Helping families cope with PTSD

The harrowing combination of nightmares, flashbacks, hypervigilance, hyperarousal, anger and depression that plagues people with post-traumatic stress disorder (PTSD) is a devastating condition to experience. And it's often overwhelming for family members, too, experts say.

"PTSD tends to wreak havoc on intimate relationships," says psychologist Candice Monson, PhD, deputy director of the women's health sciences division of the National Center for Posttraumatic Stress Disorder.

Indeed, epidemiological evidence fingers PTSD as one of the mental health conditions most likely to lead to relationship problems: Common examples include PSTD sufferers not wanting to attend family or social events for fear they'll be "cornered" by an unforeseen person or circumstance; not sleeping in the same beds as their spouses because of nightmares; inciting relationship conflict due to excess anger and irritability; and overcontrolling their children's behavior, because of unrealistic fears about their youngsters' safety, Monson notes.

Yet while research has shown that PTSD is linked to such problems, little has been done on how it does that, notes psychologist Casey Taft, PhD, staff psychologist in the behavioral science division of the National Center for PTSD. To tackle at least a couple of potential minefields in the area, Taft and Monson are studying interventions that address PTSD in the context of relationship issues.

For one, the team is collaborating with the Centers for Disease Control and Prevention on a five-year study that aims to prevent domestic violence-a phenomenon up to three times more common in veterans with PTSD than among those without it. They will randomly assign 400 couples either to a domestic-violence prevention program or to a supportive-therapy condition.

Monson also has a grant from the National Institute of Mental Health to test a treatment she has developed with couples wherein one or more partners has PTSD. The three-year study will randomize 60 couples either to her intervention-which includes psychoeducation and targeting couple-level behaviors and cognitions that may be maintaining the disorder-or to a wait-list control.

On a clinical level, Huntington, N.Y., trauma expert and private practitioner Elizabeth Carll, PhD, has developed a panoply of approaches to working with families in which a member has PTSD. Her work is drawn from trauma and bereavement research, as well as from clinical knowledge she and others have gleaned from working with families and with people impacted by large-scale disasters, says Carll, editor of the new two-volume "Trauma Psychology: Issues in Violence, Disaster, Health, and Illness" (Praeger, 2007).

Carll's strategies include:

• Teaching stress-management skills.

• Using families' previously effective coping skills to build a framework for present and future resilience.

• Discussing how the traumatized person and family members want to address the event with people outside the family. This concept is particularly important in the case of emotionally loaded traumas such as rape.

• Helping the family to understand that everyone is impacted by the event, even if that is not apparent at first.

• Seeing family members in flexible configurations-individual, dyadic or group level-depending on need and treatment flow.

• Understanding that men and women, as well as individuals, process trauma differently. Women may want to talk about it more, for example, while men may shut down or take their feelings out through exercise or activity. Likewise, not everyone processes trauma in the same way, and recovery times and patterns may vary significantly from person to person, Carll notes.

Carll and Monson agree that psychoeducation about the condition and its treatment is a key strategy practitioners can use to help PTSD clients and their family members heal.

"Providing psychoeducation as a part of individual evidence-based treatment can help significant others understand what their loved one is going through, and help clients engage in and adhere to treatments that work but aren't a piece of cake," Monson says.