A review of couple based interventions for PTSD and relational functioning in military populations and their partners. Empirical study: The association between maladaptive emotion regulation and cause of injury type in UK military veterans with co-occurring TBI and PTSD
Thesis or dissertation
University of Exeter
Reason for embargo
18 months selected in order to publish both the literature review and empirical study.
Literature review: Background: Military-related stressors can adversely affect veterans’ mental health, in particular PTSD. This can have a detrimental impact on intimate relationships and family adjustment. To date, couple based interventions for PTSD and relational functioning in military couples have not been systematically reviewed. Objectives: This review summarises and synthesises literature investigating couple based interventions for PTSD and relational functioning in military couples. Method: A systematic review of all literature to date across 24 databases using an advanced combination of search terms. Ten studies were included (nine USA; one Australian). Results: A wide range of couple based interventions were identified: complementary and alternative therapies (CAM), sport and recreation programmes, retreats, courses as well as structured disorder focused couple therapies. There was preliminary evidence of support for couple based interventions treating PTSD, with relatively stronger support for disorder focused couple therapies over sports and recreation activities, CAM and retreats/courses. There was relatively little support for improved relational functioning assessed in couple based interventions treating PTSD. However, spouses tended to report a greater degree of improved relational functioning compared to veterans. Conclusions: There was relatively stronger evidence to support disorder focused couple therapies over other treatment modalities. However, there was a lack of robust designs used in effectiveness research of couple based interventions in military populations. There is potential for couple based interventions to be effective in treating PTSD in the UK military. Empirical study: Objective: Deployment to the armed conflicts in Afghanistan (Operation HERRICK/Enduring Freedom) and Iraq (Operation TELIC/Iraqi Freedom) can adversely affect the physical and mental health of those deployed. This study explored the association between traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), the mediating effect of maladaptive emotional regulation strategies (MERS) and the effect of cause of injury (no injury, blunt force related or blast force related) in UK military veterans. Methods: 16 month longitudinal follow-up was conducted on a sample of 123 veterans (Murphy et al., 2015). Regression based secondary data analyses investigated the mediating effects of MERS (n=116) whilst correlational analyses explored the effect of injury mechanism on the relationship between TBI severity and PTSD severity (n=29). Results: Findings revealed support for the role of anger in mediating the effect that TBI severity had on PTSD severity. There was no support that the mechanism of injury was associated with greater reporting of psychological symptoms (anger, alcohol use or PTSD) or that MERS influenced the association between TBI severity and PTSD recovery at 16 month follow-up. Conclusion: Findings contribute to the understanding of how anger may underlie the relationship between TBI severity and PTSD severity, i.e., TBI severity was positively associated with PTSD scores and this effect operated due to increased TBI severity leading to higher rates of expressed anger which in turn increased PTSD symptoms. Future research using larger samples is required to further understand how the complicating factors of MERS and cause of physical injury affect outcome in veterans with co-occurring TBI and PTSD.