3 - (SYM 4) Family Supported Prolonged Exposure Compared to Standard Prolonged Exposure Therapy for PTSD: Role of Relationship Type, Conflict, Depth, and Functioning in Treatment Retention

Background:

Evidence-based trauma-focused therapy (TFT) is highly effective in treating PTSD, yet dropout rates among veterans remain high (Dodge et al., 2023). One avenue for improving treatment retention is including family support during TFT. Specifically, supportive family relationships (Meis et al., 2010) and family encouragement of TFT have been found to facilitate treatment engagement for veterans with PTSD (Shepherd-Banigan et al., 2023). However, PTSD symptoms often correlate with relationship distress and conflict (Birkley et al., 2016; Miller et al., 2013, Campbell et al., 2013). Relationship distress and conflict may, in turn, negatively impact treatment engagement. We conducted a secondary analyses of data from an RCT comparing standard Prolonged Exposure (SPE) to family supported Prolonged Exposure (FSPE) in order to determine whether relationship factors including conflict, relationship depth, and family functioning moderated treatment completion.

Methods:

A total of 128 veteran and partner dyads were randomized to either SPE or FSPE. A series of logistic and binomial-gamma mixture models were run to examine the role of relationship conflict, depth, and functioning in moderating treatment completion.

Results:

Greater partner reported relationship conflict predicted session attendance for both treatment arms (b=.37, p=.027). An interaction effect showed a trend toward relationship conflict more strongly predicting treatment completion for FSPE than for SPE (b=.97, p=.098). Partner reported family dysfunction also predicted greater session attendance for both treatment arms (b=.70, p=.006). An interaction effect showed poorer session attendance for those in FSPE compared with SPE at the highest levels of family dysfunction (b=-1.13, p=.006). Greater relationship depth was associated with treatment completion in both intervention arms (b = -1.37, p = .022), but the effects did not differ significantly between treatment arms (b = -.37, p = .712). Relationship type (e.g., spouse, other family member, friend) did not predict treatment completion.

Conclusion:

Including a supportive person in TFT increases treatment retention. Relationship conflict may serve as a motivating factor for staying in treatment, particularly in interventions that include family such as FSPE. Relationship dysfunction may also serve as a motivating factor for engaging in treatment. However, efforts to include family in TFT may be most effective in improving treatment retention when relationship dysfunction is moderate to low.