for people ages 18 years and up (full criteria)
at San Diego, California
study started
completion around
Principal Investigator
by Leslie A. Morland, PsyD
Headshot of Leslie A. Morland
Leslie A. Morland



Leveraging veterans' intimate relationships during treatment for posttraumatic stress disorder (PTSD) has the potential to concurrently improve PTSD symptoms and relationship quality. Brief Cognitive-Behavioral Conjoint Therapy (bCBCT) is a manualized treatment designed to simultaneously improve PTSD and relationship functioning for couples in which one partner has PTSD. Although efficacious in improving PTSD, the effects of CBCT on relationship satisfaction are small, especially among Veterans. Pharmacological augmentation of bCBCT with intranasal oxytocin, a neurohormone that influences mechanisms of trauma recovery and social behavior, may help improve the efficacy of bCBCT. The purpose of this randomized placebo-controlled trial is to compare the clinical and functional outcomes of bCBCT augmented with intranasal oxytocin (bCBCT + OT) versus bCBCT plus placebo (bCBCT + PL). The investigators will also explore potential mechanisms of action: communication, empathy, and trust.

Official Title

A Randomized Clinical Trial Examining Intranasal Oxytocin Augmentation of Brief Couples Therapy for Veterans With PTSD


The primary aim of this study is to investigate the effects of Brief Cognitive Behavioral Conjoint Therapy (bCBCT) paired with intranasal oxytocin (OT) versus placebo on PTSD symptoms, intimate relationship satisfaction and psychosocial functioning in a sample of veterans with PTSD (across all measures) and their intimate partners (relationship satisfaction only). The study will also explore the impact of intranasal oxytocin on potential mechanisms of action (i.e., communication skills, empathy, and trust).

bCBCT is a modified PTSD-specific cognitive-behavioral psychotherapy attended by the couple that uses close relationships as the vehicle for recovery. Across eight 75-minute sessions, this manualized therapy addresses the patient's PTSD and relationship functioning simultaneously via its focus on PTSD psychoeducation within relationship contexts, communication skills, behavioral approach exercises, and cognitive interventions.

Oxytocin is a 9-amino-acid nonapeptide hormone produced by the paraventricular and supraoptic nuclei of the hypothalamus that regulates human emotions, social cognition, and social behaviors. Oxytocin is released to several brain areas, including the amygdala, hypothalamus, hippocampus, insula, and striatum, and effects are mediated by oxytocin receptors found in these regions.

Intranasal administration of oxytocin may offer understanding of the causal effects of oxytocin on human behavior. Intranasal oxytocin is safe and easy to administer, with a short half-life that makes it highly suitable for adding to behavioral interventions. Intranasal oxytocin is best known for its widespread effects on affiliative processes and behaviors. For example, intranasal oxytocin increases trust, empathy, generosity, positive communication, and emotional disclosure. Oxytocin also improves social cognition, including emotion recognition and empathic accuracy. The combination of intranasal oxytocin with provision of social support suppresses cortisol release and subjective responses to social stress.

Intranasal oxytocin can be conceptualized as a "psychotherapy process catalyst", in that oxytocin could enhance patients' openness to intervention, attention to others' communication, and willingness and ability to develop therapeutic alliance. A recent systematic review of 14 studies of the effects of intranasal oxytocin on PTSD symptoms concluded that there is tentative evidence for the clinical utility of intranasal oxytocin for PTSD, although more studies with chronic administration among clinical samples are needed.

The investigators will employ a double blind, placebo-controlled RCT design in which Veterans will receive a dose of oxytocin or placebo before each bCBCT session and complete mid-treatment, post-treatment, 3-month, and 6-month follow-up assessments. Based on the findings from past bCBCT trial and the investigators' recent bCBCT + OT pilot study, the investigators anticipate about 1/3 of the sample will be dual Veterans or the identified Veteran is female. The investigators project an approximate 20-25% attrition rate, resulting in approximately 100 couples completing treatment. Consistent with past trials, to enhance retention, the investigators will ask couples to provide contact information for collateral informants who can reach them if the investigators are unable to do so via their primary contact information. Study personnel will routinely remind couples of appointments via telephone and/or letters and the team will meet weekly to review and problem-solve retention strategies. These are all established procedures implemented from successful prior trials. If successful, the study will advance knowledge of strategies for improving Veterans' quality of life by improving their intimate relationships along with PTSD symptoms.


Post-Traumatic Stress Disorder (PTSD), Post Traumatic Stress Disorder (PTSD), Oxytocin, Relational Problems, Brief Cognitive Behavioral Conjoint Therapy, Veterans, Traumatic Stress Disorders, Post-Traumatic Stress Disorders, Oxytocin nasal spray, Saline nasal spray, Brief Cognitive-Behavioral Conjoint Therapy, Brief Cognitive Behavioral Conjoint Therapy for PTSD plus Intranasal Oxytocin


You can join if…

Open to people ages 18 years and up

Inclusion criteria for Veterans

  1. Be a veteran (age 18 or older) with a current DSM-5 diagnosis of PTSD (as assessed by the CAPS-5) no less than 3 months after the index trauma occurred (to allow for potential natural recovery)
  2. Be on a stable psychoactive medication regimen for at least 2 months (if eligible)
  3. Veteran must be enrolled and eligible to receive care at the VASDHS

Inclusion criteria for Partners

1.Be an intimate partner (age 18 or older) who is willing to participate in the intervention (partners can also be veterans but cannot meet criteria for possible PTSD per the PCL-5)

Inclusion criteria for Veterans and Partner dyads

  1. Be married, or cohabitating for at least 6 months
  2. Willing to be randomized into both treatment conditions
  3. Agree to have assessment and treatment sessions audio recorded
  4. Agree not to receive other individual or conjoint trauma-focused psychotherapy for PTSD during the treatment portion of the study
  5. Have the capacity to participate in virtual care (access to internet via DSL or a cable provider, private space)

You CAN'T join if...

Exclusion criteria for Veterans and Partners

  1. Current substance dependence in either member of the couple not in remission for at least 3 months, as assessed by the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST)
  2. Any current uncontrolled psychotic disorder in either member of the couple as assessed by the SCID-5 psychosis module
  3. Positive screen (7+) for borderline personality disorder (BPD) in either member of the couple as assessed by the MacLean Screening Instrument for BPD
  4. Imminent suicidality or homicidality in either member of the couple
  5. Any severe cognitive or medical impairment in either member of the couple making it difficult to regularly attend weekly couple's psychotherapy
  6. Any perpetration of severe physical or sexual relationship aggression (as assessed by the CTS-2) or fear/intimidation (3-item IPV screen, Couples Questionnaire) in the past year

Exclusion criteria for Veterans with PTSD:

  1. Severe ongoing medical problems, including heart disease and neuroendocrinological disorders (e.g., diabetes)
  2. Uncontrolled hypotension (systolic blood pressure <100 mm Hg) or hypertension (BP >160/100 mm Hg) as assessed by self-report and verified with VA chart review (in absence of chart documentation in past month, participant will be sent digital BP device and cuff to verify BP stability during video monitoring)
  3. Pregnancy, delivery in the past 6 months, or current breastfeeding


  • VA San Diego Healthcare System, San Diego, CA
    San Diego California 92161-0002 United States

Lead Scientist at UCSD

  • Leslie A. Morland, PsyD
    Dr. Leslie Morland is a clinical psychologist and a senior researcher at the VA National Center for PTSD (NCPTSD) Women’s Health Science Division and a Professor of Psychiatry in the School of Medicine at the University of California, San Diego (UCSD). Dr. Morland served as the Chief of Outpatient Access and Director of Telemental Health for the VA San Diego Healthcare System for the past 9 years.


not yet accepting patients
Start Date
Completion Date
VA Office of Research and Development
Phase 2 research study
Study Type
Expecting 240 study participants
Last Updated