Considerations in Adapting Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder to a Family Setting

Cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) is a manualized therapy for couples designed to simultaneously decrease PTSD symptoms and improve relationship functioning. CBCT has only been tested in couples, not families of three or more members. Family therapy for PTSD may have merit given that there is a bidirectional relationship between PTSD symptoms and poor family adjustment. Adapting CBCT for families has the potential to broaden the impact of CBCT on multiple family members. We review the current evidence for CBCT, the familial impact of PTSD, and presently available family-focused treatments for PTSD. Next, we provide an overview of considerations for adapting CBCT to a family context, as informed by an initial effort to administer this intervention to a family of three. Considerations include lengthening the number and duration of sessions to accommodate hearing from more family members, replacing couple-specific content, tweaking instructions for worksheets, and ensuring that all members are included in the in-session and out-of-session practice. Logistical considerations when seeking to deliver family therapy during COVID-19 or virtual treatment are also described. Future research is needed to determine the efficacy of CBCT for treating PTSD within families. Public Health Significance StatementThis paper describes an initial effort to adapt an evidence-based intervention for PTSD (CBCT), designed for use with couples, for use with families of three or more individuals. It concludes that CBCT may be readily adapted to the family context, and it provides key considerations and recommendations for this approach.