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Symposia

Couples / Close Relationships

Innovations in Relationship Care for Veterans and their Loved Ones

2 - (SYM 51) A Randomized Controlled Trial of Treatment for Relationships and Safety Together (TR&ST): A Couples Suicide Intervention

Sunday, November 23, 2025
10:22 AM - 10:39 AM CST
Location: Foster 2, Level 2
Keywords: Couples / Close Relationships, Veterans, Treatment
Recommended Readings: Liebman, R. E., Whitfield, K. M., Sijercic, I., Ennis, N., & Monson, C. M. (2020). Harnessing the healing power of relationships in trauma recovery: A systematic review of cognitive-behavioral conjoint therapy for PTSD. Current Treatment Options in Psychiatry, 7, 203-220.,   Landes, S. D., Wilmoth, J. M., London, A. S., & Landes, A. T. (2023). Risk factors explaining military deaths from suicide, 2008–2017: A latent class analysis. Armed Forces & Society, 49(1), 115–137. https://doi.org/10.1177%2F0095327X211046976,   Monson, C. M., Wagner, A. C., Mithoefer, A. T., Liebman, R. E., Feduccia, A. A., Jerome, L., ... & Mithoefer, M. C. (2020). MDMA-facilitated cognitive-behavioural conjoint therapy for posttraumatic stress disorder: an uncontrolled trial. European Journal of Psychotraumatology, 11(1), 1840123.,   ,  
Abstract Body



Background: Relationship functioning is intimately tied to suicide risk; indeed, couple distress is often the number one predictor of suicide and supportive relationships serve as a protective factor. For years, suicide prevention has been the top clinical priority within the Veterans Affairs Healthcare System; however, no couple-based suicide interventions are available. To meet this need, a Career Development Award (CDA) supported the development and clinical trial of Treatment for Relationships and Safety Together (TR&ST), an 11-session couples’ intervention focused on emotion regulation, communication about suicide and relationship distress, and conjoint cognitive work to modify maladaptive thoughts.



Method: To date, 39 couples have been randomized to TR&ST or VA Standard Suicide Care. All couples include a veteran who reported CSSRS >2 (active suicidal ideation) in the past 1 month and/or a suicide attempt in the prior 3 months. Couples completed baseline, weekly, post-treatment, and 3-month follow-up measures of multiple domains of relationship functioning and suicidal ideation, as well as qualitative interviews at post and follow-up. Preliminary analyses used t-tests to examine baseline to post-treatment effect sizes. Latent growth curve models will be used to analyze the full sample.



Results: Preliminary outcomes indicate that TR&ST reduces suicidal ideation (p = .011; moderate effect, g = 0.74) and depression (p = .024; moderate effect, g = 0.64) for veterans. For veterans and partners, respectively, TR&ST reduces perceived burdensomeness and thwarted belonging (p = .002; large effect, g = 0.97; p = .027; moderate effect, g = 0.63), and improves communication (p = .002; large effect, g = 1.42; p = .012; moderate effect, g = 0.73). VA Standard Suicide Care reduced depression (p = .016; moderate effect, g = 0.64) but not suicidal ideation (p = .38; moderate effect, g = 0.21) for veterans. Standard Care did not improve relationship functioning for veterans or partners. The retention rate for TR&ST was 80%. Suicide behavior data and follow-up assessments will be examined and presented with the full sample.




Discussion: TR&ST data suggests that veterans and their partners are engaged in and benefitting from this couple-based suicide intervention and that TR&ST may be effective at reducing suicide risk and improving relationship functioning, leading to a more meaningful and connected relationship and life.