The Partners for Life Program: A Couples Approach to Cardiac Risk Reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety‐three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.     

Couples treatment for major depression: critique of the literature and suggestions for some different directions

Current couples approaches to the treatment of depression show considerable promise for some couples, but have substantial room for improvement – in terms of efficacy as well as applicability and acceptability to a broader population. Although conjoint approaches have been shown to be efficacious in reducing couple distress and are possibly efficacious in ameliorating depression that co-occurs with couple distress, methodological problems hamper generalization from the published findings. Therefore, it is not clear that most depressed persons are likely to benefit from currently available conjoint formats. Most basically, there may often be obstacles that prevent or delay partner involvement, highlighting the need for treatments that can enhance relationship functioning without relying on a conjoint format. Existing treatment delivery systems may also fail to reach a considerable segment of the population. Developing a more flexible set of options for implementing couple-focused treatment, as well as rethinking dominant assumptions about depression, may be integral to extending the viability of couples therapy for depression.     

澳门和东北地区夫妻沟通模式与婚姻满意度研究

采用问卷调查法对澳门（118对）和东北地区（266对）夫妻进行研究,以检验两地夫妻沟通模式的差异,及其对婚姻满意度的主客体效应。结果发现：澳门夫妻双方回避沟通显著少于东北夫妻;两地夫妻报告的妻子要求/丈夫回避行为多于丈夫要求/妻子回避行为;建设性沟通对两地夫妻婚姻满意度正向预测力最强;要求/回避沟通只对澳门夫妻的婚姻满意度有负向预测力。两地妻子的建设性沟通都能显著正向预测丈夫的婚姻满意度,而只有东北地区丈夫的建设性沟通能正向预测妻子婚姻满意度。     

Marital Quality of Newlywed African American Couples: Implications of Egalitarian Gender Role Dynamics

This research examined associations between husbands’ and wives’ gender role attitudes, division of household labor, and marital quality in a sample of 697 newlywed African American couples residing in the southern region of the United States. Guided by a cultural ecological framework, we tested hypotheses specific to the unique socio-cultural context of African Americans using a mixed model ANCOVA design. Results revealed that: (1) couples reported lower marital quality when husbands had relatively more traditional gender role attitudes; (2) husbands reported lower marital quality when the couple engaged in a relatively more traditional division of household labor; and (3) husbands with more traditional attitudes who also engaged in a traditional division of labor reported lower marital quality compared to all other husbands. Although African Americans are thought to have more flexible gender role orientations than other racial/ethnic groups within the U.S., these results document within group variability in couple gender dynamics and its association with variability in marital quality.     

Behavioral Marital Therapy: An Outcome Evaluation of Conjoint,Group and One Spouse Treatment

Abstract

Behavioral Marital Therapy has focussed on the modification of marital behavior in conjoint and couples group settings. This study extends previously published outcome studies in that one treatment condition involved treating only one of the partners. Fifty-seven couples were consecutively assigned to one of the three treatment conditions. Outcome evaluations included an independent assessment, marital satisfaction, sexual adjustment and an assessment of target problems. The results revealed no significant differences between the three treatment conditions. However, couples in the conjoint treatment resolved their target problems more rapidly than the other two treatments. The implications of the result as well as issues of outcome prediction, cost-effectiveness and the viability of treating one spouse are discussed.     

A cross-cultural examination of the relation of marital communication behavior to marital satisfaction.

Numerous studies have examined the communication behaviors of Western, primarily North American, couples and have demonstrated a robust and reliable association between marital satisfaction and couple communication. However, there has been relatively less attention given to the generalizability of these findings to non-Western couples. To address this issue, the authors conducted an observational study of marital communication among couples from 3 different cultural groups: 50 White American couples, 52 Pakistani couples in Pakistan, and 48 immigrant Pakistani couples in America. The results show that positive and negative communication behaviors were associated with marital satisfaction within each of the 3 cultural groups. However, the American group's marital satisfaction was more strongly related to marital communication behaviors than was that of the Pakistani group and, to a lesser extent, the immigrant group.     

Evaluating Marital Therapy: A Hospital and Community Study

The study investigated the application of marital therapy using three contrasting clinical approaches: conjoint treatment, couples groups, and treating the partner alone. Thirty-six couples comprised the research sample, with eighteen couples being treated in each of two NHS treatment settings. The duration of the treatment was ten weekly sessions each lasting one hour, and couples were followed up six months after termination. Outcome evaluations included marital satisfaction, sexual adjustment, and an assessment of target problems. The analysis of the results showed no significant difference between groups at the post-treatment and follow-up assessments. There was, however, a significant difference in the rates of change between experimental groups. The implications of these results are discussed.     

Multiplicity Within and Between: Addressing Multiple Roles Through Role Profiles in Couples

The purpose of this study is to test the validity of a personality assessment, Role Profiles, by exploring the relationship between role balance and individual well-being and the relationship between couples’ role profiles similarity and their marital satisfaction. Twenty couples were recruited and completed the assessments. This study partially supported Role Profiles’ validity and the findings were consistent with previous studies: individuals with higher role confusion were more likely to report lower self-esteem, and couples who shared many identical roles in their roles profiles were more likely to report higher marital satisfaction. The utility of Role Profiles as a clinical assessment in couples therapy is discussed.     

The transition to parenthood: II. Stability and change in marital structure

At 1 year postpartum, 22 of 38 couples demonstrated the same level of marital competence as they had prenatally, 14 couples demonstrated deterioration in their marital relationship, and 2 couples were improved. At each of four levels of marital competence, there was a trend for the couples to demonstrate the same relationship response to parenthood. Highly competent relationships remained at high levels of competence. Competent but pained relationships were most vulnerable to regressive change in structure. Dominant-submissive, complementary relationships tended to remain stable at that level. Dominant-submissive, conflicted or severely conflicted relationships were most unpredictable and stability, regression, and improvement were seen. These findings are explored for possible correlations and are discussed from the perspective of several current models of family development.     

Marital interaction of agoraphobic women: a controlled,behavioral observation study

Married couples with a female agoraphobic spouse (n = 22) were compared with demographically similar community control couples (n = 21) on self-report and observational measures of marital interaction. Consistent with hypotheses, husbands of agoraphobic women were more critical of their wives than were control husbands, and clinical couples were less likely to engage in positive problem solution than control couples. Contrary to hypothesis, clinical husbands were not less supportive than control husbands. Where general measures of marital distress were concerned, clinical couples, relative to control couples, evinced more distress by self-report, by their higher rate of negative nonverbal behavior, and by their longer sequences of negative exchanges.     

Depression, Marital Satisfaction and Communication in Couples: Investigating Gender Differences

The correlation between depression and dysfunctional marital interaction is well documented, but only a few studies have examined gender-related differences in marital interaction patterns of couples with a depressed partner. In this paper we examined differences in observed marital communication in a sample of 62 Swiss couples presenting for treatment of depression. There were 16 maritally distressed couples with a depressed wife, 21 maritally nondistressed couples with a depressed wife, 18 maritally distressed couples with a depressed husband, and 7 maritally nondistressed couples with a depressed husband. Marital interaction behavior was found to depend on gender, depression, marital distress, as well as gender of the depressed partner. Our results suggest the need for a gender-sensitive model of the link between marital interaction and depression.     

Using Acceptance and Commitment Therapy to Treat Distressed Couples: A Case Study With Two Couples

Although the field of couple therapy has made significant strides in recent years, there continues to be a need for theoretically sound and empirically supported treatments. The current case study examines whether Acceptance and Commitment Therapy (ACT), an experiential acceptance-based behavior therapy, can be effective in treating distressed couples. Although ACT has demonstrated effectiveness in treating a variety of disorders in individuals, it has not been systemically applied to the treatment of couple distress, and the current study is the first empirical examination of ACT for the treatment of couples. Two married couples participated in the study. A number of core ACT interventions were modified to treat couples in a conjoint format. Cognitive defusion exercises were used to help couples reduce their fusion with and the believability of negative thoughts and feelings related to the relationship. Mindfulness and acceptance techniques were used to help couples increase awareness of their reactions to negative relationship cycles. Finally, value-directed action was used to help partners act in ways consistent with relationship values even in the presence of unwanted thoughts and feelings. The results of this preliminary case study suggest that ACT may be effective in increasing marital adjustment and satisfaction, and in reducing interpersonal and psychological distress in couples. Future studies with larger samples and more controlled designs are needed to build on the results from this single-case study.     

老年人夫妻冲突一般特点及其与依恋的关系

采用开放式与封闭式问卷相结合的方式对27对60～84岁(M=69.93±5.89)的老年夫妻测查了老年人夫妻依恋风格及夫妻冲突的特点。结果表明,老年人夫妻冲突具有低频率、低强度、较低的威胁性、较高的建设性及易解决的特点;不同依恋风格的老年人夫妻冲突的强度、频率、冲突解决程度均不存在显著差异;在冲突性质上,安全型依恋风格老年人感知到的冲突建设性显著高于不安全型依恋风格个体,但其感知到的冲突威胁性无显著差异;老年夫妻对冲突的感知存在冲突知觉一致性效应。     

Understanding general and specific connections between psychopathology and marital distress: a model based approach

Marital distress is linked to many types of mental disorders; however, no study to date has examined this link in the context of empirically based hierarchical models of psychopathology. There may be general associations between low levels of marital quality and broad groups of comorbid psychiatric disorders as well as links between marital adjustment and specific types of mental disorders. The authors examined this issue in a sample (N = 929 couples) of currently married couples from the Minnesota Twin Family Study who completed self-report measures of relationship adjustment and were also assessed for common mental disorders. Structural equation modeling indicated that (a) higher standing on latent factors of internalizing (INT) and externalizing (EXT) psychopathology was associated with lower standing on latent factors of general marital adjustment for both husbands and wives, (b) the magnitude of these effects was similar across husbands and wives, and (c) there were no residual associations between any specific mental disorder and overall relationship adjustment after controlling for the INT and EXT factors. These findings point to the utility of hierarchical models in understanding psychopathology and its correlates. Much of the link between mental disorder and marital distress operated at the level of broad spectrums of psychopathological variation (i.e., higher levels of marital distress were associated with disorder comorbidity), suggesting that the temperamental core of these spectrums contributes not only to symptoms of mental illness but to the behaviors that lead to impaired marital quality in adulthood.     

Relationships among measures of communication, marital satisfaction and exposure during couples treatment of agoraphobia

The goals of this study were to examine the relationships among measures of couples interactions (satisfaction and communication), and response to treatment within a group of agoraphobic clients and their partners. The treatment included the clients' partners in structured, graduated in vivo exposure practices. Twenty-two clients and their partners completed pre-, mid- and post-treatment assessments. Treatment responders rated themselves and their partners as more communicative regarding the client's fears, at pre- and mid-assessments in comparison to nonresponders; measures of communication related inversely to levels of anxiety reported during exposures, but marital satisfaction did not relate to any measure of exposure. In addition, level of anxiety during exposure differentiated responders from nonresponders; responders experienced a significant reduction in their levels of anxiety. Finally, ratings of frequency of communication at mid-assessment were highly predictive of treatment outcome at post-assessment. The implications from these findings for communication skills training for a subset of couples who enter couples treatment for agoraphobia are discussed.     

The Transition to Parenthood: III. Incorporation of the Child into the Family

The major focus of this article is the relationship of the parents' marital relationship structure to the incorporation of the child into the family. Our central hypothesis is that couples who have evolved more competent marital structures prenatally are more likely to incorporate the child successfully into the family.     

Attributions in marriage: state or trait? A growth curve analysis

Research on attributions in marriage rests on 2 assumptions. First, the attributions spouses make for their partners' behaviors have been treated as a style or a trait, reflecting enduring aspects of the perceiver. Second, attributions have been described as a causal factor in the development of the marriage over time. To evaluate the evidence for these assumptions, the authors analyzed 8 waves of longitudinal data from a sample of newlywed couples. Results offered no support for the idea of an enduring attributional style; attributions changed linearly, and changes in attributions were strongly associated with changes in marital satisfaction within each spouse. Nevertheless, controlling for these associations, initial levels of attributions predicted changes in marital satisfaction more than initial satisfaction predicted changes in attributions. Effects of neuroticism and effects on marital dissolution were also examined.     

Husbands' and wives' alcohol use disorders and marital interactions as longitudinal predictors of marital adjustment

In this longitudinal study, the relationships among wives' and husbands' lifetime alcoholism status, marital behaviors, and marital adjustment were tested. Participants were 105 couples from the Michigan Longitudinal Study (MLS), an ongoing multimethod investigation of substance use in a community-based sample of alcoholics, nonalcoholics, and their families. At baseline (T1), husbands and wives completed a series of diagnostic measures, and lifetime diagnosis of alcohol use disorder (AUD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), was assessed. Couples completed a problem-solving marital interaction task 3 years later at T2, which was coded for the ratio of positive to negative behaviors. Couples also completed a measure of marital adjustment at T4 (9 years after T1 and 6 years after T2). Results showed that husbands' lifetime AUD predicted lower levels of their wife's positive marital behaviors 3 years later but was not related to their own or their wife's marital adjustment 9 years from baseline. By contrast, wives' lifetime AUD had direct negative associations with their own and their husband's marital satisfaction 9 years later, and wives' marital behaviors during the problem-solving task predicted their own and their husband's marital satisfaction 6 years later. Findings indicate that marital adjustment in alcoholic couples may be driven more by the wives' than the husbands' AUD and marital behavior. Implications for intervention with alcoholic couples were discussed.     

What are the Marital Problems of Happy Couples? A Multimethod,Two-Sample Investigation

How couples handle marital conflict may depend on what issues they are facing, as some issues may be more difficult to resolve than others. What is unclear, however, is what issues happy couples face and how these issues may be different for couples depending on their developmental stage. To explore this possibility, the current study used both self-reports and observations drawn from two separate samples of happily married couples—one early in middle adulthood (N = 57 couples; average marital duration = 9 years) and one in older adulthood (N = 64 couples; average marital duration = 42 years). Results indicated that all issues were relatively minor, but early middle-aged couples reported more significant problems than did older couples. As to determining the most salient topic for happy couples, it depended on the spouses’ gender, developmental stage, and how salience was assessed (i.e., highest rated issue vs. most discussed issue). Only moderate links were found between what happy couples said was their most serious concern and what they actually tried to resolve during observations of marital problem-solving, but there were differences in how spouses behaved based on the proportion of their time discussing certain topics. Findings suggest that more attention should be devoted to understanding what marital issues happy couples discuss and why, as doing so may reveal how couples maintain their marital happiness.