal relationship functioning. However, the extent to which each member of a dyad's subjective PTSD ratings influence the other's subjective relationship functioning ratings is less understood. The present study tested: (a) associations between self- and partner-PTSD severity ratings and relationship functioning ratings and (b) whether exposure to the index trauma, gender, and relationship type (i.e., intimate vs. nonintimate dyad) moderated these associations in a sample of 104 dyads of individuals with PTSD and a close significant other. Each partners' ratings of PTSD severity were uniquely and positively associated with their own (actor) and their partner's ratings of relationship conflict, but not support or depth. Gender moderated the partner effect; women's (but not men's) subjective PTSD severity were positively associated with their partners' subjective relationship conflict. There was a relationship type by actor effect interaction for relationship support, which indicated that perceptions of PTSD severity were negatively associated with each partner's perceptions of relationship support for intimate but not nonintimate dyads. Results support a dyadic conceptualization of PTSD in which both partners' perception of symptoms are important for relationship functioning. Conjoint therapies may be particularly potent for PTSD and relationship functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Couple and family therapy for substance use disorders: Evidence-based update 2010-2019.

This article updates the evidence-based on couple and family therapy interventions for substance use disorders (SUD) since publication of the previous JMFT reviews in 2012. It first summarizes previous reviews along with findings from more recent reviews and meta-analytic studies. It then presents study design and methods criteria used to select 13 studies of couple and family therapy for level of support evaluation. Cumulative level of support designations are then determined for identified treatment approaches. Findings indicate that systemic family therapy is well-established as a standalone treatment, and behavioral family therapy and behavioral couple therapy are probably efficacious as standalone treatments and well-established as part of a multicomponent treatment. The article then suggests practice guidelines with regard to treatment modality considerations and implementation challenges. It concludes with future directions for delivering couple and family interventions in routine systems of care for SUD.

A comparison of psychosocial adjustment among children of women who received behavioral couples therapy versus individually based therapy for substance use disorder.

BACKGROUND: Children of women with substance use disorder (SUD) exhibit elevated risk for psychosocial adjustment problems. However, little research has examined whether women's SUD treatment is beneficial for their children. In comparison to individually based therapy (IBT), behavioral couples therapy (BCT) is superior for reducing women's SUD problems and improving their intimate partner relationships. The current study sought to examine whether BCT is more efficacious than 12-step-oriented IBT for reducing psychosocial adjustment problems among the children of women with SUD. METHODS: The study obtained the data from two larger randomized clinical trials, both of which compared BCT plus IBT versus IBT alone for women with SUD. Participants were women (N = 75) and their male partners who had an identified target child between the ages of 6 and 16 years old (M = 10.63). Most (62%) were the biological child of both partners, and 92% lived with the couple. Both partners completed the Child Behavior Checklist (CBCL) in relation to the target child at baseline, post-treatment, and 6-month follow-up. RESULTS: Comparisons of CBCL scores from baseline to following treatment mostly showed significant improvement in BCT + IBT but not IBT. Generalized estimating equations, which controlled for baseline CBCL, showed better retainment of treatment gains for mother-reported internalizing CBCL scores in BCT + IBT, but the study found no other between treatment differences. CONCLUSION: These findings suggest that BCT + IBT produces more consistent improvements for children of women with SUD versus IBT.

Exploring the efficacy of a residential treatment program incorporating cognitive processing therapy-cognitive for veterans with PTSD and traumatic brain injury.

As the numbers of military personnel participating in the wars in Afghanistan and Iraq continue to grow, the percentage of individuals who return with both a traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) also increases. Although there appears to be significant overlap in the symptoms resulting from PTSD and TBI, the best course of treatment remains an area of controversy. The authors present initial findings from a Veterans Administration residential program for comorbid PTSD and TBI. Forty-two participants completed a program comprising psychoeducational groups and cognitive skill building that was augmented with a modification of standard cognitive processing therapy. The results suggest that residential programs that incorporate this form of cognitive therapy can anticipate meaningful participation from patients, and that it may be an effective approach to treat PTSD in individuals with a history of TBI.

Disengagement coping as a mediator between trauma-related guilt and PTSD severity.

This study examined disengagement coping as a partial mediator between trauma-related guilt and severity of posttraumatic stress disorder (PTSD) in a sample of veterans (N = 175) entering residential PTSD treatment with either PTSD or subthreshold PTSD. Disengagement coping partially mediated the relationship between guilt and self-reported PTSD severity (b = .07; 95% CI = [-.003, .13]; p = .06), but did not mediate the relationship when PTSD severity was based on clinicians' ratings. These findings bolster Street, Gibson, and Holohan's (2005) contention that higher guilt-related cognitions are related to increases in the use of disengagement coping strategies, which can interfere with PTSD recovery. The findings support the importance of PTSD treatments that target reductions in guilt-related cognitions and disengagement coping strategies.

A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy.

The current wars in Iraq and Afghanistan are producing large numbers of veterans who have experienced a variety of combat stressors. The potential impact of combat exposure has been established, including significant rates of posttraumatic stress disorder (PTSD). Limited research has examined potential differences between veteran groups and one study to date has examined differences between eras in terms of treatment response. The present study seeks to examine cohort differences between Operation Enduring Freedom and Operation Iraqi Freedom veterans and Vietnam veterans (N = 101) before and after completing treatment for PTSD using cognitive processing therapy. Findings suggest that veterans from these eras responded differently to treatment and there are multiple variables that should be considered in future cohort studies.

Associations among disaster exposure, intimate relationship adjustment, and PTSD symptoms: can disaster exposure enhance a relationship?

This study examined associations among disaster characteristics, relationship adjustment, and posttraumatic stress disorder (PTSD) symptomatology 9 months postdisaster in 205 women exposed to extensive flooding. Bivariately, threat/harm and loss exposure dimensions were related to each other but differentially related to relationship adjustment and PTSD symptoms. Results from structural equation modeling revealed a positive and significant direct association between threat/harm and PTSD symptoms. Conversely, loss was not significantly associated with PTSD symptoms, but was positively and significantly associated with relationship adjustment. Relationship adjustment was negatively and significantly related to PTSD symptoms. These data suggest that some aspects of disaster exposure can have a mobilizing and positive effect on intimate relationships. In turn, positive intimate relationships may buffer individuals against PTSD symptoms.

Group Versus Standard Behavioral Couples' Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness.

OBJECTIVE: The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners--group behavioral couples' therapy plus individual-based treatment (G-BCT), or standard behavioral couples' therapy plus individual-based treatment (S-BCT). METHOD: We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS: The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS: As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples' therapy.

Family-of-origin maltreatment, posttraumatic stress disorder symptoms, social information processing deficits, and relationship abuse perpetration.

In this study, the authors examined the interrelations among family-of-origin maltreatment variables, posttraumatic stress disorder (PTSD) symptoms, social information processing deficits, and male-to-female psychological and physical intimate relationship abuse perpetration in adulthood among a community sample of 164 men and their partners. In bivariate analyses, higher family-of-origin childhood parental rejection was associated with the perpetration of psychological and physical abuse in adulthood, and childhood exposure to interparental violence was also associated with adult psychological abuse perpetration. Structural equation modeling analyses indicated that when childhood variables and other study variables were considered together, only childhood parental rejection was associated with the abuse perpetration outcomes, and these effects were indirect through PTSD symptoms and social information processing deficits. Results indicate a need for further investigation into the mechanisms accounting for the impact of early maltreatment on the development of abusive intimate relationship behavior.

Change in posttraumatic stress disorder symptoms: do clinicians and patients agree?

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed.

Partner violence among drug-abusing women receiving behavioral couples therapy versus individually-based therapy.

INTRODUCTION: Studies have found reductions in female-to-male (F-to-M) and male-to-female (M-to-F) intimate partner violence (IPV) following alcohol-related treatment. Despite high prevalence of IPV among drug-abusing women, there are no controlled studies examining IPV following drug-related treatment for women. This is a secondary analysis of a randomized clinical trial comparing behavioral couples therapy plus individually-based treatment (BCT + IBT) versus individually-based treatment (IBT) for drug-abusing women and their male partners (N = 61; see O'Farrell, Schumm, Murphy, & Muchowski, 2017). We hypothesized that both treatments would have reductions in F-to-M and M-to-F IPV, but reductions would be greater in BCT + IBT. MATERIAL AND METHODS: Women were mostly White, and all exhibited drug use disorders (74% opioid use disorder). Forty-five percent had a male partner with a current substance problem. The Revised Conflict Tactics Scales (CTS2) were administered at baseline and 12-months after treatment (85% follow-up rate). RESULTS: Psychological aggression frequency and F-to-M physical assault declined in both treatments. M-to-F physical assault, M-to-F sexual coercion, and female and male injury declined in IBT. However, these outcomes did not change in BCT + IBT. Thus, results showed that IBT, but not BCT + IBT, reduced M-to-F physical assault and M-to-F sexual coercion. Contrary to our hypothesis, IBT was lower than BCT + IBT on F-to-M and M-to-F physical assault, M-to-F sexual coercion, and female injury. M-to-F physical assault frequency was lower at follow-up if the male partner had versus did not have a current substance problem. CONCLUSIONS: BCT + IBT and IBT are viable interventions for reducing both partners' psychological aggression and F-to-M physical assault frequency among drug-abusing women and their male partners. IBT is promising for reducing M-to-F physical assault and female physical injury. There appears to be greater risk of M-to-F physical assault when the female but not male partner is substance-abusing.

Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans.

This study examined the association between posttraumatic stress disorder (PTSD) symptomatology and aggressive behavior among a sample of male Vietnam veterans (N = 1,328). Results indicated that the hyperarousal PTSD symptom cluster evidenced the strongest positive association with aggression at the bivariate level when compared with the other PTSD symptom clusters. When the PTSD symptom clusters were examined together as predictors, hyperarousal symptoms evidenced a significant positive relationship with aggression, and avoidance/numbing symptoms were negatively associated with aggression. Examination of potential mediators indicated that hyperarousal symptoms were directly associated with aggression and indirectly related to aggression via alcohol problems. Reexperiencing symptoms were associated with aggression only indirectly and through their positive association with physiological reactivity and negative association with alcohol problems. Study results highlight the complexity of the relationship between PTSD symptoms and aggression, and suggest possible mechanisms explaining this association.