A study published in Frontiers in Psychiatry lends support for a relationship-based approach to the treatment of post-traumatic stress disorder (PTSD). The researchers tested the efficacy of Cognitive Behavioral Conjoint Therapy, a couples therapy tailored to patients with PTSD and their partners. The intervention, which included two MDMA-assisted sessions, led to gains in both patient growth and relationship growth.

Post-traumatic stress disorder is a psychological condition that can emerge after experiencing or witnessing trauma. Patients often relive the traumatic event through nightmares or flashbacks that provoke debilitating fear, panic, and anxiety. Psychologists have noted that a key factor influencing both the development of PTSD and recovery from the disorder is a patient’s close relationships.

While negative social interactions can aggravate PTSD symptoms, PTSD symptoms can also cause strain on interpersonal relationships. This leads to a self-perpetuating cycle whereby a patient’s symptoms continually worsen. For this reason, study authors Anne C. Wagner and her colleagues emphasize the advantages of a dyadic approach to treatment — that is, therapy efforts that include both the PTSD patient and their partner.

The researchers designed a study to explore the effectiveness of Cognitive Behavioral Conjoint Therapy (CBCT) in the treatment of PTSD. Six patients with PTSD, along with their partners, took part in the 7-week therapy which involved 15 CBCT sessions. The CBCT sessions included psychoeducation about PTSD, strategies for increasing communication and reducing avoidance, and tools for coping with trauma-related thoughts.

The intervention also included two MDMA-assisted sessions following the fifth and eleventh CBCT sessions. MDMA, or 3-4 methylenedioxymethamphetamine, is a psychoactive drug commonly referred to as ecstasy that is known to facilitate empathy and partner communication. During these sessions, both partners were given MDMA and then listened to relaxing music while alternating between internal reflection and conversing with their partner.

Participants were assessed on five occasions throughout the study: at baseline, halfway through treatment, post-treatment, three months following treatment, and six months following treatment. The assessments included various questionnaires that measured relationship quality, psychosocial functioning, patient’s post-traumatic growth, and partner’s response to trauma.

According to both partner and patient reports, the PTSD patients showed improvements in post-traumatic growth throughout the therapy. Patients additionally showed lower psychological aggression, improved psychosocial functioning, and increased empathy. Notably, partners also benefited from the therapy. They decreased the extent that they accommodated their behavior in response to the patient’s PTSD symptoms — a behavior that can unintentionally reinforce PTSD symptoms.

Importantly, the couples also experienced relationship gains — both partners and patients reported increased intimacy and increased relational support. Partners additionally reported that conflict had improved within the relationship.

Moreover, these positive outcomes were maintained during the follow-up period. The researchers say their overall findings suggest that CBCT combined with MDMA sessions can lead to improvements among both patients with PTSD and their partners. "By targeting individual and relational functioning simultaneously," the authors write, "this intervention has the potential to maximize recovery from trauma and enhance present living for those with PTSD and their loved ones."

However, the study was not without limitations, such as a small and nonrepresentative sample. Wagner and her colleagues propose that their findings call for a larger, controlled study among a more diverse sample.

The study, "Relational and Growth Outcomes Following Couples Therapy With MDMA for PTSD", was authored by Anne C. Wagner, Rachel E. Liebman, Ann T. Mithoefer, Michael C. Mithoefer, and Candice M. Monson.

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