The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder

Deborah A. Perlick; Frederic J. Sautter; Julia J. Becker-Cretu; Danielle Schultz; Savannah C. Grier; Alexander V. Libin; Manon Maitland Schladen; Shirley M. Glynn

doi:10.1186/s40779-017-0130-9

Your Location：

Home >

Browse articles >

The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder

REVIEW | Updated：2026-03-12

- The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder
- Military Medical Research Vol. 4, Issue 4, Pages: 218-228(2017)
- Affiliations：
  
  1.JJPeters Department of Veterans Affairs Medical Center and VISN2 South Mental Illness Research, Education and Clinical Center, 130 West Kingsbridge Rd, Bronx, NY 10468, USA
  2.Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
  3.Southeast Louisiana Veterans Health Care System, 1601 Perdido St, New Orleans, LA 70112, USA
  4.Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
  5.Research and Development, Washington DC VA Medical Center, 50 Irving St NW, Washington, DC 20422, USA
  6.Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007, USA
  7.VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
  8.David Geffen School of Medicine, UCLA, 10833 LeConte Ave #12138, Los Angeles, CA 90095, USA
- Author bio：
  
  *: deborah.perlick@va.gov
- Funds：
- DOI：10.1186/s40779-017-0130-9
  CLC：
- Published：2017-12
- Accepted：
Scan QR Code
Perlick et al.: The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder. Mil Med Res, 2017, 4: 21
DOI：

Perlick et al.: The incorporation of emotion-regulation skills into couple- and family-based treatments for post-traumatic stress disorder. Mil Med Res, 2017, 4: 21 DOI： 10.1186/s40779-017-0130-9.

摘要

Abstract

Post-traumatic stress disorder (PTSD) is a disabling

potentially chronic disorder that is characterized by re-experience and hyperarousal symptoms as well as the avoidance of trauma-related stimuli. The distress experienced by many veterans of the Vietnam War and their partners prompted a strong interest in developing conjoint interventions that could both alleviate the core symptoms of PTSD and strengthen family bonds. We review the evolution of and evidence base for conjoint PTSD treatments from the Vietnam era through the post-911 era. Our review is particularly focused on the use of treatment strategies that are designed to address the emotions that are generated by the core symptoms of the disorder to reduce their adverse impact on veterans

their partners and the relationship. We present a rationale and evidence to support the direct incorporation of emotion-regulation skills training into conjoint interventions for PTSD. We begin by reviewing emerging evidence suggesting that high levels of emotion dysregulation are characteristic of and predict the severity of both PTSD symptoms and the level of interpersonal/marital difficulties reported by veterans with PTSD and their family members. In doing so

we present a compelling rationale for the inclusion of formal skills training in emotional regulation in couple–/family-based PTSD treatments. We further argue that increased exposure to trauma-related memories and emotions in treatments based on learning theory requires veterans and their partners to learn to manage the uncomfortable emotions that they previously avoided. Conjoint treatments that were developed in the last 30 years all acknowledge the importance of emotions in PTSD but vary widely in their relative emphasis on helping participants to acquire strategies to modulate them compared to other therapeutic tasks such as learning about the disorder or disclosing the trauma to a loved one. We conclude our review by describing two recent innovative treatments for PTSD that incorporate a special emphasis on emotion-regulation skills training in the dyadic context: structured approach therapy (SAT) and multi-family group for military couples (MFG-MC). Although the incorporation of emotion-regulation skills into conjoint PTSD therapies appears promising

replication and comparison to cognitive-behavioral approaches is needed to refine our understanding of which symptoms and veterans might be more responsive to one approach versus others.

关键词

Keywords

references

American Psychiatric Association . Diagnostic and statistical manual of mental disorders . 5th edition . Washington, D.C. : American Psychiatric Association ; 2013 .

Evans L , McHugh T , Hopwood M , Watt C . Chronic posttraumatic stress disorder and family functioning of Vietnam veterans and their partners . Aust NZ J Psychiatry . 2003 ; 37 ( 6 ): 765 - 72 .

Management of Post-Traumatic Stress Working Group . VA/DoD clinical practice guideline for management of post-traumatic stress . Washington D. C. : Veterans Health Administration, Department of Defense ; 2010 .

Riggs DS , Byrne CA , Weathers FW , Litz BT . The quality of the intimate relationships of male Vietnam veterans: Problems associated with posttraumatic stress disorder . J Trauma Stress . 2010 ; 11 ( 1 ): 87 - 101 .

Galovski T , Lyons JA . Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran's family and possible interventions . Aggress Violent Behav . 2004 ; 9 ( 5 ): 477 - 501 .

Jordan BK , Marmar CR , Fairbank JA , Schlenger WE , Kulka RA , Hough RL , et al . Problems in families of male Vietnam veterans with posttraumatic stress disorder . J Consult Clin Psychol . 1992 ; 60 ( 6 ): 916 .

Monson CM , Taft CT , Fredman SJ . Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development . Clin Psychol Rev . 2009 ; 29 ( 8 ): 707 - 14 .

Gross JJ , Barrett LF . Emotion generation and emotion regulation: One or two depends on your point of view . Emot Rev . 2011 ; 3 ( 1 ): 8 - 16 .

Sautter FJ , Glynn SM , Thompson KE , Franklin L , Han X . A couple-based approach to the reduction of PTSD avoidance symptoms: Preliminary findings . J Marital Fam Ther . 2009 ; 35 : 343 - 9 .

Perlick DA , Straits-Tröster K , Dyck DG , Norell DM , Strauss JL , Henderson C , et al . Multifamily group treatment for veterans with traumatic brain injury . Prof Psychol Res Pr . 2011 ; 42 ( 1 ): 70 .

Perlick DA , Straits-Troster K , Strauss JL , Norell D , Tupler LA , Levine B , et al . Implementation of multifamily group treatment for veterans with traumatic brain injury . Psychiatr Serv . 2013 ; 64 ( 6 ): 534 - 40 .

Price J , Manson C , Callahan K , Rodriguez J . The role of emotional functioning in military-related PTSD and its treatment . J Anxiety Disord . 2006 ; 20 : 661 - 74 .

Klemanski DH , Mennin DS , Borelli JL , et al . Emotion-related regulatory difficulties contribute to negative psychological outcomes in active-duty Iraq war soldiers with and without posttraumatic stress disorder . Depress Anxiety . 2012 ; 29 ( 7 ): 621 - 8 .

Monson CM , Price JL , Rodriguez BF , Ripley MP , Warner RA . Emotional deficits in military-related PTSD: An investigation of content and process disturbances . J Trauma Stress . 2004 ; 17 ( 3 ): 275 - 9 .

Badour CL , Feldner MT . Trauma-related reactivity and regulation of emotion: Associations with posttraumatic stress symptoms . J Behav Ther Exp Psychiatry . 2013 ; 44 ( 1 ): 69 - 76 .

Ehring T , Quack D . Emotion regulation difficulties in trauma survivors: The role of trauma type and PTSD symptom severity . Behav Ther . 2010 ; 41 ( 4 ): 587 - 98 .

Kulkarni M , Porter KE , Rauch SA . Anger, dissociation, and PTSD among male veterans entering into PTSD treatment . J Anxiety Disord . 2012 ; 26 ( 2 ): 271 - 8 .

Elbogen EB , Wagner HR , Fuller SR , Calhoun PS , Kinneer PM , Beckham JC . Correlates of anger and hostility in Iraq and Afghanistan war veterans . Am J Psychiatry . 2010 ; 167 ( 9 ): 1051 - 8 .

Novaco RW , Chemtob CM . Anger and combat-related posttraumatic stress disorder . J Trauma Stress . 2002 ; 15 ( 2 ): 123 - 32 .

Allen ES , Rhoades GK , Stanley SM , Markman HJ . Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples . J Fam Psychol . 2010 ; 24 ( 3 ): 280 .

Erbes CR , Meis LA , Polusny MA , Compton JS . Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war . J Fam Psychol . 2011 ; 25 ( 4 ): 479 .

Sherman MD , Perlick DA , Straits-Tröster K . Adapting the multifamily group model for treating veterans with posttraumatic stress disorder . Psychol Serv . 2012 ; 9 ( 4 ): 349 .

Carroll EM , Rueger DB , Foy DW , Donahoe CP . Vietnam combat veterans with posttraumatic stress disorder: Analysis of marital and cohabitating adjustment . J Abnorm Psychol . 1985 ; 94 ( 3 ): 329 .

Taft CT , Watkins LE , Stafford J , Street AE , Monson CM . Posttraumatic stress disorder and intimate relationship problems: a meta-analysis . J Consult Clin Psychol . 2011 ; 79 ( 1 ): 22 - 3 .

Tull MT , Barrett HM , McMillan ES , Roemer L . A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms . Behav Ther . 2007 ; 38 ( 3 ): 303 - 13 .

Pietrzak RH , Southwick SM . Psychological resilience in OEF–OIF Veterans: Application of a novel classification approach and examination of demographic and psychosocial correlates . J Affect Disord . 2011 ; 133 ( 3 ): 560 - 8 .

Sayer NA , Noorbaloochi S , Frazier P , Carlson K , Gravely A , Murdoch M . Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care . Psychiatr Serv . 2010 ; 61 ( 6 ): 589 - 97 .

Figley CR . Helping traumatized families . San Francisco : Jossey-Bass ; 1989 . 178 .

Herndon A , Law J . Post-traumatic stress and the family: A multimethod approach to counseling . In: Figley CR , editor . Trauma and its wake . Volume II . New York : Brunner/Mazel ; 1986 . p. 264 - 79 .

Johnson DR , Feldman S , Lubin H . Critical interaction therapy: Couples therapy in combat-related posttraumatic stress disorder . Fam Process . 1995 ; 34 ( 4 ): 401 - 12 .

Jurich AP . The Saigon of the family's mind: Family therapy with families of Vietnam veterans . J Marital Fam Ther . 1983 ; 9 ( 4 ): 355 - 63 .

Marrs R . Why the pain won't stop and what the family can do to help. Posttraumatic stress disorder and the war veteran patient . In: Kelly W . Post-traumatic stress disorder and the war veteran patient . New York : Brunner/Mazel ; 1985 . 85 - 101 .

Rosenheck R , Thomson J . “Detoxification” of Vietnam war trauma: A combined family-individual approach . Fam Process . 1986 ; 25 ( 4 ): 559 - 70 .

Williams CM , Williams T . Family therapy for Viet Nam veterans. Trauma of war: Stress and recovery . In: Sonnenberg SM , Blank AS , Talbott JA , editors . Viet Nam veterans . Washington DC : American Psychiatric Press ; 1985 . 193 - 210 .

Johnson SM , Hunsley J , Greenberg L , Schindler D . Emotionally focused couples therapy: Status and challenges . J Clin Psychol . 1999 ; 6 ( 1 ): 67 - 79 .

Johnson SM , Greenberg LS . The differential effectiveness of experiential and problem solving interventions in resolving marital conflict . J Consult Clin Psychol . 1985 ; 53 ( 2 ): 175 - 84 .

Johnson SM , Greenberg LS . Emotionally focused couples therapy: An outcome study . J Marital Fam Ther . 1985 ; 11 ( 3 ): 313 - 7 .

Mclean LM , Walton T , Rodin G , Esplen MJ , Jones JM . A couple-based intervention for patients and caregivers facing end-stage cancer: Outcomes of a randomized controlled trial . Psycho-Oncology . 2013 ; 22 : 28 - 38 .

Weissman N , Batten SV , Dixon LB , Pasillas RM , Potts W , Decker M , et al . The effectiveness of emotionally focused couples therapy (EFT) with veterans with PTSD . Veterans Affairs National Annual Conference: Improving Veterans Mental Health Care for the 21st Century. Baltimore, MD, 2011. Conference Presentation. In: A Review of the Research in Emotionally Focused Therapy for Couples. Fam Process . 2016 . http://onlinelibrary.wiley.com http://onlinelibrary.wiley.com . Accessed 20 Oct 2016 .

MacIntosh HB , Johnson S . Emotionally focused therapy for couples and childhood sexual abuse survivors . J Marital Fam Ther . 2008 ; 34 ( 3 ): 298 - 315 .

Dalton EJ , Greenman PS , Classen CC , Johnson SM . Nurturing connections in the aftermath of childhood trauma: A randomized controlled trial of emotionally focused couple therapy for female survivors of childhood abuse . CFP . 2013 ; 2 ( 3 ): 209 - 21 .

Greenman PS , Johnson SM . United we stand: Emotionally focused therapy for couples in the treatment of posttraumatic stress disorder . J Clin Psychol . 2012 ; 68 ( 5 ): 561 - 9 .

Erbes CR , Polusny MA , MacDermid S , Compton JS . Couple therapy with combat veterans and their partners . J Clin Psychol . 2008 ; 64 ( 8 ): 972 - 83 .

Jacobson NS , Christensen A . Integrative couple therapy: Promoting acceptance and change . New York : Norton ; 1996 .

Christensen A , Atkins DC , Berns S , Wheeler J , Baucom DH , et al . Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples . J Consult Clin Psychol . 2004 ; 72 ( 2 ): 176 .

Sherman MD , Fischer EP , Sorocco K , McFarlane WR . Adapting the multifamily group model to the Veterans Affairs system: The REACH Program . Prof Psychol Res Pr . 2009 ; 40 ( 6 ): 593 .

McFarlane WR , Lukens E. Link, B , Dushay R , Deakins , et al . Multiple-family groups and psychoeducation in the treatment of schizophrenia . Arch Gen Psychiatry . 1995 ; 52 ( 8 ): 679 - 87 .

Zubin J , Spring B . Vulnerability: A new view on schizophrenia . J Abnorm Psychol . 1977 ; 86 : 103 - 26 .

Glynn SM , Eth S , Randolph E , Foy DW , Urbaitis M , Boxer L , et al . A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder . J Consult Clin Psychol . 1999 ; 67 : 243 - 51 .

Monson CM , Fredman SJ , Macdonald A , Pukay-Martin A , Resick PA , Schnurr PA . Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial . JAMA . 2012 ; 308 : 700 - 9 .

Resick PA , Schnicke M . Cognitive processing therapy for rape victims: A treatment manual . Newbury Park, CA : Sage ; 1993 .

Monson CM , Schnurr PP , Resick PA , Friedman MJ , Young-Xu Y , et al . Cognitive processing therapy for veterans with military-related posttraumatic stress disorder . J Consult Clin Psychol . 2006 ; 74 ( 5 ): 898 - 907 .

Monson CM , Schnurr PP , Stevens SP , Guthrie KA . Cognitive–behavioral couple's treatment for posttraumatic stress disorder: Initial findings . J Trauma Stress . 2004 ; 17 ( 4 ): 341 - 4 .

Schumm JA , Fredman SJ , Monson CM , Chard KM . Cognitive-behavioral conjoint therapy for PTSD: Initial findings for Operations Enduring and Iraqi Freedom male combat veterans and their partners . Am J Fam Ther . 2013 ; 41 ( 4 ): 277 - 87 .

Blake DD , Weathers FW , Nagy LM , Kaloupek DG , Gusman FD , Charney DS , et al . The development of a clinician-administered PTSD scale . J Trauma Stress . 1995 ; 8 ( 1 ): 75 - 90 .

Spanier GB , Cole CL . Toward clarification and investigation of marital adjustment . Int J Sociol Fam . 1976 : 121 – 46 .

Russell JS , Barrett LF . Core affect, prototypical emotional episodes, and other things called emotion: dissecting the elephant . J Pers Soc Psychol . 1999 ; 76 ( 5 ): 805 .

Mennin DS , Heimber RG , Turk CL , Fresco DM . Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder . Clin Psychol . 2002 ; 9 ( 1 ): 85 - 90 .

Koenigs M , Grafman J . Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala . Neuroscientist . 2009 ; 15 ( 5 ): 540 - 8 .

Farnsworth JK , Sewell KW . Fear of emotion as a moderator between PTSD and firefighter social interactions . J Trauma Stress . 2011 ; 24 ( 4 ): 444 - 50 .

Cloitre M , Miranda R , Stovall-McClough KC , Han H . Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse . Behav Ther . 2005 ; 36 ( 2 ): 119 - 124 .

Roemer L , Salters-Pedneault K , Orsillo SM . Incorporating mindfulness-and acceptance-based strategies in the treatment of generalized anxiety disorder . In: Baer RA , editor . Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications . London : Elsevier ; 2006 . 51 - 74 .

Sautter FJ , Glynn SM , Armelie AP , Wielt DB . The development of a couple-based treatment for PTSD in returning veterans . Prof Psychol Res Pr . 2011 ; 42 : 63 - 9 .

Linehan MM , Bohus M , Lynch TR . Dialectical behavior therapy for pervasive emotion dysregulation . In: Gross JJ , editor . Handbook of Emotion Regulation . New York : Guilford Press ; 2007 . 581 - 605 .

Balderrama-Durbin C , Snyder DK , Cigrang J , Talcott GW , Tatum J , Baker M , et al . Combat disclosure in intimate relationships: Mediating the impact of partner support on posttraumatic stress . J Fam Psychol . 2013 ; 7 ( 4 ): 560 .

Monk JK , Nelson Goff BS . Military couples’ trauma disclosure: Moderating between trauma symptoms and relationship quality . Psychol Trauma . 2013 ; 6 ( 5 ): 537 .

Sautter FJ , Glynn SM , Arseneau J , Cretu JB , Yufik T . Structured Approach Therapy (SAT) for PTSD in returning Veterans and their partners: Preliminary findings . Psychol Trauma . 2014 ; 81 : S66 - 72 .

Sautter FJ , Glynn SM , Cretu JB , Senturk D , Vaught AS . Efficacy of structured approach therapy in reducing PTSD in returning veterans: A randomized clinical trial . Psychol Serv . 2015 ; 12 ( 3 ): 199 .

Sautter FJ , Glynn SM , Cretu JB , Senturk D , Armelie AP , Wielt DB . Structured approach therapy for combat-related ptsd in returning u.s. veterans: complementary mediation by changes in emotion functioning . J Trauma Stress . 2016 ; 29 : 384 - 7 .

Linehan MM . Skills training manual for treating borderline personality disorder . New York : Guilford Press ; 1993 .

Fruzzetti AE . The high conflict couple: A dialectical behavior therapy guide to finding peace, intimacy, and validation . Oakland : New Harbinger Publications ; 2006 .

Mueser KT , Glynn SM . Behavioral family therapy for psychiatric disorders . New York : New Harbinger ; 1999 .

Brown WJ , Dewey D , Bunnell BE , Boyd SJ , Wilkerson AK , Mitchell MA , et al . A critical review of negative affect and the application of CBT for PTSD . Trauma Violence Abuse . 2016 : 1 – 19 .

Litz BT , Stein N , Delaney E , Lebowitz L , Nash WP , Silva C , et al . Moral injury and moral repair in war veterans: A preliminary model and intervention strategy . Clin Psychol Rev . 2009 ; 29 ( 8 ): 695 - 706 .

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

Fostering hope and recovery: enhancing psychological resources in military personnel with post-traumatic stress disorder

Gulf War illness with or without post-traumatic stress disorder: differential symptoms and immune responses

Disentangling the effects of PTSD from Gulf War Illness in male veterans via a systems-wide analysis of immune cell, cytokine, and symptom measures

Dementia in military and veteran populations: a review of risk factors—traumatic brain injury, post-traumatic stress disorder, deployment, and sleep

Related Author

Marion Trousselard

Charles Martin-Krumm

Bénédicte Aubet

Faith Nguyen

Ashok K. Shetty

Bénédicte Aubet

Nancy Klimas

Esha Sultana

Related Institution

École du Val de Grâce, 1 Place Laveran

UMR SPIIRE Inserm, Lorraine University

Stress Neurophysiology Unit, Department of Neurosciences and Cognitive Sciences, Institut de Recherche Biomédicale des Armées (IRBA), BP 73

École de Psychologues Praticiens (EPP), 23 rue du Montparnasse

Department of Cell Biology and Genetics, School of Medicine, Institute for Regenerative Medicine, Texas A&M University Health Science Center, 1114 TAMU, Olsen Boulevard

⁰