AN EXAMINATION OF RELATIONSHIPS BETWEEN POST-TRAUMATIC STRESS DISORDER, MARITAL DISTRESS, AND RESPONSE TO THERAPY BY VIETNAM VETERANS (COUPLES GROUPS, RAP GROUP THERAPY)

Diagnosis and treatment of Post Traumatic Stress Disorder (PTSD) in Vietnam veterans has become an important clinical and social issue. Using a sample of 60 combat veterans and partners, this study examined (1) the validity of current measures of PTSD; (2) the role of marital distress in severity of PTSD; (3) the effects of rap group treatment on the marital realtionship; (4) attitudes toward conjoint treatment; and (5) the effects of couples group therapy in reducing marital dissatisfaction in severely distressed veterans.^ The results lent support to the Vietnam Era Stress Inventory as a valid self-report measure of stress symptoms. Severity of PTSD was found to correlate highly with standardized measures of anxiety and marital distress according to veterans\u27 and spouses\u27 reports. PTSD scores also correlated highly with behavioral ratings by rap group counselors. Multiple Regression Analyses showed marital factors to be significant predictors of severity of PTSD.^ This study hypothesized treatment-specific effects for the rap group in anxiety, but nongeneralizable effects to the marriage. Neither reductions in the high levels of anxiety or the extent of dissatisfaction with the marriage were correlated significanty with length of time in rap group therapy.^ Spouses reported themselves to be more willing to participate in conjoint treatment than their patterns. Higher levels of PTSD correlated with preferences for separate treatment for veterans and wives. Contrary to statements of willingness, few couples were actually willing to commit themselves to conjoint therapy groups. Veterans who did agree had higher PTSD and anxiety scores than the general sample, a finding contrary to general psychotherapy outcome research.^ Results of the Marital Satisfaction Inventory indicated affective and problem-solving communication to be central areas of concern for veterans and partners. A seven-week couples group, focusing on basic communication skills, was assessed. Improvements were seen in global satisfaction and communication. Generalizations beyond the marital system included spouse observations of lower anxiety and rap group counselor ratings of increased ability to cope with stress and fewer PTSD symptoms.^ The inclusion of a conjoint component in the treatment of PTSD was strongly recommended.