Specifying the Effects of an Online, Self-Help Couples' Intervention on PTSD Clusters and the Influence of Improvements in Relationship Satisfaction

Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction; CH) is an online dyadic intervention for individuals with posttraumatic stress disorder (PTSD) and their partners. Initial analyses provide support for the efficacy of CH in improving general PTSD symptoms and relationship satisfaction, but it is unclear which symptom clusters of PTSD are improving (i.e., intrusions, avoidance, cognitions and mood, and/or arousal). Moreover, there is a potent association between PTSD symptoms and relationship distress, such that improvements in relationship satisfaction are associated with improvements in PTSD symptoms. However, it is unclear whether this is true in CH, and if so, for which clusters. This information is pertinent to identify when relationship satisfaction requires direct targeting to promote recovery from PTSD symptoms. The current study was a secondary data analysis of the CH case series and uncontrolled trial (N = 27 dyads) and had two aims: (1) to identify which clusters of PTSD are impacted by CH, and (2) to examine whether changes in relationship satisfaction was associated with changes in PTSD clusters. Hierarchical multilevel modelling revealed that CH led to improvements in intrusions, cognitions and mood, and arousal symptom clusters, but not in the avoidance cluster. Avoidance symptoms did improve when changes in relationship satisfaction were moderate to high. Changes in relationship satisfaction were not associated with changes in intrusions, cognitions and mood, or arousal. This study suggests that CH effectively targets intrusion, cognition and mood, and arousal symptoms, but changes in avoidance symptoms are dependent on changes in relationship satisfaction.