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People with posttraumatic stress disorder (PTSD) often report difficulties with “interpersonal functioning,” which we define as quality, satisfaction, and day-to-day functioning within close relationships, such as those with family, intimate partners, and/or friends (Jellestad et al., 2021; Scoglio et al., 2022). The associations between PTSD and interpersonal functioning are likely bidirectional, meaning that PTSD has negative effects on relationships, and problematic relationships can maintain or exacerbate PTSD. As would be expected, then, concerns surrounding close relationships and interpersonal functioning are often a key motivator for people with PTSD to seek psychological treatment (Rosen et al., 2013). However, interpersonal relationships are not central to the theories underlying most trauma-focused psychotherapies (TFPs) – the most effective treatments for PTSD – and are therefore not generally key targets of intervention. While it seems plausible that reductions in PTSD symptoms enable improved interpersonal functioning, we know surprisingly little about how well TFPs address concerns regarding functioning in close relationships. To address this question, we pre-registered and undertook a systematic review and meta-analysis to examine the extent to which TFPs for PTSD improve interpersonal functioning.

The full protocol can be found on Open Science Framework. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 6 databases, including the PTSD Trials Standardized Data Repository, for randomized controlled trials (RCTs) that measured interpersonal functioning before and after TFPs for PTSD. Our search ultimately yielded 21 independent samples that met inclusion criteria. We examined the overall evidence from these samples by conducting random effects meta-analysis. Here are the main findings:

  • On average, TFPs for PTSD resulted in moderate improvement in interpersonal functioning.
  • TFPs were associated with significantly greater improvement in interpersonal functioning when compared directly to inactive controls, and difficulties with interpersonal functioning were stable in the absence of active treatment. 
  • RCTs that reported greater reductions in PTSD symptoms also tended to report greater improvements in interpersonal functioning.
  • Of note, there was considerable variability between studies in terms of interventions, measures, populations, and effect sizes.
  • There was minimal statistical evidence of publication bias.  

The finding that TFPs for PTSD do tend to improve interpersonal functioning is an important result, considering the negative impacts PTSD can and often does have on people’s close relationships and the important role that close relationships play in recovery from PTSD. At the same time, the moderate magnitude of that average effect suggests that there is ample room to enhance the efficacy of PTSD treatments with respect to interpersonal functioning, particularly given that this is often a primary motivator for treatment. For example, it may be helpful in some cases to offer additional services specifically aimed at improving close relationships. 

In summary, this study helps to answer questions about the extent to which highly recommended psychological treatments for PTSD tend to improve interpersonal functioning. We hope these results can inform shared decision-making and treatment planning for people who are seeking treatment for PTSD and who may be struggling with interpersonal relationships.  

Target Article

Swerdlow, B. A., Baker, S. N., Leifker, F. R., Straud, C. L., Rozek, D. C., & Sippel, L. M. (2023). The impact of trauma-focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta-analysis of randomized clinical trials. Journal of Traumatic Stress. Advance online publication. https://doi.org/10.1002/jts.22906

Discussion Questions

  • Which types of services or interventions aimed at improving close relationships might be helpful additions to TFPs for PTSD?
  • How might we go about practically integrating such services into already existing TFPs for PTSD?
  • What barriers might we have to troubleshoot when it comes to integrating interpersonal functioning services into TFPs for PTSD?

About the Authors

Benjamin Swerdlow, PhD,
 is an Assistant Professor in the Department of Psychology at Lake Forest College. His research program is centered around clinical affective science. Particular research interests include mood dysregulation, interpersonal emotion regulation processes, close relationships, and ecological sampling methods. Dr. Swerdlow can be contacted at bswerdlow@lakeforest.edu and found on twitter at @BenjaminSwerdl1.

Shelby Baker, 
B.S., B.A., is a doctoral student in the Clinical Psychology PhD Program at the University of Central Florida and a member of UCF RESTORES. Her research focuses on improving treatments for PTSD and suicide, and specifically, understanding the intersection between physical symptomology and suicide risk. She can be contacted at shelby.baker@knights.ucf.edu and found on Twitter at @shelb_baker.

Feea Leifker, PhD, MPH,
 is a Research Assistant Professor and Co-Director of the Behavioral Health Innovation and Dissemination Center and the University of Utah. Her research is focused on understanding the bidirectional relationship between mental health and intimate relationship functioning, with a particular focus on PTSD and suicide. She is also interested in the development and dissemination of couple-based interventions for relationship distress and mental health conditions. She can be contacted at feea.leifker@utah.edu.

Casey Straud, PsyD, ABPP, 
is a board-certified clinical psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at UTHSCSA, with joint appointments in the Department of Psychology at UTSA and at the STVHCS. He is also a member of the STRONG STAR Consortium and the STRONG STAR Training Initiative. His research is focused on enhancing PTSD treatment outcomes through biological and pharmacological mechanisms, with an emphasis on the endocannabinoid system. He also has a background in biostatistics. Dr. Straud can be contacted at straud@uthscsa.edu

David Rozek, PhD, ABPP, 
is an assistant professor at UCF RESTORES and the Department of Psychology at the University of Central Florida. Dr. Rozek’s research and clinical expertise are in cognitive and behavioral therapies for suicide, depression, and PTSD. He regularly provides training to clinicians and medical professionals about managing suicidal patients and is an active researcher focusing on how to best improve clinical care. Dr. Rozek can be contacted at david.rozek@ucf.edu and he can be found on Twitter @davidrozekphd.

Lauren Sippel, PhD, 
is a licensed clinical psychologist, an Associate Director at the Department of Veterans Affairs Northeast Program Evaluation Center (NEPEC), an Assistant Professor of Psychiatry at the Geisel School of Medicine at Dartmouth, and an affiliate of the National Center for PTSD. Dr. Sippel leads the national program evaluation for the Behavioral Health Interdisciplinary Program (BHIP). Her research program focuses on how trauma affects how we perceive and respond to the social world, which work (1) examining cognitive, affective, and neurobiological mechanisms of trauma recovery and interpersonal problems experienced by trauma-exposed individuals and (2) developing novel treatments that target these shared mechanisms in an effort to improve social functioning, such as intranasal oxytocin. 

References Cited

Jellestad, L., Vital, N. A., Malamud, J., Taeymans, J., & Mueller-Pfeiffer, C. (2021). Functional impairment in posttraumatic stress disorder: A systematic review and meta-analysis. Journal of Psychiatric Research136, 14–22. https://doi.org/10.1016/j.jpsychires.2021.01.039

Rosen, C., Adler, E., & Tiet, Q. (2013). Presenting concerns of veterans entering treatment for posttraumatic stress disorder: Patient-centered care and veterans with PTSD. Journal of Traumatic Stress26(5), 640–643. https://doi.org/10.1002/jts.21841

Scoglio, A. A. J., Reilly, E. D., Girouard, C., Quigley, K. S., Carnes, S., & Kelly, M. M. (2022). Social functioning in individuals with post-traumatic stress disorder: A systematic review. Trauma, Violence, & Abuse23(2), 356–371. https://doi.org/10.1177/1524838020946800