Despite considerable research indicating that spouses of veterans with posttraumatic stress disorder (PTSD) experience appreciable levels of psychological and marital distress, there is little empirical information about the mechanisms by which this distress develops. Given the ongoing military conflicts in Iraq and Afghanistan, and the fact that spouses form a primary support for combat veterans who return from deployments with symptoms of PTSD, a more comprehensive understanding of such mechanisms is critical. In this chapter, we review research that helps explain spouses' distress from a cognitive-behavioral framework. Relevant veteran behaviors include internalizing behaviors (e.g., emotional withdrawal and avoidance) and externalizing behaviors (e.g., verbal and physical aggression). Although less research exists regarding spousal factors that may contribute to their distress, we review existing knowledge about spouse behaviors (e.g., accommodation of veterans' symptoms) and cognitions (e.g., perceptions of burden and attributions for veterans' symptoms). Finally, we provide recommendations for future research in this area.
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