Unrealistic beliefs of clinical couples: Their relationship to expectations,goals and satisfaction

Abstract

Forty-seven marital therapy couples completed inventories measuring unrealistic beliefs about self and unrealistic beliefs about marital relationships. In addition, they completed questionnaire measures of their expectations and goals for therapy and their levels of marital satisfaction. As hypothesized, the clients' unrealistic beliefs, particularly those regarding relationships, were negatively associated with their estimated chance for improvement in therapy, desire to improve rather than terminate the relationship, preference for marital versus individually oriented treatment, and overall marital satisfaction. These results are consistent with the theoretical rationale for cognitive therapy with clinical couples and suggest specific targets for intervention in this process. Directions for future research are discussed.     

The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study

The current study is a pilot project conducted at Baltimore VA Medical Center investigating the use of emotionally focused couples therapy (EFT) for couples in which one partner is a veteran who has been diagnosed with posttraumatic stress disorder (PTSD). Fifteen couples enrolled in the study and seven of these couples completed treatment (26 to 36 weekly sessions of EFT). Both partners were assessed on measures of relationship satisfaction, psychological distress, depression, and quality of life, and veterans were assessed on measures of PTSD symptoms at baseline and 2 weeks after the intervention. Paired t-tests were used to compare scores before and after EFT. In terms of results, the veterans' partners reported significant improvements in relationship and life satisfaction and in decreased depression and a decrease in psychological distress. Veterans demonstrated a significant decrease in self-reported symptoms of PTSD. These results provide preliminary evidence for the usefulness of EFT to help foster improved relationship satisfaction, and psychological well-being for veterans with PTSD and their partners who completed treatment.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

Commitment: A variable in women's response to marital therapy

Abstract

The relationship between commitment to one's marriage at the onset of therapy and changes during marital therapy was examined. In a sample of 42 couples seeking marital therapy, wives' commitment level accounted for a significant amount of unique variance in marital satisfaction before therapy and gains in marital satisfaction resulting from therapy. In keeping with earlier findings, results for men were less striking, and often nonsignificant. The importance of considering the variable of commitment in marital research is discussed.     

Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Youth Internalizing Symptoms

This study examined the secondary effects of Behavioral Couples Treatment (BCT) for parents with substance use disorder on youth reports of internalizing symptoms (i.e., depressive and anxiety symptoms). Participants were 59 triads (father, mothers, and youth; 32 girls, 27 boys) in which one or both parents met criteria for drug or alcohol use disorder (or both). Mothers, fathers, and youth completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Two piecewise latent growth models examined whether number of sessions attended was associated with parents’ relationship satisfaction or its growth over time, and in turn if parents’ relationship satisfaction was uniquely associated with youth depressive/anxiety symptoms or their growth over time. A significant indirect effect at post-intervention revealed the number of sessions attended contributed to decreases in youth depressive symptoms via increases in mothers’ and fathers’ relationship satisfaction. Mothers’ relationship satisfaction uniquely mediated the relationship between number of sessions attended and youth depressive symptoms at post-intervention. With regards to fathers, there was a non-significant trend such that increases in sessions attended was associated with decreases in youth depressive symptoms post- intervention via increasing relationship satisfaction among fathers. Findings suggest that BCT may have protective secondary effects in reducing youth reports of depressive symptoms among couples in which one or both parents have substance use disorder.     

The psychosocial predictors of long-term distress in partners of patients with acute coronary syndrome

Objective: Partners of acute coronary syndrome (ACS) patients are at risk of experiencing long-term distress and the purpose of this study was to identify its predictors.

Design: Using an observational design, 80 partners of ACS patients completed validated questionnaires at three time points. The predictor variables, marital satisfaction and optimism were assessed three weeks after patient hospital discharge (T1). The outcomes, depressive symptoms and physical health status (from a quality of life scale) were measured 6 (T2) and 12 (T3) months post-discharge, and scores were combined to indicate the long-term response.

Main outcome measures: Depressive symptoms and physical health status.

Results: Partner depressive symptoms increased and physical health status deteriorated over the months following the patients’ ACS. After controlling for demographics, clinical severity of ACS and T1 levels of the outcome variable, partners’ long-term depressive symptoms were predicted by poor marital satisfaction and low optimism at T1, and poor physical health status was predicted by low T1 optimism.

Conclusion: Psychosocial factors are predictors of long-term distress for ACS partners. Partners in an unhappy marriage or with low optimism after ACS are at an increased risk of depression and low physical health status, and should be the target of additional support.     

How do humility prototypes affect the association between perceptions of spouse’s humility and depressive symptoms and couple conflict?

ABSTRACT

Relational humility (RH) is associated with positive outcomes (e.g., fewer depressive symptoms; less couple conflict). Traditional conceptualizations of RH rely on other-report measures, but do not account for how one’s perception of another’s humility relates to one’s RH prototype (i.e., one’s expectations of how humble others, such as a spouse, should be). The current study (N = 69 couples; mean age = 30.80 years; 71% white) analyzed the effect of RH prototypes on the association between participants’ perception of their spouse’s RH and their reports of depressive symptoms and couple conflict. RH prototype was tested as both a moderator and a mediator to these associations. Actor-partner independence moderation and mediation models indicated that RH prototype functions as a moderator in the association between perceived spousal RH and both depressive symptoms and couple conflict, wherein greater discrepancies between spousal RH and RH prototype was associated with more depressive symptoms and conflict.     

Conflict management: A premarital training program in mutual problem solving

Abstract

The purpose of this study was to evaluate the effectiveness of a structured educational program designed to train premarital couples in communication and mutual problem-solving skills. Twenty-six couples participated in an eight-week, 24-hour problem-solving training program, while 28 similar couples participated in an eight-week, 24-hour relationship discussion group. Results indicated that the problem-solving group, as compared to the relationship-discussion group, showed a significant increase in communication and mutual problem-solving skills. Discussion focused on the benefits for premarital couples of learning effective problemsolving procedures as well as the need for follow-up assessments of both behavioral skill level and relationship satisfaction and adjustment.     

Longitudinal Associations Among Service Members’ PTSD Symptoms,Partner Accommodation,and Partner Distress

Romantic partners’ accommodation of trauma survivors’ posttraumatic stress disorder (PTSD) symptoms (e.g., participating in avoidance and safety behaviors, not expressing one’s thoughts and feelings) is a putative mechanism linking PTSD symptoms and partner distress, but this hypothesis has never been empirically tested. The current study investigated this proposed within-couple mediation process from service members’ PTSD symptoms to partners’ depressive symptoms and relationship satisfaction through partner accommodation, as well as between-couple associations among these constructs and the possible moderating role of partners’ conflict avoidance and helplessness (CAH) motivations for accommodating service members’ PTSD symptoms. We examined these questions in 272 male service member/female civilian couples assessed four times over an 18-month period using the multiple-group version of the random intercept cross-lagged panel model. Within couples, service members’ higher levels of PTSD symptoms at one time point significantly predicted partners being more accommodating at the next time point (βs = .14–.19), which, in turn, significantly predicted higher levels of partner depressive symptoms at the subsequent time point (βs = .09–.19) but did not predict partners’ subsequent relationship satisfaction. At the between-couple level, partner accommodation was significantly positively associated with partners’ depressive symptoms only among those endorsing high CAH motivations for accommodation (r = .50). In addition, accommodation was significantly negatively associated with partners’ relationship satisfaction regardless of CAH motivation level (rs = −.43 to −.49). These findings are discussed in light of the potential for couple-based treatments for PTSD to enhance partner individual and relational well-being.     

Self-Compassion and Forgiveness: Major Predictors of Marital Satisfaction in Young Couples

Abstract

This study examined self-compassion and forgiveness versus marital satisfaction in 200 couples aged 20-40?years, with a marriage history of 1-10?years. We collected the data, using the Enrich couple, self-compassion and family forgiveness scales. Pearson’s correlation and multiple regressions for women showed that marital satisfaction was associated with self-compassion; however, forgiveness predicted marital satisfaction in men. Self-compassion primarily and forgiveness, to a lesser extent, could predict marital satisfaction in the total samples. These variables were the predictors of marital satisfaction in the young couples. Family counselors should encourage couples to improve upon these attributes to enhance their marital relationships.     

Marital Satisfaction Prior to Couples Therapy

SUMMARY

The author predicted that couples would begin therapy with a high potential for separation or divorce and with one partner significantly more dissatisfied than the other. Using the Index of Marital Satisfaction (Hudson, 1982), 24 couples were studied using a practitioner-researcher model. Although the first hypothesis was not confirmed at the level of prediction, partners were found to be at a level of dissatisfaction close to the predicted levels. A highly significant statistical difference (p = .0001) was observed between the satisfaction levels of the partners in the couples. Based upon the research findings, some clinical wisdom was revised and other beliefs were confirmed.     

Emotionally-focused therapy and treatment as usual comparison groups in decreasing depression: A clinical pilot study

Abstract

Decades of research have shown that depression can have deleterious effects on couple relationships. Emotionally-focused therapy (EFT; Johnson, 2004 Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. East Sussex, UK: Brunner-Routledge. [Google Scholar]) is an empirically validated form of couple therapy, which has shown effectiveness in reducing depressive symptoms in couples where the wife has depression. The aim of the current pilot study was to examine the extent to which EFT and the comparison treatment as usual (TAU) therapy group decrease depressive symptoms in distressed couples. Results show that both groups were effective in decreasing depressive symptoms, with EFT showing a clinically significant reduction. Clinical implications and future research are discussed.     

Elucidating the relation between childhood emotional abuse and depressive symptoms in adulthood: The mediating role of maladaptive interpersonal processes

ObjectiveThe purpose of this study is to assess the potential unique and relative mediating effects of three interpersonal risk factors (i.e., excessive reassurance-seeking [ERS], negative feedback seeking [NFS], and rejection sensitivity [RS]) in the relationship between childhood emotional abuse (CEA) and depressive symptoms.MethodOne hundred eighty-five undergraduates were followed over a four-month interval. Participants completed assessments of childhood abuse history, ERS, NFS, and RS, and depressive symptoms at baseline, as well as depressive symptoms at four-month followup.ResultsFindings from single-mediator analyses indicated that RS and NFS, but not ERS, mediated the relationship between CEA and prospective depressive symptoms, after accounting for childhood sexual and physical abuse, as well as baseline depressive symptoms. In our multi-mediator model, only RS remained a significant mediator of the relationship between CEA and prospective depressive symptoms.ConclusionsThe current study provides preliminary evidence that negative behavioral styles may function as a mechanism linking prior experiences of CEA to subsequent depressive symptoms. Clinical implications of these findings suggest that targeting maladaptive behavioral tendencies, particularly RS, may be an effective adjunct in behavioral modification treatments of CEA victims at risk for depression.     

Emotion-Focused Therapy for Couples in the Treatment of Depression: A Pilot Study

Emotion-focused therapy (EFT) for couples was compared to pharmacotherapy in the treatment of major depressive disorder. Eighteen distressed couples in which the female partner met diagnostic criteria for major depressive disorder were randomly assigned to 16 weekly sessions of emotion-focused therapy or pharmacotherapy with desipramine, trimipramine, or trazadone. Twelve couples completed the study. Both interventions were equally effective in symptom reduction. There was some evidence that females receiving EFT made greater improvement after the conclusion of treatment than those receiving pharmacotherapy. The results suggest EFT might be useful in the treatment of comorbid major depressive disorder and relational distress.     

Family Measurement Techniques

Abstract

This study examined the extent to which a brief, structured couples therapy program based on Imago Relationship Therapy was associated with improvements on the COMPASS scales of individual psychological functioning as well as on a measure of relationship satisfaction, the Marital Satisfaction Inventory. An examination of pre- to post-treatment differences revealed statistically significant differences on three of the four COMPASS scales and all three MSI scales. The rate of improvement in individual distress per couples therapy session was approximately equal to the improvement, found in previous studies, yielded by individual therapy. The results support previous findings that couples therapy may be an effective modality for the treatment of intrapersonal difficulties, and suggest that both relationship and individual distress indices should be utilized in the evaluation of the efficacy of marital therapies.     

Intensive,Multi-Couple Group Therapy for PTSD: A Nonrandomized Pilot Study With Military and Veteran Dyads

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients’ self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients’ PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD.     

Insomnia symptoms are associated with elevated C-reactive protein in young adults

Abstract

Objective: Insomnia is associated with elevated inflammation; however, studies have not investigated if this relationship is confounded with depression and neuroticism, which are associated with insomnia and inflammation. The current study examined the association of insomnia symptoms with C-reactive protein (CRP) and with interleukin-6 (IL-6), independently and after controlling for depressive symptoms and neuroticism. Design: Fifty-two young adults (mean age?=?25.2?±?3.9 years, 52% female) completed a baseline survey to assess psychological characteristics, followed by a plasma blood draw. Main outcome measures: Plasma CRP and IL-6. Results: When examined alone, insomnia symptoms were significantly associated with elevated CRP (β?=?0.52; R²?=?0.27), as was neuroticism (β?=?0.41, R²?=?0.17), but not depressive symptoms (β?=?0.21, R²?=?0.05). The association between insomnia symptoms and CRP remained significant when depressive symptoms and neuroticism were entered into the model simultaneously; this model did not explain more variance than the model with insomnia symptoms alone. No variables were associated with IL-6. Conclusions: Results suggest that insomnia symptoms are independently associated with elevated CRP in young adults, even after controlling for presumed overlapping psychological constructs. Findings highlight the potential importance of treating insomnia to reduce systemic inflammation.     

Structural couple therapy in the treatment of inhibited sexual drive

Abstract

This paper presents a study of a structural couple therapy approach to the treatment of inhibited sexual desire (ISD). ISD is first conceptualized as a relational phenomenon that may be most effectively treated in a couple context. Structural couple therapy is advanced and applied to the treatment of a clinical sample of couples presenting with ISD. Results of the study suggest that a structural couple therapy approach to ISD is effective in reducing symptoms of the sexual disorder and in increasing couple satisfaction.     

The Role of Positive Emotions in Reducing Depressive Symptoms Among Army Wives

The homecoming period following combat deployment can be as stressful to military spouses as the deployment itself. This study used the broaden-and-build theory of positive emotions to examine whether personal resources (adaptive coping, maladaptive coping, and resilience) mediate the relationship between positive emotions and depressive symptoms in Army wives (N = 252) following the homecoming of a deployed active-duty service member. Using path analysis, after controlling for demographic variables and marital satisfaction, positive emotions were related to all 3 personal resources (positively to adaptive coping and resilience, negatively to maladaptive coping). In turn, adaptive coping and resilience were related to fewer depressive symptoms and maladaptive coping to greater depressive symptoms. The direct path between positive emotions and depressive symptoms was nonsignificant, suggesting complete mediation. The final model accounted for 54% of the total variance in depressive symptoms. Results support the important role that positive emotions play in decreasing depressive symptoms in this high-risk population.     

Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence‐based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the “active” treatment stage after the 3–4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non‐Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non‐Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment.