This 2 hour webinar will explore links between Post-traumatic Stress Disorder and Domestic Violence in Military Couples. Dr. Taft will provide background information regarding intimate partner violence (IPV) in military populations, discuss the development and treatment elements of the interventions, present treatment outcome data obtained from treatment development grants funded through the Centers for Disease Control, Department of Defense, and Department of Veterans Affairs, and discuss current efforts to implement the programs. He will also provide specific tips and skills for working with this challenging population.

1. Links between PTSD and Domestic
Violence in Military Couples
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6. 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/

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. PTSD and IPV
Avoidance/
Numbing
Re-
experiencing
Hyperarousal
e.g., Taft et al., 2007

14. 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

15. Other Contributing Factors
1. Depression
2. Alcohol use problems
3. Traumatic brain injury
4. Power conflicts
5. Trust issues
6. Self-esteem problems

16. IPV
Intervention

17. 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

18. 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

19. Men’s Program

20. • 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

21. Stage 1
Stage 2
Stage 3
Stage 4
Men’s Program Stages

22. 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

23. 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

24. 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

25. Strength at Home Stages
• Stage IV (Sessions 7-12): Communication Skills
• Roots of communication style
• Active listening
• Assertive messages
• Expressing feelings
• Communication “traps”

26. • 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

27. 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%

28. 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)

29. Physical IPV
0
0.5
1
1.5
2
2.5
3
Pre-Tx Post-Tx 3-Month
Follow-up
MeanScore
Strength at Home
Enhanced Treatment
as Usual
B(.061)= -0.135, p=.029, CI [.773, .986]

30. Psychological IPV
(CTS)
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Pre-Tx Post-Tx 3-Month
Follow-up
MeanScore
Strength at Home
Enhanced Treatment
as Usual
B(.135)= -0.304, p=.026, CI [.565, .964]

31. Restrictive Engulfment
(MMEA)
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Pre-Tx Post-Tx 3-Month
Follow-up
MeanScore
Strength at Home
Enhanced Treatment
as Usual
B(.027)= -0.072, p=.01, CI [.882, .983]

32. Couples Prevention
Program

33. • 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

34. • 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

35. 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

36. Proportion of Treatment
Completers
0
10
20
30
40
50
60
70
Treatment Completers
%ofSample
Strength at Home
Supportive Therapy

37. Veteran Physical IPV
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Pre-Tx Post-Tx 6-Month
Follow-up
12-Month
Follow-up
MeanScore
Strength at Home
Supportive Therapy

38. Partner Physical IPV
0
0.5
1
1.5
2
2.5
Pre-Tx Post-Tx 6-Month
Follow-up
12-Month
Follow-up
MeanScore
Strength at Home
Supportive Therapy

39. Veteran Psychological IPV
0
5
10
15
20
25
30
35
40
Pre-Tx Post-Tx 6-Month
Follow-up
12-Month
Follow-up
MeanScore
Strength at Home
Supportive Therapy

40. Partner Psychological IPV
0
5
10
15
20
25
30
35
Pre-Tx Post-Tx 6-Month
Follow-up
12-Month
Follow-up
MeanScore
Strength at Home
Supportive Therapy

41. Veteran Emotional Abuse
0
10
20
30
40
50
60
70
80
90
100
Pre-Tx Post-Tx 6-Month
Follow-up
12-Month
Follow-up
MeanScore
Strength at Home
Supportive Therapy

42. Partner Emotional Abuse
0
10
20
30
40
50
60
70
80
90
Pre-Tx Post-Tx 6-Month
Follow-up
12-Month
Follow-up
Meanscore
Strength at Home
Supportive Therapy

43. Process and Clinical
Considerations

44. 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

45. 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

46. 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

47. 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?”

48. 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.

49. 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/

50. Upcoming Webinars:
Social Emotional Development in the Early Years:
Understanding Social Emotional Development
Thursday, June 18, 2015 11:00 am- 12:30pm Eastern
Social Emotional Development in the Early Years:
Promoting Positive Relationships
Thursday, August 13, 2015 11:00 am- 12:30pm Eastern

51. Find all upcoming and recorded webinars
covering:
http://www.extension.org/62581
Personal Finance
Military Caregiving
Family Development
Family Transitions
Network Literacy
Nutrition & Wellness
Community Capacity Building