Problem-solving skills in happy and distressed couples: Effects of videotape and verbal feedback

Investigated communication in happy and distressed married couples, in two studies. Fifty-eight couples' problem-solving behaviors were evaluated by the spouses themselves and by trained observers. Some distressed couples viewed their own videotape; others received a placebo intervention. Half of the distressed couples received written feedback before a second discussion. Results indicated that (a) distressed and happy couples differed on some behavioral measures; (b) both happy and distressed wives engaged in more negative behaviors than husbands; (c) videotape and written feedback were ineffective in altering behaviors; (d) husbands' and wives' negative behaviors were correlated highly; and (e) spouses' and observers' ratings were independent. Implications for research on marriage and for behavioral couple therapy are discussed.     

Infidelity and behavioral couple therapy: optimism in the face of betrayal

Infidelity is a common issue with which distressed couples and their therapists grapple. However, there are no data on the efficacy of commonly used therapies to treat couples in which there has been an affair. In the present exploratory study, the authors examined the therapy outcomes of a sample of infidelity couples (n=19) who had participated in a randomized clinical trial of marital therapy (N=134). Results show that infidelity couples began treatment more distressed than noninfidelity couples; however, evidence suggests that couples who had an affair and who revealed this affair prior to or during therapy showed greater improvement in satisfaction than noninfidelity couples. Implications for therapy with infidelity couples are discussed.     

Effects of behavioral marital therapy: a meta-analysis of randomized controlled trials

This meta-analysis summarizes results from 30 randomized experiments that compare behavioral marital therapy with no-treatment control with distressed couples. Results showed that behavioral marital therapy is significantly more effective than no treatment (d=.585). Although behavioral marital therapy research studies tend to be conducted under conditions that are less clinically representative than other samples of studies, representativeness was not significantly related to outcome. However, evidence also suggested that publication bias may exist in this literature whereby small sample studies with small effects are systematically missing compared with other studies. This bias may inflate the effects of behavioral marital therapies reported in previous meta-analyses, though we also explore a number of alternative explanations for this small sample bias.     

Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved.     

Marital therapy as a treatment for depression

The purpose of this study was to compare cognitive-behavioral therapy (CT; n = 20), behavioral marital therapy (BMT; n = 19), and a treatment combining BMT and CT (CO; n = 21) in the alleviation of wives' depression and the enhancement of marital satisfaction. BMT was less effective than CT for depression in maritally nondistressed couples, whereas for maritally distressed couples the two treatments were equally effective. BMT was the only treatment to have a significant positive impact on relationship satisfaction in distressed couples, whereas CO was the only treatment to enhance the marital satisfaction of nondistressed couples. On marital interaction measures CO was the only treatment to significantly reduce both husband and wife aversive behavior and to significantly increase wife facilitative behavior.     

Supplementing behavioral marital therapy with cognitive restructuring and emotional expressiveness training: an outcome investigation

The current study investigated whether the effectiveness of behavioral marital therapy (BMT) would be increased by the addition of cognitive restructuring (CR) and/or emotional expressiveness training (EET) for maritally distressed couples. Sixty such couples were randomly assigned to 1 of 3 therapists and 1 of 5 treatment conditions (BMT Alone, CR + BMT, BMT + EET, CR + BMT + EET, or waiting list) for 12 weeks of conjoint marital therapy. Within each treatment condition, couples typically improved on the variables focused on in treatment. However, comparisons among active treatment conditions showed few significant differences among treatments; the treatments were equally effective in increasing marital adjustment. Thus, the addition of CR and EET did not appear to increase the overall effectiveness of treatment. Possible reasons for the current findings are provided, and suggestions for future marital outcome investigations are outlined.     

Prediction of response to treatment in a randomized clinical trial of marital therapy

This study investigated demographic, intrapersonal, and interpersonal predictors of treatment response in a randomized clinical trial of 134 distressed married couples, which examined traditional (N. S. Jacobson & G. Margolin, 1979) and integrative (N. S. Jacobson & A. Christensen, 1996) behavioral couple therapy. Results based on hierarchical linear modeling revealed that interpersonal variables were the strongest predictors, but their effects were largely limited to predicting initial marital dissatisfaction; greater individual mental health was also associated with less distress initially. Couples who were married longer demonstrated stronger treatment gains, and exploratory analyses suggested that sexually dissatisfied couples showed slower initial, but overall more consistent, gains in the integrative versus the traditional approach. Findings are considered in light of the previous literature on predicting response to marital therapy.     

Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy

Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy.     

Helping themselves to get pregnant: a qualitative longitudinal study on the information-seeking behaviour of infertile couples

BACKGROUND: Couples seeking infertility treatment are generally hungry for information about available therapeutic options and how to help themselves achieve pregnancy. This study examined couples' perceptions of the information available from various sources in the context of achieved pregnancy or continuing treatment. METHODS: A 3 year prospective interview study started in April 2004, following couples undergoing infertility treatment at a tertiary fertility clinic at Aberdeen Maternity Hospital. Fifty-four couples were invited to participate. Up to three semi-structured interviews took place, and were analysed thematically using a variation of grounded theory. RESULTS: Twenty-seven couples agreed to participate and of the 25 couples followed up, 11 were diagnosed with unexplained infertility. The age range of the women was 22-41 years. All hoped to be given information on helping themselves to achieve pregnancy, spontaneous or assisted, and 19 of the 25 couples became pregnant. Most couples were dissatisfied with the written and verbal information routinely provided by the fertility clinic because it suggested lifestyle changes they had already attempted to adopt. They sought additional information from the internet, books and magazines. Those who became pregnant were generally empowered by the experience and thought that it had helped them to conceive. Women who were still undergoing treatment however, sometimes became distressed, blaming themselves for failing to follow the lifestyle advice provided. CONCLUSIONS: Couples, especially those diagnosed with unexplained infertility, seek information to help themselves conceive, but only those who succeed find it an empowering experience.     

Why are infertile patients not using psychosocial counselling?

The purpose of this study was to examine the sources of support that infertile patients relied on when distressed, and the factors that prevented them from using psychosocial counselling. The sample consisted of 143 infertile patients (49 couples plus 45 additional women) who were in their mid-thirties and had been infertile for approximately 6 years. Before their clinic appointment, participants completed (anonymously) a short questionnaire concerning various sources of support and factors related to the uptake of counselling. The results showed that patients relied primarily on their spouse and family when distressed, rather than on formal support resources such as psychosocial counselling. The principal reason preventing patients from using counselling varied as a function of current distress level. Less distressed patients reported that the coping resources available to them were sufficient to cope with the strains of infertility, while the more distressed patients failed to initiate contact with a counsellor because of practical concerns such as knowing who to contact and/or the cost of counselling. The findings of this study indicate that alternative ways of intervening with infertile patients would need to be developed, as few use the type of psychosocial services most frequently offered.     

Demand-withdraw interaction in couples with a violent husband.

This study examined the relationship between demand-withdraw interaction and battering in couples with a violent husband. The authors compared the interaction patterns of 47 couples with a violent husband with the interaction patterns of 28 distressed but nonviolent couples and 16 happily married nonviolent couples. All couples engaged in videotaped discussions of problem areas in their marriage. Both batterers and battered women showed less positive communication and more negative communication than did their nonviolent counterparts. Additionally, batterers showed significantly higher levels of both demanding and withdrawing than did other men. Battered women demanded more change than did women in nonviolent marriages but were significantly less inclined to withdraw than were their husbands. The discussion of these findings focuses on the interactional dynamics between batterers and battered women and how these interactions might be understood.     

Challenges and Lessons Learned in the Development and Implementation of a Couples-Focused Telephone Intervention for Adults with Type 2 Diabetes: The Diabetes Support Project

BACKGROUND: Type 2 diabetes (T2DM) studies report that marital/family support relates to glycemic control, adherence and quality-of-life. Yet, there are few reports of couples-focused interventions. PURPOSE: To describe the challenges faced and lessons learned in the implementation of a theoretically-based, couples intervention. METHODS: 350 couples (one partner has T2DM in poor glycemic control) are randomized to a couples intervention, individual intervention, or enhanced usual care. All contacts are by telephone, to increase reach. OUTCOMES: medical (e.g. glycemic control), psychosocial (e.g. diabetes distress), and behavioral (e.g. regimen adherence). Challenges in recruitment, assessment and intervention with couples are described, with suggestions about how to address them. RESULTS: Findings concerning the efficacy and cost-effectiveness of the couples intervention, its effect on partners, and possible mechanisms of demonstrated changes, are anticipated in 2013. CONCLUSIONS: Interventionists need specific skills to work with couples to promote communal coping and increase the likelihood of an efficacious couples intervention.     

Self-disclosure patterns in clinical and nonclinical couples

Examined differences in the self-disclosing patterns of 10 clinical and 10 nonclinicl couples in a structured interview using the Self-Disclosure Coding System (SDCS), a behavioral content analysis system designed to assess the basic parameters of disclosing behavior. A discriminant function analysis revealed that two SDCS variables, (1) time spent talking; and (2) judged degree of congruence between verbal content and affective manner of presentation, could discriminate the two groups and would classify correctly 70% of the couples. These results suggest that is not what clinical couples say, but how they say it that will distinguish them from nonclinical couples.     

Communication, conflict, and psychological distance in nondistressed, clinic, and divorcing couples

This study compared communication patterns and conflicts over psychological distance in 25 nondistressed couples, 15 clinic couples, and 22 divorcing couples. Data consisted of questionnaire reports completed independently by husbands and wives. The two distressed groups, compared with nondistressed couples, had less mutual constructive communication, more avoidance of communication, more demand/withdraw communication, and more conflict over psychological distance in their relationships. In addition, the divorcing group had less mutual constructive communication than the clinic group and evidenced a trend for more conflict over psychological distance than the clinic group. Consistent with past research, wife demand/husband withdraw communication was more likely across all groups than husband demand/wife withdraw communication. Results are discussed in terms of skills deficits and incompatability models of marital discord.     

Neural evidence for the threat detection advantage: differential attention allocation to angry and happy faces

Threat stimuli are considered to be processed with higher priority due to an automatic threat detection system that enables rapid shifts of attention. However, direct evidence is still missing. The present study used the face-in-the-crowd task and event-related potentials to find evidence for the functionality of attention shifts in threat detection. The threat detection advantage was replicated in the behavioral results. An N2pc was observed that was more pronounced and earlier for angry compared to happy faces, suggesting differential attention allocation underlying the threat detection advantage. A larger sustained posterior contralateral negativity indicated that angry faces also gained more enhanced subsequent processing. An early posterior negativity observed 160 ms after stimulus onset revealed early emotion-specific processing that may have caused differences in attention allocation toward threatening stimuli.     

Automatic emotion regulation in response inhibition: The temporal dynamics of emotion counter‐regulation during a go/no‐go task

Recent behavioral studies indicate that emotion counter‐regulation automatically allocates attention to events that are opposite in the valence to the experienced emotional state. The present study explored the effect of emotion counter‐regulation on response inhibition by using ERPs in a go/no‐go paradigm. We recruited 58 subjects and randomly assigned them to either the angry priming group (watching Nanjing Massacre movie clips) or the neutral priming group (watching “mending a computer” movie clips). The behavioral results revealed that participants in the angry priming group responded significantly more accurately to go happy and no‐go angry faces than go angry and no‐go happy faces. The analyses of ERPs revealed that the amplitudes of the no‐go N2 and no‐go P3 were significantly larger for the happy faces than for the angry faces in the angry priming group. However, no such effects were found in the neutral priming group. These results suggest that highly aroused angry emotion could prompt a priority response to happy emotion stimuli and restrict the responses to angry emotion stimuli through emotion counter‐regulation.     

Emotionally Focused Couples Therapy: Status and Challenges

This article presents the basis for, and the research on, emotionally focused couples therapy (EFT), now recognized as one of the most researched and most effective approaches to changing distressed marital relationships. Drawing on attachment theory and the research on interactional patterns in distressed relationships, we describe the theoretical context of EFT. We then outline the nature of the clinical interventions used in EFT and the steps hypothesized to be crucial to couple change. The central role of accessing and working with emotional issues in the relationship context is highlighted. Following this presentation, we review both the outcome and process research on EFT and present meta-anarytic data from randomized clinical trials to substantiate the clinical impact of EFT on couple adjustment. Finally, the empirical and clinical challenges facing EFT are summarized.     

Brief report: a cognitive behavioral intervention for distressed adolescents with type I diabetes

OBJECTIVE: To examine the impact of a cognitive behavioral intervention for distressed adolescents with Type I diabetes. METHODS: Six youths with elevated levels of anxiety, anger, or diabetes stress received training in cognitive restructuring and problem solving in individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through measures of anxiety, anger expression, and diabetes stress. RESULTS: Four youths displayed some improvement on one or more variables for which they had elevated levels during baseline, while others showed no impact. CONCLUSIONS: Cognitive behavioral interventions show some promise for distressed youths with Type I diabetes. Individual youths responded to treatment differently. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.     

Looking at facial expressions: dysphoria and facial EMG

Previous research on interpersonal deficits among dysphoric individuals has been equivocal, with some studies finding that dysphoric persons show an increase in negative behavior and other studies finding no group differences. Most studies in this area have employed self-report instruments and behavioral coding systems to examine interpersonal displays. Using a different approach, we examined facial electromyography (EMG) reactivity to pictures of happy and unhappy expressions among dysphoric persons. Dysphoric and non-dysphoric persons viewed happy and unhappy facial expressions while zygomatic EMG and corrugator EMG activity was recorded. Results indicated that both groups showed the appropriate increase in corrugator EMG to unhappy expressions; however, dysphoric persons did not show the expected increase in zygomatic EMG activity to happy expressions while the control participants did show this response. Unexpectedly, the dysphoric group displayed an increase in corrugator EMG activity (e.g. frown response) to the happy facial expressions. These findings indicate that dysphoric persons have impaired interpersonal reactivity that is specific to happy facial displays.     

Treating couples recovering from infidelity: an integrative approach

Infidelity is one of the most difficult problems to address in couple therapy, most likely because it involves a traumatic relationship event that alters the ways in which couples process information about each other and established behavioral patterns. We present a three-stage treatment designed to address the cognitive, behavioral, and emotional sequelae of affairs that integrates cognitive-behavioral and insight-oriented strategies with the literatures on traumatic response and forgiveness. A case study with pretreatment, posttreatment, and 6-month follow-up data is presented to illustrate the treatment methods.