Sudden gains in treatment-as-usual couple therapy for military veterans

Previous studies of couple therapy have conceptualized change as a gradual process. However, there is growing evidence that, for many clients, the majority of gains in other treatment modalities are often achieved between just 2 sessions. Isolating the frequency, nature, and predictors of these sudden gains (SGs) in couple therapy can add to a growing understanding of how and why couple therapy works. In a sample of 67 couples receiving treatment-as-usual couple therapy in two Veterans Affairs hospitals, 25% of individuals experienced a SG in relationship satisfaction. The magnitude of these SGs were large (d = 1.62) and fully explained the total pre-post change for individuals who experienced them. Individuals with SGs showed significantly greater satisfaction gains during therapy; however SGs were not related to relationship satisfaction or relationship status at 18-month follow-up. SGs were predicted by the content of the previous session, putative change mechanisms of communication, intimacy, and behavior, as well as the partner's SGs during the same period. Results suggest that SGs are an important component of change during couple therapy for some individuals, challenging the assumption of continuous change in previous studies. In addition, predictors of SGs were generally consistent with theoretical and empirical examinations of mechanisms of change in couple therapy.     

Couples in Therapy: Actor-Partner Analyses of the Relationships Between Adult Romantic Attachment and Marital Satisfaction

This study was the first to investigate the relationship between adult romantic attachment and marital satisfaction in a clinical sample of 172 distressed couples seeking therapy. Fifty-six therapy-seeking nondistressed couples were also assessed for comparison. Analyses of variance showed that attachment avoidance was a distinctive characteristic of distressed couples. Actor-partner analyses revealed that attachment avoidance (for men and women) and attachment anxiety (for women only) were predictive of marital dissatisfaction for distressed couples. Gender-stereotype discordant partner effects were also found. Results suggest that attachment orientations (especially avoidance) are relevant predictors of marital dissatisfaction in distressed couples seeking therapy, and that couple therapists can gain important information by assessing partners’ attachment orientations.     

Observed communication and associations with satisfaction during traditional and integrative behavioral couple therapy

To investigate changes in couple communication and potential mechanisms of change during treatment, 134 distressed couples, who were randomly assigned to either traditional or integrative behavioral couple therapy (TBCT; IBCT), were observed in relationship and personal problem discussions prior to and near the end of treatment. Analyses were conducted using the Hierarchical Linear Modeling program. Over the time in therapy, during relationship problem discussions, positivity and problem solving increased while negativity decreased. Compared to IBCT, TBCT couples had the largest gains in positivity and reductions in negativity. During personal problem discussions, negativity decreased, while withdrawal increased and positivity decreased. TBCT couples had larger declines in negativity. In both discussion types, increases in marital satisfaction were associated with increases in positivity and problem solving. Declines in marital satisfaction were associated with increased negativity during relationship problem interactions and increased withdrawal during personal problem interactions. However, no treatment differences in these associations were found. Differences in rule-governed and contingency-shaped behavior change strategies between the two therapies and implications of findings are discussed.     

Greater emotional arousal predicts poorer long-term memory of communication skills in couples

Many studies have examined the importance of learning skills in behaviorally based couple interventions but none have examined predictors of long-term memory for skills. Associations between emotional arousal and long-term recall of communication skills delivered to couples during a behaviorally based relationship distress prevention program were examined in a sample of 49 German couples. Fundamental frequency (f(0)), a vocal measure of encoded emotional arousal, was measured during pre-treatment couple conflict. Higher levels of f(0) were linked to fewer skills remembered 11 years after completing the program, and women remembered more skills than men. Implications of results for behaviorally based couple interventions are discussed.     

Maintenance of Gains in Relationship and Individual Functioning Following the Online OurRelationship Program

In the United States, more than 40% of marriages end in divorce and more than one third of intact marriages are distressed. Unfortunately, only a minority of couples seek couple therapy to improve their relationships. Online interventions, with their increased reach and reduced costs, offer the potential to improve relationships nationwide. The online OurRelationship program has been shown in previous nationwide studies to improve relationship and individual functioning. The present study examined whether initial gains in the OurRelationship program were maintained in the following year and whether the extent of maintenance varied across important demographic and individual factors. In this study, 151 distressed heterosexual couples (302 individuals) who were randomized to the OurRelationship program were assessed 3 and 12 months following the intervention. Initial gains in relationship satisfaction, relationship confidence, and negative relationship quality were maintained through 12 months; positive relationship quality significantly improved over follow-up. Furthermore, couples maintained their initial gains in depressive symptoms, perceived health, work functioning, and quality of life; anxious symptoms continued to significantly decrease over follow-up. Finally, there was no evidence that historically underserved groups—racial/ethnic minorities, lower income couples, or rural couples—experienced greater deterioration. In fact, Hispanic couples reported continued improvement in relationship confidence and negative relationship quality in the 12 months following the program. The ability of the OurRelationship program—an 8-hour, primarily self-help program—to create long-lasting improvements in distressed relationships indicates it may have the potential to improve the lives of distressed couples on a broad scale.     

Effect of marital satisfaction on self-regulation efforts in couples: Value of heart rate variability measurements

This study explored self-regulatory efforts during the viewing of couple interactions and their association with relationship satisfaction. High-frequency heart rate variability (HF-HRV) was measured for each participant during a video recall of a recent couple interaction to quantify the self-regulatory processes governed by parasympathetic activity. Among 30 couples, HF-HRV was measured continuously during three specific periods to explore its change over time using a video-recall procedure: (1) resting state; (2) viewing of couple interactions (expressing daily life situations and conflictual interactions); and (3) recovery. Results of multilevel models revealed a u-shaped pattern of HF-HRV responses for men and women across the three periods with a nadir at the midway through the process. This pattern of physiological change (vagal suppression) reflects a flexible response to a stressful situation. Nevertheless, the pattern of physiological responses varied according to the level of relationship satisfaction. Men who were more satisfied in their couple relationship presented greater vagal suppression than dissatisfied men. In contrast, no significant HF-HRV changes were found in women over the different periods of the video-recall procedure and no moderating effect of relationship satisfaction. We discuss the different patterns of physiological responses observed both for men and women in terms of interindividual variability according to the level of their relationship satisfaction. The present study highlights the important role of relationship satisfaction in regulatory processes.     

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.     

“Hold Me Tight”: The Generalizability of an Attachment-Based Group Intervention to Chinese Canadian Couples

“Hold Me Tight” (HMT) groups are an adaptation of emotionally focused therapy (EFT) for couples and have emerged out of 30 years of research into the efficacy and process of EFT. The goal of this study was to test the effects of a Chinese-language version of the HMT relationship enrichment program in a sample of Chinese Canadians. Twenty-three men and 23 women (N = 46) in committed couple relationships completed an HMT relationship education program with their partners in Toronto, Ontario, Canada. Results indicated statistically significant improvements in participants' satisfaction with their attachment relationships, in their attachment security, and in their family functioning. The implications of these findings are discussed in light of relevant cross-cultural literature on attachment and couple relationships.     

Treatment‐as‐Usual for Couples: Trajectories Before and After Beginning Couple Therapy

Couple therapy has been shown to be a meaningful way to improve couples’ relationships. However, less information is known about couples’ functioning prior to entering treatment in community settings, as well as how their relationship functioning changes from initiating therapy onward. This study examined 87 couples who began community‐based couple therapy during a longitudinal study of couples in the military. The couples were assessed six times over the course of 3 years, including time points before and after starting couple therapy. Using an interrupted‐time series design, we examined trajectories across the start of couple therapy in relationship satisfaction, divorce proneness, and negative communication. The results demonstrated that couples’ relationship satisfaction was declining and both divorce proneness and negative communication were increasing prior to entering couple therapy. After starting couple therapy, couples’ functioning on all three variables leveled off but did not show further change, but previous experience in relationship education moderated these effects. Specifically, those who were assigned to the relationship education program (vs. control) demonstrated greater reductions in divorce proneness and greater increases marital satisfaction after starting therapy; however, they also started more distressed.     

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.     

CORRELATES OF RELATIONSHIP SATISFACTION IN LESBIAN COUPLES

This study broadens the construct of intimate relationships to include the experience of lesbian couples. Various psychological variables were assessed in both partners of 275 lesbian couples who considered themselves to be dual career. Because of the paucity of information on lesbian relationships in the literature, considerable attention is first given to describing this sizable sample. Individual and couple scores on each variable were correlated with relationship satisfaction scores. Among individuals, role conflict and personal autonomy were found to correlate negatively with relationship satisfaction, whereas dyadic attachment, power, intimacy, self-esteem, and life satisfaction were all positively correlated with relationship Satisfaction. Although career commitment was not correlated with relationship satisfaction among individuals, differences between partners'levels of career commitment correlated negatively with each partner's relationship satisfaction. The findings counter extant stereotypes regarding lesbian relationships and provide a more accurate basis for developing an heuristic model of intimate relationships among women.     

Predictors of relationship adjustment among couples coping with a high risk of developing breast/ovarian cancer

This study investigated the association between supportive and collaborative processes and dyadic adjustment in 94 women at increased risk of breast/ovarian cancer and their partners. Participants were recruited through two familial cancer clinics. They completed mailed, self-report questionnaires that included measures of psychological distress, dyadic adjustment (consensus, cohesion and satisfaction) and couple predictor variables (perceived support and team approach). Most couples reported average-to-high levels of consensus, cohesion and satisfaction, with a small proportion of couples (6.4%) reporting scores that reached clinically significant levels of dyadic distress. Greater perceived support was associated with better dyadic consensus and satisfaction, and dyadic cohesion and satisfaction were higher among couples who reported greater use of a team approach. General distress did not moderate the association between dyadic coping and relationship quality. There were no significant relationships between intra-couple congruence on support or team approach, and dyadic adjustment. Most couples had a functional relationship in the face of the current health stressor, although a subgroup may be at elevated risk of negative psychological consequences, including further relationship strain. The results highlight that dyadic coping strategies are important factors involved in the quality of couples' relationship following genetic counselling for breast/ovarian cancer risk.     

A randomized clinical trial of a brief, problem-focused couple therapy for depression

The aim of this study was to evaluate a brief couple therapy for depression targeted for mildly discordant or nondiscordant couples struggling with the negative impact of depression. Subjects included women with major depression or dysthymia who had husbands without clinical depression. Thirty-five couples were randomly assigned to the 5-week intervention (n = 18) or a waitlist control group (n = 17), and followed up 1 and 3 months later. Results showed a significant effect of treatment in reducing women's depressive symptoms, with 67% of women improved and 40% to 47% recovered at follow-up, compared to only 17% improved and 8% recovered among women in the control group. Treatment was also effective in secondarily improving women's marital satisfaction, reducing husbands' levels of psychological distress and depression-specific burden, and improving both partners' understanding and acceptance of depression. The treatment was implemented in five 2-hour sessions, representing an efficient, cost-effective approach. Findings support the growing utility of brief, problem-focused couple interventions that simultaneously target depression, relational functioning, and psychological distress experienced by the loved ones of depressed persons.     

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.     

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.     

Examining congruence between partners' perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples

Because studies examining the emotional impact of infertility-related stress generally focus on individuals, there has been little research examining how relationship and individual variables are linked. The purpose of this study was to explore the impact of congruence (e.g., agreement) between partner's perceived infertility-related stress and its effects on depression and marital adjustment in infertile men and women. Couples referred for infertility treatments at a University-affiliated teaching hospital completed the Fertility Problem Inventory (FPI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS) 3 months prior to their first treatment cycle. Study findings show that men and women in couples who perceived equal levels of social infertility stress reported higher levels of marital adjustment when compared to men and women in couples who perceived the stress differently. In addition, women in couples who felt a similar need for parenthood reported significantly higher levels of marital satisfaction when compared to women in couples where the males reported a greater need for parenthood. While couple incongruence was unrelated to depression in males, incongruence over relationship concerns and the need for parenthood was related to female depression. These findings provide initial support for the theory that high levels of agreement between partners related to the stresses they experience help them successfully manage the impact of these stressful life events. Possibilities for future research examining the construct of couple congruence are discussed.     

The Effects of a Couples‐Based Health Behavior Intervention During Pregnancy on Latino Couples’ Dyadic Satisfaction Postpartum

Many couples tend to report steadily decreasing relationship quality following the birth of a child. However, little is known about the postpartum period for Latino couples, a rapidly growing ethnic group who are notably underserved by mental and physical health caregivers in the United States. Thus, this study investigated whether a brief couples’ intervention focused on helping couples support each other while increasing healthy behaviors might improve dyadic functioning postpartum. This study presents secondary analyses of data regarding couple functioning from a larger randomized controlled trial with 348 Latino couples to promote smoking cessation. Portions of the intervention taught the couple communication and problem‐solving skills to increase healthy behavior. Couples participated in four face‐to‐face assessments across 1 year starting at the end of the first trimester. Latent growth curve analyses revealed that the treatment group reported an increase in relationship satisfaction and constructive communication after the intervention, which diminished by 1‐year follow‐up, returning couples to their baseline levels of satisfaction. Results suggest that incorporating a brief couple intervention as part of a larger health intervention for Latinos may prevent postpartum decreases in relationship satisfaction.     

The Impact of a Digital Recorder Intervention in Pragmatic/Experiential Therapy for Couples: A Pilot Study to Assess Emotional Flooding

The present study explored the effectiveness of a unique intervention for couple therapy, the Canned Attitude Method (a technique developed by Brent Atkinson), which utilized a digital recorder in and between therapy sessions. Participant dyads were randomly assigned to the intervention group utilizing the digital recorders or the control group, in which Pragmatic/Experiential Therapy for Couples (Atkinson in J Syst Ther 17:18–35, 1998) was conducted without the use of digital recorders. Both the intervention and the control groups were composed of five couples each for a total of 20 participants. This study hypothesized that the use of the Canned Attitude Method in couple therapy would produce a significant change in marital satisfaction, emotional flooding, and positive psychological tendencies associated with intimate relationships. Findings approached significance, demonstrating decreases in the experience of emotional flooding, gains in relationship satisfaction, and a shift towards positive attributes within the couples’ relationships.     

An investment model of sociosexuality,relationship satisfaction,and commitment: Evidence from dating,engaged, and newlywed couples

Using an investment model (Rusbult, 1980, 1983) of sociosexual attitudes (SOI-A), we examined SOI-A’s association with relationship outcomes using actor–partner interdependence models (APIMs) of over 400 dating, engaged, and newlywed couples. Men’s SOI-A negatively related to both men’s (actor effect) and women’s (partner effect) relationship satisfaction. This actor effect persisted after controlling for men’s and women’s relationship commitment, and was stronger (more negative) among dating couples (vs. engaged or newlywed couples) and couples with shorter relationship durations. Moderated-mediation APIMs suggested that (a) both actor-effect satisfaction–commitment associations were more positive in couples dating for 6 months and (b) men’s relationship satisfaction mediated the link between men’s SOI-A and men’s relationship commitment, but only in couples dating for 6 months.