The Marriage Checkup: a randomized controlled trial of annual relationship health checkups

Profiles of Low-Income Help-Seeking Couples and Implications for Intervention Gains: A Couple-Centered Approach

Using a couple-centered approach, the current study seeks to understand (a) the specific ways in which help-seeking couples vary in how their relationship satisfaction changes over time, (b) whether there are important differences in relationship characteristics at the beginning of the interventions, and (c) whether couples with distinct relationship characteristics benefit equally from effective online relationship programs. Mixed-gender low-income couples (Ncouple = 659) seeking help for their relationship were randomly assigned to one of two online relationship programs (n = 432) or the wait-list control group (n = 227). Latent profile analyses were conducted to identify (a) trajectory profiles with both partners' relationship satisfaction assessed at baseline, during, and postprogram, and at 2- and 4-month follow-ups; and (b) baseline couple profiles with indicators of baseline communication, commitment, emotional support, and sexual satisfaction reported by both partners. Four unique satisfaction trajectories were identified: women-small-men-medium improvement (39%), men-only decline (25%), large improvement (19%), and women-only improvement (17%). Five unique baseline couple profiles were identified: conflictual passionate (30%), companionate (22%), men-committed languishing (22%), satisfied (16%), and languishing (10%). Compared to control couples, intervention couples' odds of following the large improvement trajectory increased and their odds of following the men-only decline trajectory decreased; the odds of following the other two intermediate trajectories did not differ by intervention status. Moreover, couples with more distressed baseline profiles were more likely to follow trajectories characterized by greater satisfaction gains regardless of their intervention status. However, program effects did not differ based on baseline couple profiles, suggesting that a universal approach may be sufficient for delivering online relationship programs to improve relationship satisfaction in this population.

Improvements in depressive symptoms following a brief relationship intervention

In the United States, 21 million adults are diagnosed with depression. Couple therapy effectively treats depression, however, couples encounter access barriers. The Relationship Checkup is an assessment and feedback intervention delivered in participants' homes. The current study examines changes in relationship satisfaction and depressive symptoms, and moderators and mechanisms of change in a community sample (N = 85 couples). Changes in depressive symptoms and satisfaction, and the association between changes in satisfaction and depressive symptoms were examined with multilevel modeling. Depressive symptoms (Cohen's d = 0.36) and satisfaction (d = 1.43) improved from baseline to 1-month follow-up, with greater declines in depression (d = 0.44) for those with more severe symptoms. Increases in satisfaction were associated with decreases in depressive symptoms (d = 0.23), and decreases in depressive symptoms were associated with increases in satisfaction (d = 0.33). Individuals with depression and relationship distress may be well served by this intervention.

Development and Validation of Brief Family Intervention for Young Adults with Substance Use Disorder: A Qualitative Study

Background

Substance abuse is more prevalent in young adults, putting them at risk for chronic use and early onset of dependence on substances. A well-documented relationship exists between substance use and poor family functioning. Traditional family intervention approaches are time-consuming.

Aim

To develop a brief family intervention for parents of young adults with substance use disorder.

Methods

A qualitative research design was used. Extensive literature searches and key informant interviews (face to face) with young adults (n = 5), their parents (n = 5), and mental health professionals (n = 5) were conducted. The interviews were audio recorded. A thematic analysis was conducted using Braun and Clarke's six-step approach, and intervention strategies were identified by examining the themes. In addition, experts were consulted to ensure the content validity of the BFI.

Results

The BFI program combines psychoeducation and behavioral techniques for parents. BFI involves seven sessions with parents, 45-60 min each, over one week. The BFI sessions consisted of (1) Engagement and Assessment, (2) Healthy Family Functioning, (3) Psychoeducation, (4) Relapse Prevention, (5) Communication Skill Training, (6) Problem-Solving Skill Training, and (7) Parental Monitoring and Supervision.

Conclusion

Considering all stakeholders' perspectives, the BFI manual for young adults with substance use disorder has been developed. However, additional research is required to evaluate its feasibility and effectiveness.

The Role of Shame in the Relationship between Alcohol Use Severity and Relational Intimacy among Sexual Minority Women

Background: Sexual Minority Women (SMW) are disproportionately likely to struggle with substance use and shame, two factors that are associated with poorer relationship quality and decreased relational intimacy (Doyle & Molix, 2015). However, there is a dearth of research examining shame and substance use concurrently among SMW. Objectives: The current study elucidated the role of shame-based cognitions (SBCs) and shame-based behaviors (SBBs) in explaining the relationship between alcohol use severity and relational intimacy. We recruited adult cisgender women (N = 105) in a romantic relationship who self-identified as a sexual minority and reported alcohol use during the past three months through Amazon Mechanical Turk. Participants completed an online survey assessing alcohol use, SBCs, SBBs, and relational intimacy. Results: There was a significant positive relationship between alcohol use severity with SBCs (r = .29, p = .003) and with SBBs (r = .62, p <.001). SBBs were shown to be negatively correlated with relational intimacy (r = -.48, p < .001). Parallel mediation analysis demonstrated that SBCs and SBBs accounted for approximately 34.4% of the variance in intimacy. The indirect effects of SBCs were significant (β = .10, 95% CI [.02, .18] while SBBs (β = -.14, 95% CI [-.29, .01]) did not show effects. Discussions: Given the disproportionate rates of alcohol use among SMW, this study offers a nuanced picture of the relationships between constructs known to impact alcohol use. The findings underscore the importance of SBCs and point to a potential treatment target among SMW presenting with alcohol use and diminished relational intimacy.

Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns

INTRODUCTION

Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns.

METHODS

We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes.

RESULTS

Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner.

CONCLUSION

The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.

The Head, the Heart, and the Community: Piloting a Brief Home-Based Mindfulness Intervention for Couples With Low Income

Although mindfulness is documented to reduce both individual and relationship stress and has the flexibility to be taught anywhere (e.g., at home, clinic setting, etc.), research examining mindfulness interventions among individuals with low income and economic marginalization (LIEM; APA, 2019), or persons whose economic position negatively impacts their health or well-being due to factors such as access to healthcare, is limited. To address this gap, the author and colleagues used Community Based Participatory Research methods to develop a brief, couple-based, mindfulness intervention tailored for communities with LIEM (see Lenger et al., 2022). The present study tested this newly developed brief, couple-based, mindfulness intervention's effectiveness in improving individual and relationship health through 1- and 2-months post-intervention. The intervention was piloted on a sample of 39 couples with an overrepresentation of couples with LIEM. To improve access to care, couples could participate in their home or a variety of local clinics. Thirty-nine couples received the intervention and completed assessments on mindfulness, depression, anxiety, stress, relationship satisfaction, and communication at baseline, 1-month, and 2-months post-intervention. Results revealed that mindfulness, depression, and relationship satisfaction improved from baseline to 1-month post-intervention. Mindfulness improved at a greater rate for couples with LIEM relative to couples with higher incomes. From baseline to 2-months post-intervention, depression and stress significantly improved at similar rates for couples with higher income and couples with LIEM. Thus, this study indicates that mindfulness can be taught in a brief, two-session format, and can have favorable outcomes on individual and relationship functioning.

Revisiting "ill will versus poor skill": Relationship dissatisfaction, intimate partner violence, and observed "communication skills deficits"

For decades, researchers, interventionists, and the lay public have subscribed to the notion that couples low in relationship satisfaction and/or experiencing psychological, physical, or sexual intimate partner violence (IPV) have communication skills deficits. In contrast, experimental studies of communication have concluded that differences were more likely due to partners' "ill will than poor skill." We revisited this debate by recruiting a fairly generalizable sample of couples (N = 291) via random-digit dialing and asking them to discuss two top conflict areas ("at your best" and "as you typically do"), thus measuring will-conscious inhibition of hostility and negative reciprocity and production of positivity (i.e., the "conflict triad"). The conflict triad was observed with the Rapid Marital Interaction Coding System, Second Generation. We found partial support for the hypotheses grounded in Finkel's I3 meta-model. Frequency of hostility was associated with a complicated satisfaction × IPV-extent × conversation type × gender interaction, indicating that couples' communication skills are multi-determined. Unhappier couples showed almost no change in positivity when at their best, whereas happier couples nearly doubled their positivity despite their considerably higher typical positivity mean. Negative reciprocity was associated with satisfaction and IPV-extent but not conversation type, implying that immediate instigation combined with risk factors overwhelms conscious inhibition. Intervention implications are discussed.

The influence of relationship pattern labeling on intimacy, acceptance, and relationship satisfaction

Relationship health has a strong influence on physical and emotional health, and with reported rates of divorce at 40-50%, relationship health is a critical public health issue. Thus, it is important to identify mechanisms that encourage healthy relationship functioning. This study measures the impact of engaging in discussions of challenging relationship patterns, or Relationship Pattern Labeling (RPL). Such discussions are embedded in existing interventions, and yet there is no literature, to our knowledge, that examines the impact of these discussions independently. Our results indicate significant small increases in intimacy (p = 0.002), acceptance (p < 0.001), and relationship satisfaction (p = 0.003) when participants engaged in RPL. We present preliminary evidence that supports the current applications of RPL and indicates that it may be successfully extended into independent online interventions.

Randomized controlled trial of the Marriage Checkup: Stress outcomes

Several couple interventions targeting relationship distress also show beneficial effects on individual mental health. Yet, strikingly few studies report effects on perceived stress. This study examined the effects of a brief couple intervention, the Marriage Checkup (MC), on perceived stress. We randomly assigned 231 couples to receive two MCs (Weeks 7 and 51) or to a waitlist control. Survey data were collected at seven time points over 2 years and analyzed using multilevel models. We found no significant between-group treatment effects on average stress at any time point. However, women, but not men, in the intervention group experienced decreased stress after the second MC (d = -0.23) and more women in the intervention group (26.5%) compared with the control group (14.9%) experienced reliable improvements in stress after the second MC. Overall, the MC did not result in main effects on stress but caused temporary reliable change in terms of stress relief for women.

A randomized controlled trial of a 5-year marriage checkup booster session for a subsample of responder couples

This study examined maintenance and booster effects of a brief couple intervention, the Marriage Checkup (MC), across 5 years. A subsample of 63 couples who benefitted from two previous MCs (responder couples), were randomly assigned to a third MC or control. Before randomization (at 4-years-9-months), the responder sample had maintained small to medium effects on two measures of relationship functioning. After randomization, we found no significant between-group effects. Yet, within-group analyses revealed that while control couples showed flat trajectories in all outcomes after the 4-year-9-months baseline, couples receiving a third MC (at Year 5) reported small to medium improvements in three measures of relationship functioning and maintained follow-up effect in one measure. Findings indicate that couples who initially improved from the MC can maintain some of their improvements over long periods. The potential of boosting such improvements with recurrent MCs is a relevant target for further investigation in larger samples.

Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels

This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

PURPOSE OF REVIEW

Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD.

RECENT FINDINGS

Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.

Disentangling acceptance: Direct and indirect effects of partner acceptance on felt acceptance and relationship satisfaction

Acceptance in intimate relationships predicts relationship satisfaction, as well as positive treatment outcomes in some couple interventions. However, little research has attempted to disentangle the dyadic effects of husbands' and wives' partner acceptance (i.e., acceptance of one's partner) and felt acceptance (i.e., felt sense of being accepted by one's partner) on relationship satisfaction. This study utilized a modified actor-partner interdependence mediation model (APIMeM) to examine whether the associations between acceptance of one's partner and each partner's relationship satisfaction are mediated by each partner's felt acceptance. We analyzed baseline self-report data from 209 heterosexual married couples who participated in a brief marital intervention in the United States. The final model supported the prediction that a person's acceptance of their partner would relate to their partner's relationship satisfaction through their partner's felt acceptance (i.e., an "accuracy effect") and to their own relationship satisfaction through their own felt acceptance (i.e., a "projection effect"). In all, the study demonstrates the utility of examining partner acceptance and felt acceptance as distinct, but related, constructs. Researchers and clinicians working with couples may consider conceptualizing, assessing, and even targeting partners and felt acceptance separately. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What are they doing? A national survey of help-seeking and relationship-repair behavior of individuals who are thinking about divorce

Guided by the Stages of Change (SOC) model, we explored relationship-repair behaviors among those thinking about divorce, employing a recent national longitudinal survey of married individuals (N = 745). Person-centered analyses explored whether there were distinct typologies of relationship-repair behaviors. We found four distinct classes: Intense Seekers (6%), who engaged at high levels of all kinds of repair behaviors, including professional services; Moderate-fading Seekers (14%), who engaged in moderate levels of various repair behaviors, including professional services, but did not sustain that behavior over a year; and Minimal-private Seekers (42%) and Private-sustained Seekers (38%), who eschewed professional services and engaged in low-to-moderate personal and private repair behaviors. We discuss possible applications of the SOC model to the divorce decision-making process and conclude with implications for practice, including the need to allocate greater attention to personal and self-help interventions that match the way most people try to repair their relationships.

Couples and COVID-19 vaccination: Frequency and reasons for discordance

The purpose of this study was to determine the frequency of concordance and discordance in the COVID-19 vaccination status of intimate couples. Partners are well known to influence each other’s health behaviors, but previous reports of couples’ COVID-19 vaccination status were not found. Among 1305 respondents to an on-line survey who were living with their partners, couples’ COVID-19 vaccination status was 15.63% discordant and 84.37% concordant. Different potentially modifiable reasons for being unvaccinated were emphasized by unvaccinated participants with vaccinated partners and by vaccinated participants with unvaccinated partners. This study provides an estimate of the proportion of couples with discordant COVID-19 vaccine status. The development of tailored, scalable interventions potentially involving the partner might increase the COVID-19 vaccine concordance rate.

Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010-2019

This article systematically reviewed 34 rigorous evaluation studies of couple relationship education (CRE) programs from 2010 to 2019 that met the criteria for Level 1 well-established interventions. Significant advances include reaching more diverse and disadvantaged target populations with positive intervention effects on a wider range of outcomes beyond relationship quality, including physical and mental health, coparenting, and even child well-being, and evidence that high-risk couples often benefit the most. In addition, considerable progress has been made delivering effective online CRE, increasing services to individuals rather than to couples, and giving greater attention to youth and young adults to teach them principles and skills that may help them form healthy relationships. Ongoing challenges include expanding our understanding of program moderators and change mechanisms, attending to emerging everyday issues facing couples (e.g., healthy breaking ups, long-distance relationships) and gaining increased institutional support for CRE.

A review of the research during 2010-2019 on evidence-based treatments for couple relationship distress

The current article presents a review of the published research from 2010 to 2019 on the treatment of couple relationship distress; 37 studies met all criteria for inclusion. Behavioral Couple Therapy, Cognitive Behavioral Couple Therapy, Emotionally Focused Therapy, and Integrative Behavioral Couple Therapy meet criteria as "well-established" approaches, Insight-Oriented Couple Therapy is a "possibly efficacious" approach, and several other others are "experimental" treatments for treating couple relationship distress (Southam-Gerow & Prinstein, 2014). Furthermore, several less-intensive interventions-the Marriage Check-up, OurRelationship, and Hold Me Tight programs-have generated substantial support for their ability to improve relationships and are classified as "well-established" or "probably efficacious" interventions. We recommend that future research focus on expanding the reach of evidence-based interventions across a range of settings and populations, deepening our understanding of the mechanisms of change and underlying factors in the change process across approaches, and improving treatment success through treatment matching and progress monitoring.

Couplelinks online intervention for young couples facing breast cancer: A randomised controlled trial

OBJECTIVE

Young women with breast cancer and their partners are more distressed than couples who are affected later in life. While dyadic interventions in the context of cancer are promising, there are access barriers, particularly for younger couples. This study evaluated Couplelinks, a professionally facilitated, web-based program designed to help couples improve their conjoint coping.

METHOD

This randomised controlled trial employed a waitlist control evaluation of the program. Outcomes included dyadic coping, relationship adjustment, depression, and anxiety.

RESULTS

Seventy-five couples consented to participate and were randomised. The final analysis included 31 couples in the treatment group and 36 couples in the waitlist group. Modest improvements were found in positive dyadic coping but effects were not maintained at 3-month follow-up. No effect was seen on overall relationship adjustment.

CONCLUSIONS

Our findings inform the rapidly expanding field of online programming for couples in general, and those affected by BC in particular. Intervention timing, 'dose', low overall relational distress, and the mainly enrichment rather than problem-focus of Couplelinks may help explain the lack of change on relationship adjustment.

The Before Baby Relationship Checkup: A Couples-Based Intervention to Reduce Relationship Risk Factors for Perinatal Mood and Anxiety Disorders

Relationship conflict and lack of partner support are risk factors for perinatal mood and anxiety disorders. An intervention to strengthen couples' relationships before birth may reduce relationship risk factors for perinatal mood and anxiety disorders, though no research has explored this to date. The aims of this Stage 1 open-series non-experimental proof of concept study were to adapt the 'Marriage Checkup', an evidence-based intervention for relationship distress, as a preventative intervention for perinatal mood and anxiety disorders and to assess its feasibility and acceptability. Pregnant women receiving care at a university-based obstetric practice, and their partners, were recruited. Ten couples participated in the Before Baby Relationship Checkup, a personalized relationship health service offered in the obstetric clinic. Quantitative and qualitative data gathered suggests the intervention is feasible to implement in an obstetric setting, and acceptable to perinatal couples. Specific adaptations to the Marriage Checkup for perinatal couples are warranted and further testing is needed to evaluate efficacy.

An Integrative Behavioral Couple Therapy (IBCT)-Based Conflict Prevention Program: A Pre-Pilot Study with Non-Clinical Couples

Integrative Behavioral Couple Therapy (IBCT) has demonstrated its efficacy treating severe couple conflict. Nevertheless, its capacity to prevent such conflicts before they appear has not been analyzed. The following empirical study examines the effectiveness of a conflict prevention program based on IBCT's main therapeutic strategies (empathic joining, unified detachment). A sample of 12 individuals (six couples) from the Community of Madrid completed the DAS (Spanier, 1976; Martín-Lanas et al., 2017), IBCTQ (Barraca et al., 2017), and ASPA-A (Carrasco, 1996) pre-treatment, posttreatment, and at a three-year follow up. Three of these couples were randomly assigned to the experimental group, in which they received five, 120-minute sessions of an IBCT-based conflict prevention program. The three remaining couples were assigned to a control group and received no treatment. Results indicated that the experimental couples grew in their acceptance of differences and significantly improved their level of empathic joining and unified detachment; they also manifested greater satisfaction in their total DAS score. At the three-year follow up, neither group showed significant changes with regard to their posttreatment scores. Although the data are based on a small number of couples and should be replicated, the results suggest that a program based on IBCT strategies can help prevent couple conflict up to three years after its application.

Dealing with loss in the face of disasters and crises: Integrating interpersonal theories of couple adaptation and functioning

The COVID-19 pandemic has highlighted the significant and varied losses that couples can experience during times of global and regional disasters and crises. What factors determine how couples navigate their close relationships during times of loss? In this paper, we elaborate and extend on one of the most influential frameworks in relationship science-the Vulnerability Stress Adaptation Model (VSAM, Karney and Bradbury, 1995)-to enhance the model's power to explain relationships during loss-themed disasters/crises. We do so by elaborating on attachment theory and integrating interdependence theory (emphasizing partner similarities and differences). Our elaboration and extension to the VSAM provides a comprehensive framework to guide future research and inform practice and policy in supporting relationships during and beyond loss-themed disasters/crises.

The Impact of Couple Therapy Based on Relationship Enrichment Approach on Couples’ Intimacy and Sexual Function

Background: Intimacy is one of the basic and psychological needs of couples and is a motivating factor in their sexual participation. Objectives: To determine the impact of couple therapy based on the relationship enrichment approach on the intimacy and sexual function of the couples consulting healthcare centers. Methods: This research was a quasi-experimental study and was performed on 60 couples referring to Comprehensive Health Centers in the southeast of Iran in 2020. The research instruments included a demographic information questionnaire, three standard questionnaires of intimacy and sexual function of men and women. The educational content was implemented only for the intervention group. Data were collected at baseline, 8th week, and 12th week after the intervention. Data were analyzed using descriptive statistics and two-factor repeated measures ANOVA using SPSS (ver. 21) software. Results: The results showed that the intervention had a significant effect on sexual function and intimacy in the intervention group in three time periods (P < 0.001), whereas in the control group, no significant difference was observed in the three time periods (P > 0.05). Conclusions: The results showed that relationship enrichment counseling can increase intimacy and sexual function of couples.

Longitudinal Associations of Global and Daily Support with Marital Status

The provision and receipt of emotional support demonstrates benefits for relationships; however, little research has investigated how either global or day-to-day spousal support influences marital stability. This project assessed how global perception of support from a partner and daily provision and receipt of emotional support over 1 week contributed to divorce 10 years later, accounting for demographic covariates. There were no significant associations of support variables with future divorce. Greater education attainment was the only factor significantly associated with decreased risk for divorce. Results suggest that despite potential short-term benefits, global and daily support may not predict long-term marital stability.

Maintenance of Relationship and Individual Functioning Gains Following Online Relationship Programs for Low-Income Couples

Initial evidence suggests that gains in relationship functioning from brief, web-based programs are maintained through one year following the intervention; however, whether these results generalize to a low-income sample is unclear. Furthermore, previous research from in-person couple therapy suggests there may be different shapes of maintenance slopes for behavioral versus acceptance-based techniques. This study contacted 668 individuals who enrolled in online behavioral (ePREP) or acceptance-based (OurRelationship) programs one year following completion of the program. Multilevel modeling was used to examine linear and quadratic rates of change in the year following the online intervention as well as total amount of change from pretreatment to 12-month follow-up for both relationship and individual functioning. The majority of couples who responded continued to be in a relationship with the same partner (68.3%). Examinations of relationship functioning indicated couples in both programs maintained their gains over follow-up (i.e., no significant linear or quadratic changes), with medium-to-large within-group effect sizes from pre- to one-year follow-up. There were no significant differences in relationship outcomes between OurRelationship and ePREP. Similarly, examinations of individual functioning outcomes indicated couples maintained their gains over follow-up or continued to improve. In total, couples experienced small-to-medium within-group effect sizes from pretreatment to one-year follow-up, with larger effects for individuals who were initially distressed. These results suggest that online programs create lasting change for low-income couples in relationship and individual functioning, with minimal differences between behavioral and acceptance-based orientations.

An Uncontrolled Trial of Flexibly Delivered Relationship Education with Low-Income, Unmarried Perinatal Couples

OBJECTIVE

To examine couple and parenting outcomes from an American version of Couple CARE for Parents (CCP) in low-income, unmarried couples.

BACKGROUND

We adapted an evidence-based, flexibly delivered program for use with low-income, unmarried couples, for whom the outcome literature is scarce.

METHOD

Couples (n = 443) were recruited from maternity units and began CCP. They completed measures before, during, and immediately after the intervention, and 6 months later.

RESULTS

Moderate psychological intimate partner violence (IPV) declined and perceived parenting efficacy increased over time; there was no change in severe psychological or physical IPV. Individuals with lower levels of relationship commitment than their partners showed improvement in relationship satisfaction, whereas those with similar or higher levels of commitment maintained their baseline levels despite being in a period of expected satisfaction decline.

CONCLUSION

CCP showed some signs of helping low-income couples during a stressful period and its flexible service delivery model allowed these couples to participate by reducing the impediments of transportation challenges, conflicting work schedules, and overall time poverty.

IMPLICATIONS

Practitioners interested in using CCP with low-income couples would likely maximize the impact by (a) focusing on pregnant, first-time parents; (b) integrating CCP within post-natal healthcare; and/or (c) assuming that a considerable minority of couples will avail themselves of only up to two sessions, and thus practitioners should front-load content, making other content optional or just-in-time. In addition, non-psychoeducational elements (e.g., gamification, easy computerized tasks to reduce angry responses, watching couple-themed movies) could enliven preventative offerings for perinatal couples.

Randomized Controlled Trial of the Marriage Checkup: Depression Outcomes

The association between relationship functioning and depressive symptoms is well established. This study examined the effects of the Marriage Checkup, a brief two-session Assessment and Feedback relationship intervention, on depressive symptoms. Two hundred and nine married couples participated in the Marriage Checkup and were randomized into Treatment (N = 108) and Waitlist-Control Conditions (N = 101). Compared to the control condition, intervention participants reported significant improvements in depressive symptoms (d = 0.55), with an even greater effect for those who were reporting more severe baseline depression symptoms (d = 0.67). These outcomes are comparable to those within long-term individual psychotherapy, couple therapy, and pharmacology trials, making this the briefest intervention to date to demonstrate significant improvements in depressive symptoms. Clinical implications are discussed.

The path to couples therapy: A descriptive analysis on a Veteran sample

The current study uses descriptive data from a sample of Veterans and their partners (N = 97 opposite-sex couples) presenting to a Veterans Affairs Medical Center (VAMC). The purpose of this investigation was to examine 1) the problems couples face prior to seeking treatment; 2) how long it took couples to seek treatment; 3) what attempts couples made to improve their relationship prior to couples therapy. We also examined how these treatment initiation factors were related to relationship distress and expectations for therapy. Results suggest the relationship problems that precede Veteran couples seeking treatment are varied (e.g., stressors outside of relationship, communication problems, lack of trust) and agreement between partners on type of relationship problem is not predictive of relationship satisfaction, perception of relationship problem severity, nor expectations for therapy. Partners tend to wait approximately 4-7 years before pursuing couples therapy to resolve relational concerns. The length of time partners wait to pursue therapy is positively associated with optimistic expectations for therapy. In addition, prior to treatment initiation, partners tend to make multiple attempts to improve their relationship (M = 1.79 attempts for men; M = 2.40 attempts for women) and the number of unique attempts made to improve the relationship is associated with greater distress and more negative perceptions of relationship problem severity. Findings have implications for identifying Veteran couples who may be more or less receptive to intervention and informing the development of a stepped-care approach for couples treatment referral and planning.

Interventions for Couples

Because relationship discord and dissolution are common and costly, interventions are needed to treat distressed couples and to prevent distress among vulnerable couples. We review meta-analytic evidence showing that 60-80% of distressed couples benefit from behavioral and emotion-focused approaches to couple therapy, but we also note that treatment effects are weaker in actual clinical practice than in controlled studies, dissipate following treatment for about half of all couples, and may be explained by factors that are common across models. Meta-analyses of prevention programs reveal reliable but smaller effects, reflecting a need to know more about whether and how communication mediates effects, about how risk and diversity moderate effects, and about how technology-enabled interventions can reduce attrition in vulnerable populations. Interventions for couples are improving and expanding, but critical questions remain about how and for whom they work.

Research on Marital Satisfaction and Stability in the 2010s: Challenging Conventional Wisdom

Although getting married is no longer a requirement for social acceptance, most people do marry in their lifetimes, and couples across the socioeconomic spectrum wish their marriages to be satisfying and long-lasting. This review evaluates the past decade of research on the determinants of satisfaction and stability in marriage, concluding that the scholarship of the past ten years has undermined three assumptions that were formerly accepted as conventional wisdom. First, research exploiting methods like latent class growth analyses reveal that, for most couples, marital satisfaction does not decline over time but in fact remains relatively stable for long periods. Second, contrary to predictions of behavioral models of marriage, negative communication between spouses can be difficult to change, does not necessarily lead to more satisfying relationships when it is changed, and does not always predict distress in the first place. Third, dyadic processes that are reliably adaptive for middle-class and more affluent couples may operate differently in lower-income couples, suggesting that influential models of marriage may not generalize to couples living in diverse environments. Thus, the accumulated research of the last ten years indicates that the tasks of understanding and promoting marital satisfaction and stability are more complex than we appreciated at the start of the decade, raising important questions that beg to be answered in the years ahead.

A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent-child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low-income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low-income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at-risk new parents. These results have implications for public policies that aim to benefit children and families.

What Every Therapist Needs to Know About Couple Therapy

This invited paper is a review of the significance of couple relationships to the practice of all therapists. The article begins with a summary of the evidence on the centrality of committed couple relationships to the lives and wellbeing of adults, and the association of the quality of the parents’ couple relationship on the wellbeing of children. We argue that the well-established reciprocal association between individual problems and couple relationship problems means that all therapists need to pay attention to how a couple relationship might be influencing a client's functioning, even if the relationship is not the presenting problem. There is an outline the evolution of current approaches to behavioural couple therapy, and the current state of the art and science of couple therapy. We present an analysis of the evidence for couple therapy as a treatment for relationship distress, as well as couple-based treatments for individual problems. This is followed by a description of the distinctive challenges in working with couples and how to address those challenges, and recommendations about how to address the needs of diverse couple relationships. Finally, we propose some core therapist competencies needed to work effectively with couples.

Barriers and facilitators of relationship help-seeking among low-income couples

Despite being at elevated risk for relationship distress and dissolution, couples living with low incomes are less likely than their middle-class counterparts to participate in couple therapy. To increase treatment use among economically disadvantaged couples, information is needed on how they perceive barriers to treatment and on factors that might facilitate their help-seeking. The first aim of the present study was to identify the prevalence of attitudinal, structural, and relational barriers to seeking therapy for the relationship among individuals who perceived a need for help with their relationship. The second aim was to test whether having direct experience with a relationship intervention (through receipt of premarital education) or indirect experience (by having a social network member who has received couple therapy) is associated with reduced barriers and greater use of therapy for the relationship. Using self-report data from 231 ethnically diverse newlywed couples living in low-income neighborhoods, we find that men and women identify cost and uncertainty about where to go for help as their top two barriers to seeking therapy for the relationship, followed by the partner not wanting therapy (for women) and the belief that individual counseling would be more helpful than couple therapy (for men). Direct and indirect experiences with relationship interventions was associated with increased likelihood that couples sought therapy for the relationship. These results suggest specific directions that can be taken to improve the accessibility of interventions, thereby providing low income couples with resources that might enhance their relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An Implementation Study of Relationship Checkups as Home Visitations for Low-Income At-Risk Couples

Couples with the greatest need for relationship health maintenance and intervention are often least able to afford and access it; therefore, accessible, affordable, effective, and brief interventions are needed to improve relationship health for those who need it most. Consequently, this paper examined whether a brief relationship intervention could be effectively implemented with a low-income, underserved population. All enrolled participants (N = 1,312) received the Relationship Checkup, which consists of an assessment and a feedback session delivered in their homes or at a local clinic at their request. Measures assessed relationship satisfaction, communication, psychological and physical aggression, and intimacy at baseline and 1-month follow-up, and program and relationship satisfaction at 6-month follow-up. All participants reported significant improvements on all outcomes with small effect sizes. However, moderation analyses suggested that distressed couples reported significantly larger effects across the board. Overall, participants reported that they were highly satisfied with the intervention both immediately after its delivery and 6 months later. Findings provide preliminary support for the effectiveness of this brief checkup and point to the utility of offering these kinds of low-cost brief interventions in flexible formats for those who might have the most difficulty accessing them.

The German version of the Quality of Marriage Index: Psychometric properties in a representative sample and population-based norms

The Quality of Marriage Index (QMI) is a 6-item internationally widely-used instrument assessing relationship satisfaction. This study aimed to evaluate (1) the psychometric properties of the German version in a representative sample of the German general population (N = 1431) as well as (2) effects of gender and age on relationship satisfaction. All participants were in a relationship. The German QMI demonstrates good item characteristics and excellent reliability (α = .94). The proposed one-factor solution was replicated. Differences in scoring on the QMI showed that males scored higher than females and differences between younger and older participants were found. The findings suggest that the German version of the QMI is suitable to reliably measure relationship satisfaction and may therefore be used as a brief screening instrument in a variety of settings and research questions. A cross validation in a sample of couples seeking help for relationship difficulties should be considered in future research. The limited number of items and the one-factor-solution do not suggest this instrument as a fine-tuned assessment tool for different dimensions of relationship satisfaction.

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.

A Randomized Trial of a Relationship-Enhancement Approach in Improving Marital Intimacy in Middle-Aged Iranian Couples

The purpose of this study was to evaluate the effects of a relationship enhancement education and counseling (REEC) program on improving middle-aged couples' marital intimacy. The randomized controlled trial study was conducted in Tabriz, Iran, from May to December 2017. Thirty-two married couples, attending a public health center and meeting the inclusion criteria, were randomly assigned to the intervention (receiving REEC) and control (receiving routine care) groups. The outcome measures were marital intimacy, sexual motivation, and sexual function. Data were collected at three points in time. The Statistical Package for the Social Sciences was used for the purpose of data analysis. In all analyses, the interventional group outperformed the control group on all outcome measures. In the intervention group, results showed statistically significant improvement in all variables of interest after one week and 12 weeks in comparison with preintervention. Upon the completion of the experimentation, it can be concluded that a REEC program positively affects marital intimacy, sexual function, and sexual motivation in middle-aged couples.

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.

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.

Improving Diabetes-Related Parent-Adolescent Communication With Individualized Feedback

Objective

To pilot a brief individualized feedback intervention to improve the communication skills of parents with an adolescent with type 1 diabetes.

Methods

Parent-adolescent dyads (N = 79) discussed a diabetes-related problem, while an interventionist rated the parent's communication skills to give feedback to the parents. Parents were then randomized to a brief feedback session to target person-centered communication skills or an educational session. Dyads discussed another diabetes care problem to assess for change in communication skills. Independent raters coded parent communication skills from video recordings to rate behaviors in the service of examining possible changes in communication skills. Dyads completed ratings of perceived closeness and empathy after each conversation.

Results

Controlling for overall positive communication at baseline, parents who received feedback showed more improvement in specific person-centered communication skills than parents in the control group. Adolescents in the feedback group reported greater increases in parental empathy and intimacy from pre- to postmanipulation than the control.

Conclusions

The feedback intervention showed preliminary efficacy for increasing person-centered communication skills and perceived empathy and intimacy.

Addressing Relationship Health Needs in Primary Care: Adapting the Marriage Checkup for Use in Medical Settings with Military Couples

The overall objective of this study was to pilot the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency tailored to a military population, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic. The MC was revised to fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-min appointments), and military-relevant material was added to the content. IBHCs working in primary care were then trained to offer the intervention. Thirty participants were enrolled in the study and completed a relationship checkup and one-month follow-up questionnaires. Analysis of post-test and one-month follow-up data showed statistically significant improvements in participants' marital health compared to pre-treatment. The MC intervention appeared to be well received by both couples and IBHCs.

The Online OurRelationship Program for Relationally Distressed Individuals: A Pilot Randomized Controlled Trial

Relationship distress has deleterious effects on mental health, physical health, and quality of life. Although many couples report relationship distress, one barrier to seeking services is that one member of a couple may be too busy or refuse to participate. Relationship interventions offered to individuals have shown promising efficacy, but, as most are offered in-person, barriers to their reach remain. To increase the reach of such interventions, the present pilot study examined the efficacy of a fully web-based relationship intervention for individuals (OR-I). The program was adapted from the couple version of the OurRelationship program (OR-C), which is effective in improving relationship and individual functioning (Doss et al., 2016). Results indicated that couples randomized to the OR-I program, compared to couples in a waitlist control group, saw significant improvement in quality of life (d = 0.69), work functioning (d = 0.44), and perceived health (d = 0.49) during treatment. Furthermore, gains in quality of life and perceived health for the intervention group were maintained over short-term follow-up. However, there were no significant improvements in relationship functioning or symptoms of depression or anxiety. When comparing the efficacy of OR-I and a demographically-matched subsample of OR-C, results showed that change in outcomes did not significantly differ by program. Overall, with some adaptations, OR-I may be a viable option for individuals seeking relationship help. Limitations, potential adaptations, and future directions are discussed in-depth.

Relationship Education for Military Couples: Recommendations for Best Practice

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.

Worried About us: Evaluating an Intervention for Relationship-Based Anxiety

Although romantic relationships are commonly a source of pleasure and comfort, for some individuals they can be a source of persistent anxiety. The aim of the current investigation was to explore the construct of relationship-based anxiety and to evaluate the effectiveness of a brief couple-based psychoeducational session for this issue. Common behavioral patterns and cognitive tendencies seen among individuals with relationship-based anxiety were examined, including excessive reassurance-seeking, self-silencing, and partner accommodation. In the current investigation, a single psychoeducational session was developed to address these maladaptive interactive patterns of behavior specifically. The session was administered to a sample of 21 couples and was found to decrease levels of reassurance-seeking and self-silencing significantly among individuals with relationship anxiety, and to decrease levels of maladaptive accommodation behaviors significantly in their partners.

The Effectiveness of Couple and Individual Relationship Education: Distress as a Moderator

Current literature yields mixed results about the effectiveness of relationship education (RE) with low-income participants and those who experience a high level of individual or relational distress. Scholars have called for research that examines whether initial levels of distress act as a moderator of RE outcomes. To test whether initial levels of relationship and/or individual distress moderate the effectiveness of RE, this study used two samples, one of couples who received couple-oriented relationship education with their partner (n = 192 couples) and one of individuals in a relationship who received individual-oriented RE by themselves (n = 60 individuals). We delivered RE in a community-based setting serving primarily low-income participants. For those attending with a partner, there was a significant interaction between gender, initial distress, and time. Findings indicate that women who were relationally distressed before RE reported the largest pre-postgains. Those who attended an individual-oriented RE program reported significant decreases in individual distress from pre to post, but no significant relationship gains. Findings also suggest that initial levels of distress did not moderate the effectiveness of individual-oriented RE.

Checking up on Couples-A Meta-Analysis of the Effect of Assessment and Feedback on Marital Functioning and Individual Mental Health in Couples

The primary aim of the current meta-analysis was to investigate the overall effect of a relationship checkup (RC), a couple-oriented assessment, and feedback intervention. Systematic literature searches revealed 12 eligible randomized trials published between 1995 and 2015. Results showed significant overall pre-post effect of an RC on marital functioning (Hedge's g = 0.20) and individual mental health (g = 0.44). The between-group controlled effect size was significant at postassessment (g = 0.23) and up to six-month follow-up (g = 0.23). Characteristics of the RC format, therapist-guided versus self-directed, or the study samples, distressed versus healthy, did not moderate the overall effect of the RC. Thus, our results suggest an RC to improve couples' marital functioning up to six-month follow-up, while the effect on individual mental health and repeated delivery of a RC awaits further research.