Steffany J. Fredman

Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder: Application to a Couple's Shared Traumatic Experience

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is designed to improve PTSD symptoms and enhance intimate relationship adjustment. Phase 1 includes psychoeducation about the reciprocal influences of PTSD symptoms and relationship functioning, exercises to promote positive affect and behaviors, and conflict management skills. In Phase 2, behavioral methods are used to address avoidance and emotional numbing and to increase relationship satisfaction. Couples engage in activities to promote approaching, rather than avoiding, feared situations. Phase 3 focuses on specific trauma appraisals and here-and-now cognitions that maintain PTSD and relationship problems. This article provides an overview of the treatment, a review of the outcome research, and a case illustration of a couple with a shared trauma (a stillborn child).

Recurrent Depression, Resistant Clinician?

&NA; Clinical research has established that depression is frequently a recurrent disorder;1‐3 50% of persons who have one episode of major depression will have a second, and 80‐90% of those with a second will have a third.4 Bolstered by the testimony of leading experts on affective disorders, recent media attention has been aimed at emphasizing depression as a long‐term illness with biological underpinnings in an attempt to remove the stigma attached to the disorder among the general public. Nonetheless, clinicians not uncommonly approach the treatment of depression as though the disorder were only a short‐term, episodic illness, employing long‐term maintenance strategies as the exception rather than the rule. Beyond the danger of relapse inherent in discontinuing treatment is the suggestion that clinicians may unwittingly contribute to the poor prognosis of their recurrently depressed patients by interrupting treatment or by lowering medication doses to subtherapeutic levels following response.5