Trauma disclosure and willingness to involve close others in therapy across two exposure-based treatments for PTSD

Posttraumatic stress disorder (PTSD) occurs in an interpersonal context. Little is known about veterans' communication with their loved ones regarding their trauma. Even less is known about how their attitudes (e.g., willingness to include a family member (FM) in treatment) and behaviors (e.g., trauma disclosure) evolve during and after trauma-focused treatment. The study explored these attitudes and behaviors among veterans diagnosed with PTSD (N = 167) who were randomized (1:1) to Prolonged Exposure (PE) or Written Exposure Therapy (WET). Results revealed that both willingness to involve a FM in treatment and disclosure increased over time, with no significant differences across treatments. Demographic factors such as baseline severity, sex, and history of military sexual trauma were not significant predictors of either baseline levels of willingness to involve a FM or disclosure, nor the slopes of those variables over time. The relationship between disclosure and PTSD symptom severity changed over time; early in treatment lower severity was associated with higher levels of disclosure, while later the relationship reversed. Findings of this study demonstrate that patients in trauma-focused treatment are increasingly willing to involve a FM and increasingly likely to share about their trauma over time, providing opportunities to incorporate outside sources of support beyond the early treatment phase. The significant and dynamic association of disclosure with treatment outcome over time indicates that it functions as a potential indicator at the intersection of individual distress and relationship health.