Do we really need to talk about it? Informal trauma disclosure among men and women in PTSD treatment.

Abstract

Discussing traumatic experiences is an important component of trauma-focused treatments (TFTs) for posttraumatic stress disorder (PTSD). Yet, little is known about how or when discussing these experiences with loved ones at home (i.e., informal disclosure) can amplify or interfere with treatment. Importantly, it remains unknown if the actual frequency of discussion matters versus one's perception that such discussions are welcomed (i.e., social constraints). Our objective was to examine how social constraints and disclosure relate to one another, how they predict PTSD symptom reductions during TFTs, and the role of context (i.e., relationship happiness and sex). We surveyed veterans seeking TFTs at four VA hospitals (n = 534) at TFT initiation (T1) and four months later (T2). Using multigroup path analysis, we found that reductions in perceived social constraints on disclosure were associated with better treatment response for both men and women. However, increases in the frequency of informal disclosure during treatment predicted better treatment response only for men. Several additional differences between men and women were found. For men, disclosure predicted treatment response better when men were in unhappy relationships. Additionally, informal disclosure and social constraints changed independently over time and were not significantly influenced by relationship happiness. For women, associations between informal disclosure and social constraints were bi-directional and stronger when women were happier in their relationships. Overall, results underscore that sex-sensitive attention to informal disclosure to loved ones may be beneficial for improving response to PTSD treatment, and that consideration of social constraints and relationship satisfaction may be important to achieving this aim.