INTERVENTIONS FOR COUPLES

Subjective emotion trajectories in couple therapy and associations with improvement in relationship satisfaction

Existing couple therapies are generally effective for reducing romantic relationship distress and divorce, but therapy outcomes remain poor for many. Outcomes can be improved through greater understanding of session-by-session therapeutic processes, particularly in real-world treatment settings. Modern couple therapy models commonly emphasize the importance of emotional experiences as key change processes, yet few empirical studies have tested the merits of this focus. The present study addresses this limitation by examining trajectories of subjective emotions and their association with change in a key relationship outcome, relationship satisfaction, among military veterans and their partners at a VA Medical Center. Partners rated their relationship satisfaction prior to couple therapy sessions and subjective emotions immediately after sessions. Consistent with hypotheses, both hard (e.g., anger) and soft (e.g., sadness) negative emotions decreased significantly over the course of therapy. Those couples with greater decreases in hard negative, but not soft negative, emotions showed significantly more improvement in relationship satisfaction. Positive emotions did not significantly change across couples in general, but those couples whose positive emotions did increase also showed more improvement in relationship satisfaction. These results suggest change in subjective emotions may be one process underlying improvement in couple therapy and lend empirical support to the emphasis on emotion-based change processes underlying acceptance-based and emotion-focused couple therapies.

Couple Therapy With MDMA-Proposed Pathways of Action

MDMA's first identified potential as a therapeutic catalyst was for couple therapy. Early work in the 1970s and 1980s explored its potential amongst seasoned psychotherapists and their clients. With the completion of the first pilot trial of MDMA-assisted psychotherapy with couples for PTSD, and as the possibility of conducting MDMA-assisted psychotherapy trials expands due to new regulatory frameworks, we have an opportunity to explore and investigate how and why MDMA-assisted couples therapy works. This theoretical paper will explore the neurobiological and neurochemical effects of MDMA in a relational context, the emotional, behavioral, cognitive and somatic effects within a dyadic frame, and how empathy, communication, perception of social connection/support, non-avoidance, openness, attachment/safety, bonding/social intimacy and relationship satisfaction, are all impacted by MDMA, and can be harnessed to facilitate systems-level and interpersonal healing and growth. A model to support MDMA-assisted couple therapy is introduced, and future directions, including implications for intervention development and delivery, will be elucidated.

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.

Evaluation of an Online Gottman's Psychoeducational Intervention to Improve Marital Communication among Iranian Couples

Amounting evidence indicates that insufficient knowledge of marital communication skills leads to destructive interactions and poor marital adjustments in couples, especially during stressful situations. Despite the high effectiveness of Gottman’s psychoeducational intervention, there is a lack of study on the online Gottman’s psychoeducation intervention (O-GPI) to improve marital communication and dyadic adjustments. The aim of this study was to evaluate the effectiveness of O-GPI on the improvement of marital communication patterns among Iranian couples. Method: The study followed a single-blind parallel group in a randomized controlled trial using an experimental longitudinal design, comprising 72 heterosexual couples living in Shiraz, Iran, with a 1–7-year marital age and no severe marital problems. The experimental group received eight consecutive O-GPIs via the Zoom platform, while the control group received information related to parenting skills via email. The outcome measures were the three patterns of communication: (i) constructive communication; (ii) demand–withdraw communication; and (iii) mutual avoidance communication—the screening measure was the dyadic adjustment scale. Results: The findings indicated that O-GPI could improve couples’ constructive communication significantly (45% for husbands and 40% wives) and decrease their total demand–withdrawal (51% for husbands and 65% wives) and mutual avoidance communication (60% for husbands and 62% wives). Limitations: Due to the homogenous nature of the sample, generalizations should be made with caution. Conclusions: This study demonstrates the feasibility and effectiveness of the online Gottman’s psychoeducational intervention to improve couples’ communication patterns.

Cognitive-behavioral and emotion-focused couple therapy: Similarities and differences

Background

Couples and families often seek therapy to deal with relational distress, which is a result of external or internal factors of the relationship. Two approaches are acknowledged to be most effective in dealing with relationship distress or psychological disorders in couples: (a) cognitive behavioral couple therapy with new directions (CBCT) and (b) emotion-focused couple therapy (EFCT). In this article we investigate how much CBCT and EFCT really differ with regard to working with emotions, which is claimed to be a major focus of EFCT, and whether there exist significant differences in efficacy between these two approaches.

Method

This article critically reviews the theoretical background, process, techniques and outcomes associated with CBCT and EFCT in an effort to challenge the assumptions noted above.

Results

There is no evidence that EFCT is more emotion-focused than CBCT. Both approaches were repeatedly examined with RCT studies with follow-ups. In sum, no significant differences in effect size were found between CBCT and EFCT.

Conclusion

CBCT and EFCT are both effective in reducing couples’ distress.

CBCT and EFCT are both effective in helping couples deal with relationship distress.

Both are similarly effective in helping couples to better understand and cope with their presenting concerns.

Both approaches address the importance of personal schema, triggering relevant cognitions and emotions.

Both approaches help couples wherein one partner has been diagnosed with a clinical disorder.

Psychoeducational Group Therapy for sexual function and marital satisfaction in Iranian couples with sexual dysfunction disorder

Background

Having sexual relations plays a very important role in the success and scope of procreation. Understanding sexual function can lead to sexual satisfaction and ultimately to marital satisfaction and reconciliation of spouses.

Objective

The aim of this study was to evaluate the effectiveness of a psychoeducational programme on sexual function and marital satisfaction of Iranian couples.

Materials and methods

This is a semi-experimental pre-test and post-test study with control group. The statistical population included all couples diagnosed with sexual dysfunction referred to Bahar Consulting Center in Mashhad in 2019. A total of 40 individuals were randomly assigned to the two treatment conditions which were experimental (n = 20) and control (n = 20) forming two groups. The individuals assigned to experimental condition experienced a 10 session psychoeducational program and the control condition comprised of Treatment As Usual (TAU) which was based on medical and general counseling regime. The data collection tool was marital satisfaction and sexual function questionnaire. Data was analyzed using SPSS version 22 software.

Results

there is a significant difference between the amount of sexual function and marital satisfaction before and after the test in experimental group (p < 0.01). The results of this study showed that Psychoeducational Group Therapy improved the sexual performance and improved marital satisfaction.

Conclusion

Psychoeducational Group Therapy helps to increase marital satisfaction and sexual functioning of married couples. Therefore, this intervention is recommended as an effective program for improving marital satisfaction and sexual performance of couples. It can help to strengthen the foundation of the family.

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.

Individual distress and dyadic adjustment over the course of couple therapy and three-year follow-up: A replication study

This replication study examined the change over time and the relationship between depressive symptoms and dyadic adjustment during residential couple therapy and at one- and three-year follow-up. Mixed models were used in the analyses, and a disaggregation procedure was applied to examine the results on a between-person as well as on a within-person level. Overall, the results of the previous study were replicated. Significant improvement (p < .001) occurred on measures assessing relationship satisfaction and depressive symptoms from admission to discharge (effect sizes .47 to.72) and from admission to three-year follow-up (effect sizes .59 to .66). The within-person finding implies that when a person experiences more depressive symptoms than usual for him/her, subsequent dyadic adjustment is poorer than usual. Thus, our previous clinical implication suggestion is reinforced in this study: When treating couples suffering from co-existing relational and symptomatic distress, couple therapy should include the aim of lowering individual depressive symptoms.

The Effects of Briefly Interrupting Marital Conflict

This study examined couples' (N = 94) behavior resulting from two proximal change interventions. One was a spousal "compliments intervention" to increase positivity, and the other was a "criticize intervention" to increase negativity. Participants were randomly assigned to one of the two intervention conditions or a control group. There was no main effect in affect from the pretest conflict discussion to the posttest conflict discussion between the interventions or control group. However, a manipulation check on how couples acted during either intervention produced a significant interaction effect. Pretest affect during conflict and marital satisfaction significantly predicted couples' construal of the intervention. Professionals may need to monitor how couples use specific interventions and direct the processes how the intervention is construed by the couple.

Romantic Passion as Output from a Self-Regulating, Intimacy-Seeking System: A Model for Understanding Passionate Love

This article presents a model of why individuals experience the feeling of passionate love in intimate relationships. Previous models have been limited because they do not describe the purpose and function of passionate love, do not incorporate basic emotion and personality theory, or are not applicable to help couples in distress. The present model reinterprets and integrates previous findings. New predictions are made about the functioning of passionate love in relationships by hypothesizing a self-regulating, intimacy-seeking system that produces passionate love as its outcome. A self-regulation model proposed by Carver and Scheier in 1998 is the template on which this model is based.

Security of attachment to spouses in late life: Concurrent and prospective links with cognitive and emotional wellbeing

Social ties are powerful predictors of late-life health and wellbeing. Although many adults maintain intimate partnerships into late life, little is known about mental models of attachment to spouses and how they influence aging. Eighty-one elderly heterosexual couples (162 individuals) were interviewed to examine the structure of attachment security to their partners and completed measures of cognition and wellbeing concurrently and 2.5 years later. Factor analysis revealed a single factor for security of attachment. Higher security was linked concurrently with greater marital satisfaction, fewer depressive symptoms, better mood, and less frequent marital conflicts. Greater security predicted lower levels of negative affect, less depression, and greater life satisfaction 2.5 years later. For women, greater security predicted better memory 2.5 years later and attenuated the link between frequency of marital conflict and memory deficits. Late in life, mental models of attachment to partners are linked to wellbeing concurrently and over time.

Young parenthood program: supporting positive paternal engagement through coparenting counseling

OBJECTIVES

Because of their youth, adolescent parents often lack the interpersonal skills necessary to manage the relationship challenges involved in parenting, leaving them and their children vulnerable to the health risks associated with relational stress and conflict. The primary goal of this study was to test the efficacy of the Young Parenthood Program (YPP), a 10-week counseling program administered during pregnancy and designed to facilitate interpersonal skill development and positive parenting among adolescent parents.

METHODS

Participants included 105 pregnant adolescents and their partners randomly assigned to YPP or treatment as usual. Assessments measured coparenting skills and parental functioning during the second trimester, 12 weeks after birth, and 18 months after birth.

RESULTS

Results indicated that fathers completing YPP demonstrated more positive parenting than did fathers in the control group. Moreover, the positive outcomes in paternal functioning were mediated through changes in the mother's interpersonal skill development.

CONCLUSIONS

Results supported the efficacy of this couples-focused, coparenting support program, particularly for facilitating positive paternal engagement. These findings underscored the relevance of including fathers in the delivery of maternal-child public health services.

Common factors in the enhancement of dyadic coping

Stress and coping are important constructs in understanding the dynamics of close relationships. Couple therapy and marital distress prevention approaches have become increasingly focused on these variables to gain knowledge of how stress and coping may impact the quality and stability of close relationships. In this paper, we outline couple's coping enhancement training (CCET) and the coping-oriented couple's therapy (COCT); both, couple interventions derived from stress and coping research. We address specific features of each approach and report data on their efficacy and effectiveness. We also examine both the common and specific factors that may play a role in the effectiveness of these approaches.

What's love got to do with it? Social functioning, perceived health, and daily happiness in married octogenarians

This study examined day-to-day links between perceived health and happiness and between time spent with others and happiness in 47 older adult couples over an 8-day period. Marital satisfaction and time spent with others were explored as potential moderators of links between health and happiness. For both men and women, hierarchical linear modeling revealed daily links between more time spent with others and greater happiness. Daily links between time spent with one's partner and happiness were strongly moderated by marital satisfaction. For both men and women, marital satisfaction buffered day-to-day links between poorer perceived health and a decline in happiness, but time spent with others did not. This study provides support for the role of marital satisfaction in protecting older adults' happiness from daily fluctuations in perceived physical health and for the influence of social connections in promoting happiness in the lives of older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The course of dyadic adjustment and depressive symptoms during and after couples therapy: a prospective follow-up study of inpatient treatment

A clinical sample of adult patients suffering from relational distress and concurrent psychiatric symptoms was followed from admission, through residential couple therapy, to 1-year follow-up. At follow-up, 9.8% were separated. The remaining couples showed significant improvement in dyadic adjustment at posttreatment. However, at 1-year follow-up, a subgroup of 25% of the positive treatment responders had deteriorated to below their admission levels of dyadic adjustment. Contrary to expectation, the deteriorated group had showed significantly less distress both in depressive symptoms and in one early maladaptive schema domain-Impaired Autonomy-at admission, when compared with the rest of the sample, which suggests the need for further research and possible replication in this area.

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

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

Methodological review of intimate partner violence prevention research

The authors present a methodological review of empirical program evaluation research in the area of intimate partner violence prevention. The authors adapted and utilized criterion-based rating forms to standardize the evaluation of the methodological strengths and weaknesses of each study. The findings indicate that the limited amount of empirical research related to intimate partner violence prevention demonstrates some consistent methodological strengths and limitations. The authors conclude with a presentation of recommendations for further research in the area of intimate partner violence prevention.

Emotionale und kardiovaskuläre Reaktionen von Paaren während einer paartherapeutischen Intervention

Zusammenfassung. Theoretischer Hintergrund: Die Wirksamkeit von Paartherapien und präventiven Interventionsprogrammen für Paare gilt als gut dokumentiert. Das Wissen wie diese Veränderungen zustande kommen ist jedoch defizitär. Aus diesem Grund wurde gefordert, neben dem Therapieoutcome auch die Wirkungsweise der Interventionen zu erforschen. Fragestellung: Ziel der vorliegenden Studie ist es zu untersuchen, wie Paare auf eine bewältigungsorientierte paartherapeutische Intervention, die 3-Phasen-Methode von Bodenmann (2004) , emotional und physiologisch reagieren. Methode: Während eines therapeutisch angeleiteten Gesprächs über ein paarexternes Stressereignis wurden bei den Paaren (N = 18) die Herzrate und das emotionale Befinden erfasst. Ergebnisse: Frauen wiesen gegenüber Männern stärkere emotionale und kardiovaskuläre Reaktionen auf und reagierten empathischer. Die Erfahrung von Unterstützung durch den Partner (dyadisches Coping) war mit einer emotionalen und physiologischen Entlastung assoziiert. Schlussfolgerung: Die Resultate unterstreichen unter anderem die Wichtigkeit des dyadischen Copings für emotionale und physiologische Prozesse während Paarinterventionen.

Marital quality predicts hospital stay following coronary artery bypass surgery for women but not men

This study examined how two indices of spouse support, one relatively general and chronic (perceived overall marital quality), and one relatively situation-specific and acute (spouse support while in the hospital), separately and in interaction with patient gender, predict postoperative length of stays following major (coronary bypass) surgery. In a sample of 226 male and 70 female patients drawn from three hospitals in the San Diego area, California, the results indicated that marital quality, in combination with patient gender, predicted postoperative lengths of stay, such that relatively poor marital relationships elevated risk for longer stays for female but not male patients. Lengths of stay for female patients with higher quality marital relationships were similar to those of male patients (regardless of marital quality). These results were not attributable to any assessed preoperative differences in patient health and were independent of perceptions of spouse support received while in the hospital, which did not independently predict patients' lengths of stay.

Impairment and distress associated with relationship discord in a national sample of married or cohabiting adults

The clinical importance of relationship discord was examined through evaluating the association between relationship discord and multiple measures of impairment and psychological distress in a population-based sample of married and cohabiting adults (N=2,677). In comparison to people that were not in discordant relationships, individuals in discordant relationships reported greater social role impairment with relatives and friends and greater work role impairment. They also reported higher levels of general distress and poorer perceived health and were more likely to report suicide ideation. With the exception of suicide ideation, the associations between relationship discord and impairment and psychological distress remained significant when controlling for current mood, anxiety, and substance use disorders, suggesting that relationship discord is incrementally related to impairment and psychological distress over and above the effects of psychiatric disorders.

Promoting healthy beginnings: a randomized controlled trial of a preventive intervention to preserve marital quality during the transition to parenthood

Couples expecting their first child were randomly assigned to intervention (n=28) and comparison groups (n=38) to assess the efficacy of a couples intervention and examine marital satisfaction trajectories across the transition to parenthood. The primarily European American sample (M age=30 years) completed assessments of marital satisfaction at 5 points from the final trimester of pregnancy to 66 months postpartum. Growth curve analyses indicated a normative linear decline in marital satisfaction. Intervention participants experienced significantly less decline than comparison participants, providing support for the efficacy of the intervention. Comparable childless couples (n=13) did not show a decline in marital satisfaction. The results suggest that early family transitions that strain couple relationships provide critical opportunities for preventive interventions to strengthen marriage.

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.

Current Status and Future Directions in Couple Therapy

Couple therapy research affirms that various approaches to couple treatment produce statistically and clinically significant improvement for a substantial proportion of couples in reducing overall relationship distress. Recent studies have extended these findings in indicating the effectiveness of couple-based interventions for a broad range of coexisting emotional, behavioral, or physical health problems in one or both partners. In contrast to these encouraging results, research also indicates that a sizeable percentage of couples fail to achieve significant gains from couple therapy or show significant deterioration afterward. Research on processes of change and predictors of treatment outcome in couple therapy provides preliminary evidence regarding factors potentially contributing to variable treatment response. The chapter concludes with 12 recommendations regarding future directions in couple therapy research and clinical training.

Improving relationships: mechanisms of change in couple therapy

In a sample of 134 married couples randomly assigned to traditional or integrative behavioral couple therapy (TBCT vs. IBCT), a multivariate hierarchical growth curve analysis using latent variable regression revealed that measures of communication, behavior frequency, and emotional acceptance acted as mechanisms of change. TBCT led to greater changes in frequency of targeted behavior early in therapy, whereas IBCT led to greater changes in acceptance of targeted behavior both early and late in therapy. In addition, change in behavioral frequency was strongly related to improvements in satisfaction early in therapy; however, in the 2nd half of therapy, emotional acceptance was more strongly related to changes in satisfaction. Research and clinical implications are discussed.

Birds of a feather or strange birds? Ties among personality dimensions, similarity, and marital quality

The authors examined the relationship between 6 personality dimensions (Big Five personality factors and positive expressivity) and marital satisfaction in 132 distressed, treatment-seeking couples and 48 nondistressed couples. This study's focus on personality similarity in distressed couples, a population of interest to researchers and clinicians, is unique. Results suggest that higher neuroticism, lower agreeableness, lower conscientiousness, and less positive expressivity are tied to marital dissatisfaction. However, low overall levels of partner similarity were found on these variables. Furthermore, partner similarity on these variables did not independently predict relationship satisfaction. This suggests that nonpathological variations in these personality dimensions do not contribute to satisfaction, and that similarity between partners' personalities may not be closely tied to marital happiness.

Daily marital interactions and positive affect during marital conflict among newlywed couples

The mundane and often fleeting moments that a couple experiences in their everyday lives may contribute to the health or deterioration of a relationship by serving as a foundation to major couple events such as conflict discussions and caring days. This study examines the role of playfulness and enthusiasm in everyday life to the use of humor and affection during conflict. Using observational methods, we studied 49 newlywed couples in a 10-minute dinnertime interaction and in a 15-minute conflict discussion. The conflict discussion was coded using the Specific Affect Coding System (SPAFF; Gottman, Coan, & McCoy, 1996), and a new observational system was developed to capture dinnertime interactions in a seminatural setting. We analyzed the data using path analysis and found a stronger path model when the direction of correlation moved from daily moments to the conflict discussion. These findings provide preliminary support for the importance of daily moments in couple relationships, but this research was strictly observational and therefore correlational, so further research is necessary to determine direction of causation.

You, me...and drugs--a love triangle: important considerations when both members of a couple are abusing substances

Concordant couples can be defined as couples in which both partners have issues with "substance abuse." Studies demonstrate that couples display similar patterns of "substance abuse" that cannot be explained by sociodemographic factors alone. Unfortunately, few studies have focused on the unique relationship dynamics and needs of concordant couples. "Substance abuse" by a client's partner can profoundly affect their recovery and treatment. It is therefore important to understand how clients are influenced by their partners' use. This article attempts to define the needs and issues of concordant couples within a broader psychosocial context. In addition, an overview on the concordant couple literature is provided, along with a discussion of effective treatment and potential barriers to treatment.

The revolution in couple therapy: a practitioner-scientist perspective

This article offers an overview of the expanding field of couple therapy, focusing on what the author considers to be new and even revolutionary in this field. In terms of outcome research, this article suggests that differential treatment effects are discernable. Emotionally focused therapy (EFT) appears to demonstrate the best outcomes at present. The most significant differences between research studies and everyday clinical practice may be the levels of therapist supervision rather than the essential nature of clients. The manualization of treatment is also viewed positively in this review. Areas of growth are the mapping of the territory of distress, understanding the process of change, couple therapy as an effective intervention for "individual" disorders, and the integration into couple therapy of clinical research, such as the research on gender and responses in therapy, and research on adult attachment. Practitioner-scientists can contribute to this evolving field by systematic observation and by reminding researchers of the need for clinical relevance. Couple therapy is now integrating description, prediction and explanation. As a result, theory, practice and systematic investigation are beginning to create a coherent whole.

Best practice in couple relationship education

Relationship education is widely available to couples and is intended to reduce the prevalence of relationship distress, divorce, and the associated personal and social costs. To realize the potential benefits of couple relationship education, it needs to be evidence-based, offered in ways that attract couples at high-risk for relationship problems, and focused on factors that put couples at high-risk for future relationship problems.

Who's dragging their feet? Husbands and wives seeking marital therapy

Despite its demonstrated efficacy, marital therapy's impact has been limited by couples' general reluctance to seek help until their problems become severe. To understand this delay, 147 married couples (294 individuals) in the process of seeking marital therapy were surveyed. Using multilevel confirmatory factor analysis, three relatively independent steps (problem recognition, treatment consideration, and treatment seeking) were identified. On average, wives were rated as completing all three steps before their husbands. Gender-role orientation, demographics, relationship satisfaction, and specific relationship problems (especially husbands' dissatisfaction with sex) were also predictive of the steps toward therapy. Implications for marital therapy are discussed.

Marital status and eating disorders: an analysis of its relevance

OBJECTIVES

This study attempts to understand the clinical impact of marital status on the psychopathology and symptomatology of anorexia (AN) and bulimia nervosa (BN) patients.

METHOD

Eating disorder (ED) patients (n=332, 198 BN and 134 AN) consecutively admitted to our unit participated in the study. All subjects met DSM-IV criteria for those pathologies and were female. Our sample was divided retrospectively into three subgroups based on their marital status. For the assessment, commonly applied questionnaires in the field of ED were used [Eating Attitudes Test (EAT-40), Eating Disorder Inventory (EDI), Bulimic Investigatory Test Edinburgh (BITE), Body Shape Questionnaire (BSQ), Beck Depression Inventory (BDI) and Social Avoidance and Distress Scale (SAD)].

RESULTS

2 x 3 (Diagnostic x Marital status) ANOVA and ANCOVA (with age as covariance) designs were applied in the current study. Our results suggested that ED patients who lived with a partner were significantly different with respect to the other ED patients in the following variables: higher age (P<.0001), higher motivation for change (P<.004), perfectionism (P<.03) and purging behavior (P<.04).

DISCUSSION

The main finding in this study is that ED patients who live with a partner are those who presented greater eating symptomatology and psychopathology but even higher motivation for change. Interpersonal functionality has to be considered in the development and maintenance of ED.

Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.

Psychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice

Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.

The history of couple therapy: a millennial review

In this article, we review the major conceptual and clinical influences and trends in the history of couple therapy to date, and also chronicle the history of research on couple therapy. The evolving patterns in theory and practice are reviewed as having progressed through four distinctive phases: Phase I--Atheoretical Marriage Counseling Formation (1930-1963); Phase II--Psychoanalytic Experimentation (1931-1966); Phase III--Family Therapy Incorporation (1963-1985); and Phase IV--Refinement, Extension, Diversification, and Integration (1986-present). The history of research in the field is described as having passed through three phases: Phase I--A Technique in Search of Some Data (1930-1974), Phase II--Irrational(?) Exuberance (1975-1992), and Phase III--Caution and Extension (1993-present). The article concludes with the identification of Four Great Historical Ironies in the History of Couple Therapy.

Marriage and health: his and hers

This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.

The relationship context of human behavior and development

The influence of social relationships on human development and behavior is receiving increased attention from psychologists, who are central contributors to the rapidly developing multidisciplinary field of relationship science. In this article, the authors selectively review some of the significant strides that have been made toward understanding the effects of relationships on development and behavior and the processes by which relationships exert their influence on these, with the purpose of highlighting important questions that remain to be answered, controversial issues that need to be resolved, and potentially profitable paths for future inquiry. The authors' thesis is that important advances in psychological knowledge will be achieved from concerted investigation of the relationship context in which most important human behaviors are developed and displayed.

Responses to nervous breakdowns in America over a 40-year period. Mental health policy implications

The 1957 and 1976 Americans View Their Mental Health surveys from the Institute of Social Research were partially replicated in the 1996 General Social Survey (GSS) to examine the policy implications of people's responses to feeling an impending nervous breakdown. Questions about problems in modern living were added to the GSS to provide a profile of the public's view of mental health problems. Results were compared for 1957, 1976, and 1996. In 1957, 19% of respondents had experienced an impending nervous breakdown; in 1996, 26% had had this experience. Between 1957 and 1996, participants increased their use of informal social supports, decreased their use of physicians, and increased their use of nonmedical mental health professionals. These findings support policies that strengthen informal support seeking and access to effective psychosocial treatments rather than current mental health reimbursement practices, which emphasize the role of primary care physicians.