Links between PTSD and Domestic Violence in Military Couples

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CE Credit Information• Webinar participants who want to receive 2.0 NASW CE Credits and/or 2.0 Georgia

Marriage and Family Therapy CE Credits (or just want proof participation in the training) need to take the post-test provided at the end of the webinar.

• CE Certificates of completion will be automatically emailed to participants upon completion of the evaluation & post-test. Questions/concerns surrounding the National Association of Social Workers (NASW)

CE credit certificates can be emailed to this address: MFLNfamilydevelopment@gmail.com

Sometimes state/professional licensure boards for fields other than social work recognize NASW CE credits, however, you would have to check with your state and/or professional boards if you need CE Credits for your field.

• To learn more about obtaining CE Credits, please visit this website:

http://blogs.extension.org/militaryfamiles/family-development/professionaldevelopment/nasw-ce-credits/

Today’s Presenters:

Casey Taft, Ph.D. Is a staff psychologist at the National Center for PTSD in the VA Boston Healthcare System, and Professor of Psychiatry at Boston University School of Medicine. Dr. Taft was the 2006 Young Professional Award winner from the International Society for Traumatic Stress Studies, and the 2009 Linda Saltzman Memorial Intimate Partner Violence Researcher Award winner. Dr. Taft currently serves as Principal Investigator on funded grants focusing on understanding and preventing partner violence through the National Institute of Mental Health, the Department of Veterans Affairs, the Centers for Disease Control, and the Department of Defense. Dr. Taft is on the Editorial Boards of several journals in the areas of violence, trauma, and the family. Dr. Taft has also chaired an American Psychological Association task force on trauma in the military and has consulted with the United Nations on preventing violence and abuse globally.  

Trauma and Intimate

Partner Violence

Casey Taft, Ph.D.

National Center for PTSD, VA Boston

Healthcare System

Boston University School of Medicine

Casey Taft, Ph.D.National Center for PTSD, VA Boston

Healthcare System

Boston University School of Medicine

Links between PTSD and Domestic Violence in Military Couples

Objectives• Contextualize the use of intimate partner violence

(IPV) using the social information processing model

• Review the relationship of PTSD and IPV

• Identify limitations of IPV interventions

• Discuss the Strength at Home programs and strategies for preventing IPV in military families

Social Information Processing Model

• Men who use IPV exhibit cognitive deficits (e.g., faulty attributions, irrational beliefs) that impact interpretation (decoding stage)

• Men who use IPV have difficulty generating a variety of nonviolent responses (decision-making stage)

• Men who use IPV lack the skills to enact a competent response (enactment stage)

• The process is influenced by “transitory factors” such as alcohol use, traumatic brain injury, etc.

Holtzworth-Munroe, 1992

Survival Mode Model• Vigilance to threats in warzone leads combat veteran

to enter into survival mode inappropriately when stateside

• Perceive unrealistic threats

• Exhibit hostile appraisal of events

• Overvalue aggressive responses to threats

• Exhibit lower threshold for responding to the threat

Chemtob et al., 1997

PTSD and IPV

• Service members without PTSD not more violent than civilians (Bradley, 2007)

• Rates in the National Vietnam Veterans Readjustment Study (Kulka et al., 1990)

• Veterans with PTSD = 33%• Veterans without PTSD = 13.5%

• Meta-analytic results (Taft et al., 2011)

• PTSD and physical IPV: r = .42• PTSD and psychological IPV: r = .36

PTSD and IPV

Avoidance/Numbing

Re-experiencing

Hyperarousal

e.g., Taft et al., 2007

Irrational Beliefs

a

-.22**

-.27

Total PTSD Symptoms

Physical IPV

Indices of mediation• ab- indirect effect (90% CI)

• .002 (.000042,.00316**)•percent mediation- ab/(c’ + ab)

•21%

Total PTSD Symptoms

Physical IPV

b

-.01* -.23

c‘ .01*

.21

c .01** .27

Note: unstandardized (top) and standardized (bottom) regression coefficients

* = p < .05; ** = p < .01

Other Contributing Factors

1. Depression

2. Alcohol use problems

3. Traumatic brain injury

4. Power conflicts

5. Trust issues

6. Self-esteem problems

IPV

Intervention

Lack of Empirically Supported Interventions

• No randomized clinical trial has shown treatment effects in military population (e.g., Dunford, 2000)

• Those receiving interventions in other settings average 5% reduction in recidivism relative to untreated groups (Babcock et al., 2004)

• Barriers to examining IPV interventions• Randomizing violent men to no-treatment controls• Arrest and monitoring associated with IPV reduction• Lack of victim contact• IPV practice guidelines

Limitations of Existing Interventions

• Not tailored to military populations

• Are not trauma informed

• Deemphasize psychiatric factors (PTSD) and biological factors (head injury)

• Many are not considered “therapy”

• Large, impersonal groups

Men’s Program

• Department of Defense

• Department of Veterans Affairs

• Goal to develop/evaluate model program for treating IPV in service members/Veterans

• No prior randomized clinical trial has shown treatment effects in a military population

Men’s Program Objectives

Stage 1

Stage 2

Stage 3

Stage 4

Men’s Program Stages

Strength at Home Stages

• Stage I (Sessions 1-2): Psychoeducation

• Pros/cons of abuse

• Forms of IPV and impacts of trauma

• Core themes

• Goals for group

Strength at Home Stages

• Stage II (Sessions 3-4): Conflict Management

• The anger response

• Self-monitor thoughts, feelings, physiological responses

• Assertiveness

• Time Outs to de-escalate difficult situations

Strength at Home Stages

• Stage III (Sessions 5-6): Coping Strategies

• Anger-related thinking

• Realistic appraisals of threat and others’ intentions

• Coping with stress

• Problem-focused versus emotion-focused coping

• Relaxation training for anger

Strength at Home Stages

• Stage IV (Sessions 7-12): Communication Skills

• Roots of communication style

• Active listening

• Assertive messages

• Expressing feelings

• Communication “traps”

• Contacted every three months

• High (>70%) rate of contact

• Safety planning, hotline numbers, mental health services, other support

• Perceptions of IPV

• Program feedback

Intimate Partner Involvement

Sample Characteristics

• 135 enrolled in study (67 to SAH-V intervention, 68 to ETAU)

• Average age = 38.10

• 77% White, 14% Black/African-American

• 34% married, 23% dating, 14% single

• 59% Court-involved

• 57% OEF/OIF/OND, 13% Vietnam, 8% Gulf War

• Treatment Completion (≥9 sessions): 55%

Assessed for eligibility (n=157)

Randomized (n=135)

Excluded (n=22)

Allocated to SAH intervention (n=67)

Allocated to ETAU intervention (n=68)

Completed week 12 follow-up (n=49)

Received SAH intervention (n=57)

Completed week 24 follow-up (n=52)

Received ETAU intervention (n=43)

Completed week 12 follow-up (n=57)

Completed week 24 follow-up (n=57)

Physical IPV

Pre-Tx Post-Tx 3-Month Follow-up

0

0.5

1

1.5

2

2.5

3

Strength at HomeEnhanced Treatment as Usual

Mea

n S

core

B(.061)= -0.135, p=.029, CI [.773, .986]

Psychological IPV (CTS)

Pre-Tx Post-Tx 3-Month Follow-up

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Strength at HomeEnhanced Treatment as Usual

Mea

n S

core

B(.135)= -0.304, p=.026, CI [.565, .964]

Restrictive Engulfment (MMEA)

Pre-Tx Post-Tx 3-Month Follow-up

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Strength at HomeEnhanced Treatment as Usual

Mea

n S

core

B(.027)= -0.072, p=.01, CI [.882, .983]

Couples Prevention Program

• Centers for Disease Control and Prevention

• Program for preventing IPV in returning service members/Veterans before it begins• Relationship distress but no current violence

Couples’ Program Objectives

• Phase I (Sessions 1-3): Psychoeducation• Education on trauma and impact on relationships• Promoting insight into relationship difficulties• Core themes

• Phase II (Sessions 4-5): Conflict Management• Roots of conflict management style• Assertiveness training• Time Outs to de-escalate difficult situations

• Phase III (Sessions 6-10): Communication Skills• Listening skills • Emotional expression• Communication “traps”

Couples’ Program Phases

Sample Characteristics

• 156 enrolled• 80% Caucasian, 13% African American, and 7% of

another ethnicity

• Age 24-59 years, 41 years on average

• In relationship 6 months – 25 years; 8.1 years on average

• 76% married

• 74% have children

Proportion of Treatment Completers

Treatment Completers0

10

20

30

40

50

60

70

Strength at HomeSupportive Therapy

% o

f S

amp

le

Veteran Physical IPV

Pre-T

x

Post-T

x

6-M

onth

Foll

ow-u

p

12-M

onth

Foll

ow-u

p0

0.20.40.60.8

11.21.41.6

Strength at HomeSupportive Therapy

Mea

n S

core

Partner Physical IPV

Pre-T

x

Post-T

x

6-M

onth

Foll

ow-u

p

12-M

onth

Foll

ow-u

p0

0.5

1

1.5

2

2.5

Strength at HomeSupportive Therapy

Mea

n S

core

Veteran Psychological IPV

Pre-T

x

Post-T

x

6-M

onth

Foll

ow-u

p

12-M

onth

Foll

ow-u

p05

10152025303540

Strength at HomeSupportive Therapy

Mea

n S

core

Partner Psychological IPV

Pre-T

x

Post-T

x

6-M

onth

Foll

ow-u

p

12-M

onth

Foll

ow-u

p05

101520253035

Strength at HomeSupportive Therapy

Mea

n S

core

Veteran Emotional Abuse

Pre-T

x

Post-T

x

6-M

onth

Foll

ow-u

p

12-M

onth

Foll

ow-u

p0

20

40

60

80

100

Strength at HomeSupportive Therapy

Mea

n S

core

Partner Emotional Abuse

Pre-T

x

Post-T

x

6-M

onth

Foll

ow-u

p

12-M

onth

Foll

ow-u

p0

20

40

60

80

Strength at HomeSupportive Therapy

Mea

n s

core

Process and Clinical Considerations

Rationale for Group Focus

• Group cohesion a predictor of violence reduction (Taft et al., 2003)

• Camaraderie among service members

• Sense of shared experience

• Enhances support

• Group members provide each other feedback

• Increase empathy from relating to other group members

Therapeutic Factors(Yalom, 1995)

1) Instillation of hope

2) Universality of experience

3) Imparting information

4) Altruism

5) Socialization techniques

6) Imitative behavior

7) Group cohesiveness

8) Catharsis

9) Existential factors

Leader Tasks and Techniques• Role model empathy and supportive listening

• Encourage self-disclosure

• Promote healthy relationship norms

• Make the group a safe place for exploration of personal and interpersonal problems

• Comment on process

• Accountability emphasized throughout group

Reviewing Practice Assignments

• Comment on positive work done before exploring problem areas

• Highlight use of new skills by asking “How is this different than what you’ve done in the past?”

• “If you could do it over again, how would you do it differently?”

Key Take-Away Applications

Examine IPV using the

Social Information

Processing Model

Discover tips to implement in work with military families.

Review relationship between PTSD

and domestic violence.

Explore Effectiveness of

Strengths at Home model.

CE Credit Information• Webinar participants who want to receive 2.0 NASW CE Credits and/or 2.0 Georgia

Marriage and Family Therapy CE Credits (or just want proof participation in the training) need to take this evaluation AND post-test:

https://vte.co1.qualtrics.com/SE/?SID=SV_6EHzErvYOKbkbKR

• CE Certificates of completion will be automatically emailed to participants upon completion of the evaluation & post-test. Questions/concerns surrounding the National Association of Social Workers

(NASW) CE credit certificates can be emailed to this address: MFLNfamilydevelopment@gmail.com

Sometimes state/professional licensure boards for fields other than social work recognize NASW CE credits, however, you would have to check with your state and/or professional boards if you need CE Credits for your field.

• To learn more about obtaining CE Credits, please visit this website: http

://blogs.extension.org/militaryfamilies/family-development/professional-development/nasw-ce-credits/

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