Cognitive-behavioral therapy for PTSD in the real world: do interpersonal relationships make a real difference?

The goal of this effectiveness study was to investigate the role of pre-treatment interpersonal relationship functioning in two forms of group cognitive-behavioral treatment (CBT) for veterans with PTSD. Analysis of data from 45 veterans who completed either trauma- or skills-focused CBT indicated no overall differences between the two treatments in PTSD symptomatology, alcohol abuse, or violence perpetration at four months post-treatment. However, there was a stronger inverse relationship between intimate relationship functioning and violence outcomes in the trauma-focused group versus the skills-focused group. While no differences in violence outcomes were found between the treatments at poorer levels of pre-treatment intimate relationship functioning, those receiving trauma-focused treatment with better pre-treatment intimate relationships reported less violence. Extended relationship functioning and violence outcomes were less strongly associated in the trauma-focused group versus the skills-focused group. The theoretical implications of these results, as well as the clinical opportunities to improve CBT for PTSD by capitalizing on patients' relationships, are discussed. Copyright 2004 Wiley Periodicals, Inc.