The Effectiveness of a PTSD-Focused Marital Skills Training on Trust Restoration and Emotional Regulation
Keywords:
PTSD, marital skills training, trust restoration, emotional regulation, trauma-informed therapyAbstract
This study aimed to evaluate the effectiveness of a PTSD-focused marital skills training intervention in improving trust restoration and emotional regulation among trauma-affected couples. A randomized controlled trial was conducted with 30 participants (15 couples) from Gonbad-e Kavus city, randomly assigned to an intervention group (n = 15) or a control group (n = 15). The intervention group received a structured 10-session marital training program focused on trauma-informed trust building and emotional regulation techniques, while the control group received no intervention during the study period. Standardized measures were used to assess trust (Dyadic Trust Scale) and emotional regulation (DERS) at three time points: pre-test, post-test, and five-month follow-up. Data were analyzed using repeated measures ANOVA and Bonferroni post-hoc tests via SPSS-27. Significant main effects of time, group, and time × group interactions were found for both trust restoration (F = 41.52, p < .001, η² = .597) and emotional regulation (F = 28.67, p < .001, η² = .493). Post-hoc comparisons revealed significant improvements in trust and emotion regulation from pre-test to post-test (p < .001) and maintained at follow-up (p < .001) in the intervention group. No significant changes were observed in the control group across time points. The PTSD-focused marital skills training was effective in enhancing both trust restoration and emotional regulation among couples affected by trauma. These effects were sustained over a five-month period, indicating the intervention's potential for long-term relational and psychological benefit. The findings underscore the value of integrating trauma-informed, couple-based approaches in clinical practice.
Downloads
References
Bapolisi, A., Maurage, P., Georges, C. M., Petit, G., Balola, M., Cikomola, C., Rimé, B., Philippot, P., Persu, A., & Timary, P. d. (2023). Personal and Interpersonal Factors Moderate the Relation Between Human-Made Trauma and Hypertension: A Path Analysis Approach. Psychosomatic Medicine, 85(8), 710-715. https://doi.org/10.1097/psy.0000000000001225
Carter, S., Powers, A., & Bradley, B. (2020). PTSD and Self-Rated Health in Urban Traumatized African American Adults: The Mediating Role of Emotion Regulation. Psychological Trauma Theory Research Practice and Policy, 12(1), 84-91. https://doi.org/10.1037/tra0000472
Demir, Z., Böge, K., Fan, Y., Hartling, C., Harb, M. R., Hahn, E., Seybold, J., & Bajbouj, M. (2020). The Role of Emotion Regulation as a Mediator Between Early Life Stress and Posttraumatic Stress Disorder, Depression and Anxiety in Syrian Refugees. Translational psychiatry, 10(1). https://doi.org/10.1038/s41398-020-01062-3
Fernández-Fillol, C., Pitsiakou, C., Pérez-Garcı́a, M., Teva, I., & Hidalgo‐Ruzzante, N. (2021). Complex PTSD in Survivors of Intimate Partner Violence: Risk Factors Related to Symptoms and Diagnoses. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.2003616
Holzhauer, C. G., & Gamble, S. A. (2017). Depressive Symptoms Mediate the Relationship Between Changes in Emotion Regulation During Treatment and Abstinence Among Women With Alcohol Use Disorders. Psychology of Addictive Behaviors, 31(3), 284-294. https://doi.org/10.1037/adb0000274
Jobson, L., Haque, S., Abdullah, S. Z., Lee, B., Li, H., Reyneke, T., Tan, B. K. W., Lau, W., & Liddell, B. J. (2022). Examining Cultural Differences in the Associations Between Appraisals and Emotion Regulation and PostTraumatic Stress Disorder in Malaysian and Australian Trauma Survivors. International journal of environmental research and public health, 19(3), 1163. https://doi.org/10.3390/ijerph19031163
Kline, N. K., & Reed, K. M. P. (2021). Betrayal vs. Nonbetrayal Trauma: Examining the Different Effects of Social Support and Emotion Regulation on PTSD Symptom Severity. Psychological Trauma Theory Research Practice and Policy, 13(7), 802-809. https://doi.org/10.1037/tra0000983
Mantua, J., Helms, S. M., Weymann, K., Capaldi, V. F., & Lim, M. M. (2018). Sleep Quality and Emotion Regulation Interact to Predict Anxiety in Veterans With PTSD. Behavioural neurology, 2018, 1-10. https://doi.org/10.1155/2018/7940832
Martínez‐Íñigo, D. (2021). The Role of Prison Officers’ Regulation of Inmates Affect on Their Exposure to Violent Behaviours and the Development of PTSD Symptoms. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1956126
Miles, S. R., Kent, T. A., Stanley, M. A., Thompson, K. E., Sharp, C., Niles, B. L., Young‐McCaughan, S., Mintz, J., Roache, J. D., Litz, B. T., Hale, W. J., Stanford, M. S., Keane, T. M., & Peterson, A. L. (2020). Manage Emotions to Reduce Aggression. The Journal of Nervous and Mental Disease, 208(11), 897-903. https://doi.org/10.1097/nmd.0000000000001229
Miles, S. R., Thompson, K. E., Stanley, M. A., & Kent, T. A. (2016). Single-Session Emotion Regulation Skills Training to Reduce Aggression in Combat Veterans: A Clinical Innovation Case Study. Psychological Services, 13(2), 170-177. https://doi.org/10.1037/ser0000071
Ouhmad, N., El‐Hage, W., & Combalbert, N. (2023). Maladaptive Cognitions and Emotion Regulation in Posttraumatic Stress Disorder. Neuropsychiatrie, 37(2), 65-75. https://doi.org/10.1007/s40211-022-00453-w
Pickett, S. M., Barbaro, N., & Mello, D. M. (2016). The Relationship Between Subjective Sleep Disturbance, Sleep Quality, and Emotion Regulation Difficulties in a Sample of College Students Reporting Trauma Exposure. Psychological Trauma Theory Research Practice and Policy, 8(1), 25-33. https://doi.org/10.1037/tra0000064
Powers, A., Cross, D., Fani, N., & Bradley, B. (2015). PTSD, Emotion Dysregulation, and Dissociative Symptoms in a Highly Traumatized Sample. Journal of psychiatric research, 61, 174-179. https://doi.org/10.1016/j.jpsychires.2014.12.011
Powers, A., Etkin, A., Gyurak, A., Bradley, B., & Jovanović, T. (2015). Associations Between Childhood Abuse, Posttraumatic Stress Disorder, and Implicit Emotion Regulation Deficits: Evidence From a Low-Income, Inner-City Population. Psychiatry, 78(3), 251-264. https://doi.org/10.1080/00332747.2015.1069656
Pugach, C. P., Campbell, A. A., & Wisco, B. E. (2019). Emotion Regulation in Posttraumatic Stress Disorder (PTSD): Rumination Accounts for the Association Between Emotion Regulation Difficulties and PTSD Severity. Journal of Clinical Psychology, 76(3), 508-525. https://doi.org/10.1002/jclp.22879
Rijkers, C., Schoorl, M., Hoeken, D. v., & Hoek, H. W. (2019). Eating Disorders and Posttraumatic Stress Disorder. Current Opinion in Psychiatry, 32(6), 510-517. https://doi.org/10.1097/yco.0000000000000545
Rodriguez, L., & Read, J. P. (2020). Momentary Emotional Responding and Emotion Regulation in PTSD-related Drinking Urge. Experimental and Clinical Psychopharmacology, 28(1), 99-111. https://doi.org/10.1037/pha0000292
Spies, J., Cwik, J. C., Willmund, G. D., Knaevelsrud, C., Schumacher, S., Niemeyer, H., Engel, S., Küster, A., Muschalla, B., Köhler, K., Weiss, D., & Rau, H. (2020). Associations Between Difficulties in Emotion Regulation and Post-Traumatic Stress Disorder in Deployed Service Members of the German Armed Forces. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.576553
Tripp, J. C., McDevitt‐Murphy, M. E., Avery, M. L., & Bracken, K. L. (2015). PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among College Students With a Trauma History. Journal of Dual Diagnosis, 11(2), 107-117. https://doi.org/10.1080/15504263.2015.1025013
Watkins, L. E., Schumacher, J. A., & Coffey, S. F. (2016). A Preliminary Investigation of the Relationship Between Emotion Dysregulation and Partner Violence Perpetration Among Individuals With PTSD and Alcohol Dependence. Journal of Aggression Maltreatment & Trauma, 25(3), 305-314. https://doi.org/10.1080/10926771.2015.1129657
Weaver, S., Birn, R. M., & Cisler, J. M. (2020). A Pilot Adaptive Neurofeedback Investigation of the Neural Mechanisms of Implicit Emotion Regulation Among Women With PTSD. Frontiers in Systems Neuroscience, 14. https://doi.org/10.3389/fnsys.2020.00040
Xue, M., Yuan, Y., Chen, H., Liu, Y., Dai, M., Sun, H., Qu, J., Zhou, T., Zhou, J., Qu, J., Bu, Y., Ji, S., Hu, Y., Yao, Z., Feng, Y., & Gu, X. (2022). Perceived Stress and Symptoms of Post-Traumatic Stress Disorder in Nurses: A Moderated Mediation Model of Maladaptive Cognitive Emotional Regulation and Psychological Capital. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.902558
Zhou, A., McDaniel, M., Xie, H., Mattin, M., Wang, X., & Shih, C.-H. (2023). Emotion Dysregulation Mediates the Association Between Acute Sleep Disturbance and Later Posttraumatic Stress Symptoms in Trauma Exposed Adults. European Journal of Psychotraumatology, 14(2). https://doi.org/10.1080/20008066.2023.2202056
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Mehdi Ghezelseflo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
