Relative Cost Effectiveness of In-Person and Internet Interventions for Relationship Distress

A randomized controlled trial of the online OurRelationship program with varying levels of coach support

Online programs that reduce relationship distress fill a critical need; however, their scalability is limited by their reliance on coach calls. To determine the effectiveness of the online OurRelationship program with varying levels of coach support, we conducted a comparative effectiveness trial with 740 low-income couples in the United States. Couples were randomly assigned to full-coach (ncouples = 226; program as originally designed), automated-coach (ncouples = 145; as a stand-alone program with tailored automated emails only), contingent-coach (ncouples = 145; as an adaptive program where tailored automated emails are followed by more coaching if couples did not meet progress milestones), or a waitlist control condition (ncouples = 224). All analyses were conducted within a Bayesian framework. Completion rates were comparable across conditions (full-coach: 65 %, automated-coach: 59 %, contingent-coach: 54 %). All intervention couples reported reliable pre-post gains in relationship satisfaction compared to waitlist control couples (dfull = 0.46, dcontingent = 0.47, and dautomated = 0.40) with no reliable differences across intervention conditions. Over four-month follow-up, couples in full- and contingent-coach conditions maintained gains in relationship satisfaction and couples in the automated-coach condition continued to improve. Given the comparable completion rates and minimal differences in effect sizes across intervention conditions, all three coaching models appear viable; therefore, the choice of model can vary depending on available resources as well as couple or stakeholder preferences. This study was preregistered (ClinicalTrials.govNCT03568565).

Couple therapy with parents: Results from a pragmatic randomized controlled trial testing the Integrative Brief Systemic Intervention (IBSI)

This study aimed to compare the effectiveness of the Integrative Brief Systemic Intervention (IBSI), combining therapeutic work on marital and coparenting relationships with brief systemic therapy (BST-as-usual) for parent couples. Couples were randomly assigned to the IBSI (n = 51) or BST (n = 50). Both treatments were six-session interventions and lasted about 6 months. Questionnaires on individual, marital, coparenting and family-related functioning were completed before and after therapy, and at 6-month follow-up. A significant improvement in all areas of functioning was observed after treatment and maintained at follow-up for both IBSI and BST-as-usual treatments. No significant differences in outcomes were found between the treatments. Additionally, women reported more distress overall than men, and this distress was reduced more significantly after therapy. Last, BST-as-usual couples requested more additional sessions compared to IBSI couples. This study extends the literature on couple therapy with parents.

New developments during the COVID-19 pandemic: Drama therapy as an online psychological intervention tool

The COVID-19 pandemic has caused many art therapists and psychotherapists to change their practice modes and workplace setup. As a creative arts therapy (CAT), drama therapy has also shifted to an online mode—a shift that has been highly consequential for practice. This paper reviews the existing practice of tele-CAT and tele-drama therapy, explores the advantages and disadvantages of online drama therapy as a psychological intervention tool, and puts forward some developmental suggestions for online drama therapy.

Online relationship education for help-seeking low-income couples: A Bayesian replication and extension of the OurRelationship and ePREP programs

Low-income couples are at increased risk for relationship instability and divorce. In response, online relationship education programs such as ePREP and OurRelationship have been developed to more easily reach this population. A previous trial indicated that these programs promote relationship functioning (Doss et al., 2020) and individual well-being (Roddy et al., 2020a). However, given that these effects were notably larger than previous studies of in-person relationship education and approached effect sizes observed in couple therapy, it is possible that the magnitude of these effects was somewhat spurious; therefore, these findings need replication. The current manuscript seeks to replicate these programs' previous effects on relationship functioning and determine whether these effects are stable. Using a sample of 671 low-income couples seeking relationship help (N = 1337 individuals) and Bayesian estimation, the current study replicated previous findings that the OurRelationship and ePREP programs offered with four coaching calls produced reliable improvements in relationship functioning relative to a 6-month waitlist control group. There were no statistically reliable differences between the two active interventions. Bayesian analyses indicated that the effects of the two online programs were larger than the average effects of in-person relationship education for low-income couples reported in previous studies, roughly equivalent to efficacy studies of in-person relationship education reported in previous studies, smaller than those that resulted from the OurRelationship program delivered to distressed couples without an income requirement and smaller than couple therapy.

COVID Couple Therapy: Telehealth and Somatic Action Techniques

In March of 2020, during the global COVID-19 pandemic, therapists quickly transitioned to telehealth platforms to provide their services. Teletherapy, while subject to some constraints, presents unique opportunities to work creatively with couples, particularly during these uncertain times. This paper offers a case study of work with a couple using systemic, developmental attachment, dialogical, and somatic trauma theories. Action techniques, including doubling, ideal futures creation, and a foam roller trust exercise are employed to facilitate change processes as couples face the chaos and unknowns of the pandemic and the difficulties that have become triggered between them. These exercises help to open perspective, increase awareness, and lower resistance to change. Couples are able to physically enact and metabolise alternative realities while discharging excess energies in familiar surroundings.

Evaluation des webbasierten PaarBalance®-Partnerschaftsprograms bei beratungsbegleitendem Einsatz

<b><i>Hintergrund:</i></b> Beziehungsprobleme gehen mit psychischen und physischen Problemen einher. Auch wenn effektive Behandlungsmöglichkeiten existieren, suchen viele Paare spät oder keine professionelle Hilfe. Die Kombination eines Online-Programms mit einer Paarberatung kann helfen, Barrieren wie hohe Kosten, lange Anfahrtswege oder Wartezeiten zu reduzieren und den Zugang zu effektiver Beratung zu erleichtern. <b><i>Methoden:</i></b> Die Studie prüfte die Wirksamkeit des PaarBalance®-Online-Programms zur Verbesserung der Beziehungszufriedenheit in Kombination mit einer niederfrequenten Face-to-Face-Paarberatung in einem unkontrollierten Prä-post-Design. In diesem naturalistischen, an die Routinepraxis der Beratenden (<i>n</i> = 8) angelehnten Design erhielten die 92 Teilnehmenden, welche über die Beratungsstellen oder über Zeitungsartikel rekrutiert wurden, während eines 15-wöchigen Interventionszeitraums neben wenigen Beratungsterminen einen Zugang zum Online-Programm. Gemessen wurde die Auswirkung des kombinierten Unterstützungsangebots auf Beziehungszufriedenheit, Depressivität und Angst zu drei Messzeitpunkten (Prä, Post nach 15 Wochen und Follow-up nach 12 Wochen). Die Daten wurden mit hierarchisch linearen Modellen analysiert. <b><i>Ergebnisse:</i></b> Die Beziehungszufriedenheit verbesserte sich signifikant während der Interventionsphase (Cohens <i>d</i> = 0,29) und blieb während der Follow-up-Phase stabil. Für Depression und Angst zeigten sich keine signifikanten Veränderungen. <b><i>Schlussfolgerungen:</i></b> Die Ergebnisse weisen darauf hin, dass das PaarBalance®-Programm in Kombination mit einer niederfrequenten Paarberatung ein effektives Mittel zur Verbesserung der Beziehungszufriedenheit darstellen könnte. Zukünftige kontrollierte Studien sind nötig, um die Wirksamkeit dieses Modells abschließend zu klären.

How Effective is Online Couple Relationship Education? A Systematic Meta-Content Review

Due to logistical and financial barriers that keep many distressed couples from seeking psychotherapy, online relationship education is a more accessible alternative. In the decade since a web-based program showed equivalent effectiveness to traditional marriage education (Duncan et al., 2009), several fully online programs have been developed and evaluated. We reviewed nine studies of four different programs that sampled 2,000 + couples. Specifically, we rated each study's experimental rigor and compared research designs, theoretical and empirical grounding, average post-intervention and follow-up effect sizes, and differential effectiveness. Across studies, measured outcomes included relational (improved satisfaction, quality, confidence, commitment, communication; reduced conflict and aggression) and individual functioning on various indices of mental and physical health, emotional expression, and quality of life. Finally, we discuss the strengths and limitations of the research evidence, describe the two most evidence-based programs (ePREP and OurRelationship) in some detail and make recommendations for future study of these promising kinds of interventions.

Efficacy of the web-based PaarBalance program on relationship satisfaction, depression and anxiety - A randomized controlled trial

OBJECTIVE

Although relationship distress is strongly associated with mental health problems, poorer social functioning and lower quality of life, only a minority of distressed couples engage in effective couples therapy. Common barriers are the financial burden, fear of being stigmatized, long waitlists and logistical concerns, such as the difficulty in scheduling appointments. Therefore, more accessible help for relationship distress is needed, such as internet-based interventions.

METHOD

This study evaluates the efficacy of the German web-based PaarBalance program, an 18-sessions online program for couples and individuals in an intimate relationship. Participants with relationship distress recruited via the internet had access to the unguided self-help program for twelve weeks. A total of 117 individuals (N = 60 participated as couples, N = 57 participated without a partner) were randomly assigned to begin the intervention immediately or to a 12-week waitlist control group. The primary outcome was relationship satisfaction. Secondary outcomes included symptoms of depression and anxiety.

RESULTS

The intervention group showed significant improvement in relationship satisfaction (Cohen's d =0.77) compared with the waitlist control group. Small to medium effect sizes in favor of the intervention group, but no statistically significant differences were found regarding depression (d = 0.43) and anxiety (d = 0.45).

CONCLUSION

PaarBalance seems to be an effective self-guided intervention to improve relationship satisfaction in people with relationship problems.

Relational Lockdown and Relational Trauma† in the Time of Coronavirus: A Reflection from a UK Family Therapist

Like a meteor hitting the earth's surface, 44, 131^‡ unexpected deaths have shaken, disturbed, and saddened the core of our nation. This reflection considers the consequences of the coronavirus crisis in the UK with particular reference to the impact on families and on the practice of family therapists. The perspective presented can only be partial because of the fast-changing situation and the limited access to alternative perspectives that are available during this period of relational lockdown. The author provides a systemic understanding of what has happened and what is happening.

Improvements in coparenting conflict and child adjustment following an online program for relationship distress

Many children never receive treatment for their mental health symptoms-and those that do often receive it only after years of delay. Given that relationship and parenting conflict is an identified mechanism of child mental health symptoms, reducing distress in the parents' romantic relationship may help reduce this unmet need. In the current study, 213 couples with 1 or more children between the ages of 3 and 17 (inclusive) were randomized to receive the web-based OurRelationship program or to a 2-month waitlist condition. Intervention couples were also assessed in the year following the program. Couples in the OurRelationship program experienced a significant decrease in coparenting conflict during the intervention (Cohen's d = -0.27) but also a significant increase in coparenting conflict in the following year, reducing the long-term effects of the intervention (within-group d = -0.20 at 1-year follow-up compared with baseline). Additionally, parent-reported children's externalizing (within-group d = -0.40) and internalizing (within-group d = -0.27) symptoms significantly decreased from baseline to the 1-year follow-up. As hypothesized, improvement in relationship satisfaction during the program was significantly associated with a decrease in coparenting conflict which, in turn, was associated with reduction in both externalizing and internalizing symptoms in the children. These results indicate that online relationship-focused interventions offer an important, adjunctive approach to meet society's need for reducing children's mental health symptoms. Furthermore, the improvements in child functioning strengthen the evidence suggesting the cost-effectiveness of these relationship-focused interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Improved Child Mental Health Following Brief Relationship Enhancement and Co-Parenting Interventions During the Transition to Parenthood

The transition to parenthood has been identified as a significant relationship stressor. Many couples report declines in relationship satisfaction and difficulty with individual stress and co-parenting-problems that have been associated with both child temperament as well as emotional and behavioral problems. Several parenting and relationship interventions have been developed to buffer against these difficulties. In the current study, we report secondary analyses of a randomized controlled trial of brief (6-hr) interventions that focused on improving either relationship satisfaction or co-parenting, delivered during pregnancy and the early postpartum period. In this trial, 90 opposite-sex couples (180 participants), who were pregnant with their first child, and were assessed as being at high risk for declines in relationship satisfaction, were randomized to receive either (1) a relationship intervention, (2) a co-parenting intervention, or (3) an information control. At 12 months postpartum, couples who received either the relationship or co-parenting intervention rated their infants as having lower negative emotionality and as having fewer externalizing symptoms compared to the information-only control. Lower externalizing symptoms at 12 months were, in turn, associated with reduced externalizing symptoms at 24 months postpartum. Whereas, lower ratings of child negative emotionality at 12 months were associated with reduced internalizing symptoms at 24 months postpartum. These results indicate that brief relationship or co-parenting interventions delivered during the transition to parenthood have secondary benefits for child mental health.