Comparative efficacy of the relationship checkup for same-gender couples

Same-gender couples face unique sexual minority stressors that significantly impact individual and relationship health. This impact may be even greater among same-gender couples living in regions where there are pervasive social and legal biases that affect the lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, two-spirit (LGBTQIA2S+) community (e.g., south central Appalachia). Brief relationship interventions, like the relationship checkup, are effective at improving relationship health and can be widely disseminated due to the brief and flexible nature of the program. Yet, this program was developed for different-gender couples and, as a result, may lack specific intervention for the unique stressors of same-gender couples. While many skills delivered in relationship interventions, including the relationship checkup, are applicable to all couples, untailored interventions for same-gender couples may result in less impactful outcomes. The present study examined whether the relationship checkup, in its original, unadapted format, is as effective for same-gender couples as it is for different-gender couples. Using a subsample from the larger relationship checkup study (N = 656 couples), the present sample included 64 committed couples (same-gender = 32; different-gender = 32). We used propensity score matching to match different-gender participants to the same-gender participants based on racial minority status, poverty status, marital status, and parenting status. Results revealed that same-gender couples presented similarly to different-gender couples on baseline relationship functioning and changed similarly on all relationship functioning outcomes through 1-month postintervention. Same-gender couples also reported similar degrees of satisfaction with and perceived helpfulness of the relationship checkup. The relationship checkup appears to be equally effective and acceptable for same-gender and different-gender couples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

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.

Couple variables predicting retention in a brief intervention and research

Therapy is an effective form of treatment for couple distress; yet, research shows that 20%-60% of couples terminate treatment prematurely. Predictors of couple retention in therapy and research are unclear, particularly for couples from marginalized populations, which has important implications for the quality and generalizability of research results, and the benefits derived from therapy are limited when participants are not retained. The purpose of this study (N = 1310) was to identify couple-level variables that predict (1) retention in a brief, two-session couple intervention (The Relationship Checkup) delivered as a home visitation program and (2) retention in research participation at 1- and 6-month follow-up. Hypotheses were tested using a two-level multi-level model. Couples are significantly less likely to be retained in the brief intervention if (1) at least one partner identifies as Asian, Pacific Islander, or Native American, (2) at least one partner identifies as Hispanic/Latinx, or (3) both partners report mental or emotional health as a concern in their relationship. Couples are significantly less likely to be retained in research if (1) at least one partner identifies as Asian, Pacific Islander, or Native American (1 month only), (2) at least one partner identifies as Hispanic/Latinx (1 and 6 months), (3) if either partner reports clinically significant relationship distress at baseline (1 and 6 months), or (4) if either partner reports relationship aggression at baseline (6 months only). These findings are discussed with relevance to clinicians and researchers to recruit and retain more diverse and marginalized participants in couple interventions and follow-up research.

Marriage checkup in integrated primary care: A randomized controlled trial with active-duty military couples

OBJECTIVE

This study assessed the efficacy of the marriage checkup, as adapted to integrated primary care settings and active-duty military couples, for improving relationship health and depressive symptoms.

METHOD

Married couples (N = 244, Mage = 32.4, 67.6% Caucasian) in which at least one member was active-duty Air Force were recruited from bases across the U.S. via online advertisement, emails sent from medical clinics to enrolled beneficiaries, social media posts, and flyers, and randomly assigned to active treatment or waitlist control. Treatment and control couples were linked in pairs sequentially and pairs completed nine sets of questionnaires at baseline, 1-, and 6-month posttreatment. Outcome measures included the Couples Satisfaction Index, Intimate Safety Questionnaire, Responsive Attention Scale, Partner Compassion Scale, Communication Skills Test, and the Center for Epidemiologic Studies Depression Scale.

RESULTS

A three-level multilevel model indicated, after adjustment for multiple comparisons, treatment couples experienced statistically significant small-to-moderate improvements compared to the control group (Cohen's d from 0.21 to 0.55) at 1 month that were sustained at 6 months for relationship satisfaction, responsive attention, compassion toward their partners, communication skills, intimate safety, and depressive symptoms.

CONCLUSIONS

A longitudinal randomized control trial of the MC supports the hypothesis that the MC significantly improves relationship satisfaction, intimacy, communication, partner compassion, responsive attention, and depressive symptoms. Implications for theory, treatment, and dissemination are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

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.

Your place or mine?: Examining the accessibility and efficacy of a brief, home-based, couple intervention

Interventions for couples that can be flexibly delivered (e.g., home) are gaining traction in the field of couple therapy, particularly for underserved couples who experience barriers to accessing traditional methods of care. However, questions remain regarding what types of couples prefer the home over traditional clinic settings and whether there are differences in treatment effectiveness in the home versus a clinic setting. The present study sought to address these gaps in the literature. Using a secondary data analysis approach, data from 339 couples who participated in a brief, relationship intervention were examined. Couples were able to select where they wanted to participate (i.e., their home or a local clinic). Logistic regression analyses revealed that parents were significantly more likely to choose to participate in the intervention at their home relative to nonparents. No differences in intervention setting emerged as a function of marital status, racial/ethnic minority status, or poverty status. Three 2-level multilevel models indicated that, at baseline, couples presented with similar attitudes toward relationship help seeking and relationship satisfaction across settings as well as established a similar alliance with the facilitator at 1 month after the intervention. Additionally, a series of 3-level multilevel models found that rates of change did not significantly differ between groups on attitudes toward relationship help seeking and relationship satisfaction across the intervention. Thus, despite the potential chaos of the home, home settings appear to be an equally effective delivery setting relative to traditional settings for this brief relationship intervention and may be particularly useful for reaching parents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Consensus and relationship distress before and after a brief couples' intervention

Understanding how partners' perceptions of their relationships predict couple distress and treatment outcomes can inform relationship interventions, because consensus on pretreatment relationship concerns has previously been related to better treatment outcomes. However, whether consensus specifically about relationship concerns is beneficial, or whether consensus more generally (e.g., about couples' strengths) is also related to distress and treatment outcomes, is unknown. Therefore, to replicate and extend previous findings, the present study examined how 740 couples' consensus regarding their relationship strengths and concerns was associated with their relationship distress and satisfaction from pre- to postintervention after completing the Relationship Checkup (an adaptation of the Marriage Checkup). Couples who presented with greater initial consensus on relationship concerns were less likely to be clinically distressed pre- and postintervention. Broadly, there were similar significant gains in relationship satisfaction from pre- to postintervention regardless of couples' initial level of consensus on concerns. However, when distress was modeled categorically, couples with lower initial consensus on concerns showed greater improvement in distress levels than did those with higher consensus. There were no associations between partners' consensus on strengths and their distress or satisfaction pre- or postintervention. Results indicate that a brief integrative relationship intervention can decrease relationship distress, even for couples that present with very different opinions about their relationship concerns. Implications of brief and acceptance-based models in couple education and therapy are discussed. (PsycINFO Database Record (c) 2020 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.

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.

A randomized controlled trial of the Marriage Checkup adapted for private practice

OBJECTIVE

This study examined the effectiveness of the Marriage Checkup (MC), adapted for independent practice.

METHOD

A total of 233 couples were recruited from 2 metropolitan areas of Denmark and randomized to the MC adapted for independent practice (MC-P, n = 116) or a waitlist condition (WL, n = 117). Self-report measures of relationship health were obtained online at 3 (WL) or 6 (MC-P) time points across 54 weeks. MC-P couples received 2 checkups (Week 7 and 51). WL couples received tickets to a movie night (Week 10). Data were analyzed using multilevel growth models.

RESULTS

Following the first checkup, small intervention effects were found on 3 of 4 outcome measures. Between the checkups, the effects on 2 of 3 measures first leveled off then reappeared. Following the second checkup, intervention effects in the small to medium range were found on all 4 measures including the Brief Marital Satisfaction Inventory (Cohen's d = 0.48), the Couple Satisfaction Index (d = 0.20), the Responsiveness and Attention Scale (d = 0.43), and the Intimate Safety Questionnaire (d = 0.21).

CONCLUSIONS

Couples receiving 2 annual checkups across 54 weeks experienced small to medium effects on relationship health when compared to controls. These are the first and preliminary results on a model for conducting regular relationship health checkups in a real-world therapeutic setting. Future studies are needed to investigate the comparative and long-term effects of this approach. (PsycINFO Database Record

Motivating Action and Maintaining Change: The Time-Varying Role of Homework Following a Brief Couples' Intervention

Studies regarding the effectiveness of homework assignments in cognitive-behavioral treatments have demonstrated mixed results. This study investigated predictors of compliance with homework recommendations and the time-varying relationship of recommendation completion with treatment response in a brief couples' intervention (N = 108). More satisfied couples and couples with more motivation to change completed more recommendations, whereas couples with children completed fewer. The association between recommendation completion and treatment response varied with the passage of time, with the strongest effect observed 6 months after the intervention, but no discernible differences at 1 year postintervention. Couples that completed more recommendations experienced more rapid treatment gains, but even those couples doing substantially fewer recommendations ultimately realized equivalent treatment effects, although they progressed more slowly. Implications are discussed.

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

OBJECTIVE

This study assessed the efficacy of the Marriage Checkup (MC) for improving relationship health and intimacy.

METHOD

Cohabiting married couples (N = 215, Mage women = 44.5 years, men = 47 years, 93.1% Caucasian) recruited from a northeastern U.S. metropolitan area through print and electronic media were randomly assigned to MC treatment or wait-list control. Treatment but not control couples participated in assessment and feedback visits, at the beginning of the study and again 1 year later. All couples completed 9 sets of questionnaires over 2 years. Outcome measures included the Quality of Marriage Index, the Global Distress subscale of the Marital Satisfaction Inventory-Revised, the Intimate Safety Questionnaire, and the Relational Acceptance Questionnaire.

RESULTS

A latent growth curve model indicated significant between-group differences in intimacy at every measurement point after baseline (d ranged from .20 to .55, Md = .37), significant between-group differences in women's felt acceptance for every measurement point after baseline (d ranged from .17 to .47, Md = .34), significant between-group differences in men's felt acceptance through the 1-year 2-week follow-up (d across follow-up ranged from .11 to .40, Md = .25), and significant between-group differences in relationship distress through 1-year 6-month follow-up (d across follow-up ranged from .11 to .39, Md = .23).

CONCLUSIONS

Longitudinal analysis of the MC supports the hypothesis that the MC significantly improves intimacy, acceptance, and satisfaction. Implications for dissemination are discussed.

Persuasion criteria in research and practice: Gathering more meaningful psychotherapy data

Psychotherapy research should ultimately benefit the psychotherapy client. Unfortunately, traditional psychotherapy research continues to have little influence on practicing clinicians and, therefore, does not benefit psychotherapy clients. As behavior analysts begin to show interest in this area of research, they may be in a position to improve its quality. We argue that traditional psychotherapy researchers have become prematurely wedded to a methodology that does not address the concerns of clinical audiences. Furthermore, we make a case for defining and evaluating psychotherapy data in terms of its capacity to influence both researchers and clinicians. We also suggest several alternative methods for gathering psychotherapy data based on the case formulation approach. We argue that this approach may be one of the most promising methods for gathering useful psychotherapy data.

Acceptance in behavior therapy: Understanding the process of change

Acceptance is integral to several cutting-edge behavior therapies. However, several questions about acceptance remain to be clearly answered. First, what does acceptance look like, and can it be observed and measured? Second, what are the behavioral principles involved in the promotion of acceptance? Third, when is acceptance indicated or contraindicated as a therapeutic goal? The current paper attempts to clarify answers to these questions. The goal is to provide a conceptualization of the what, how, and when of acceptance that is accessible to behavior analysts, both to promote our understanding of acceptance as a behavioral phenomenon and to facilitate its empirical study and therapeutic utility.

Intimacy: A behavioral interpretation

This paper proposes that intimacy is a process that emerges from a sequence of events in which behavior vulnerable to interpersonal punishment is reinforced by the response of another person. These intimate events result in an increase in the probability of behavior vulnerable to interpersonal punishment in the presence of the reinforcing partner. The process results in intimate partnership formation and reports of feeling intimate. In addition to positing an operant process integrating the various components of intimacy, the theory also posits that the punishment of interpersonally vulnerable behavior is an integral aspect of intimate partnership formation and that intimate partnerships can develop that reinforce behavior that may be destructive both to the individual and to others.

Mindful relating: exploring mindfulness and emotion repertoires in intimate relationships

This study tested the theory that mindfulness contributes to greater intimate relationship satisfaction by fostering more relationally skillful emotion repertoires. A sample of married couples was administered measures of mindful awareness, emotion skills, and marital quality. We hypothesized that mindfulness would be associated with both marital quality and partners' emotion skills and that the association between mindfulness and marital quality would be mediated by emotion repertoire skill. Findings suggested that emotion skills and mindfulness are both related to marital adjustment, and that skilled emotion repertoires, specifically those associated with identifying and communicating emotions, as well as the regulation of anger expression, fully mediate the association between mindfulness and marital quality. Theoretical implications are discussed.

Predicting 2-year marital satisfaction from partners' discussion of their marriage checkup

This study tested whether the observed marital interactions of partners following a marriage checkup predicted marital satisfaction 2 years later. In addition, this study examined whether recommendations to pursue therapy predicted subsequent treatment seeking and whether changes in marital distress following the checkup remained stable over 2 years. Results suggest that the affective tone of a couple's interaction predicts later marital satisfaction. Further, receiving a treatment recommendation predicted subsequent treatment seeking for wives. Finally, support was found for the hypothesis that changes in marital distress are self-sustaining.

The influence of adult attachment styles on the association between marital adjustment and depressive symptoms

This study tested the hypothesis that attachment styles moderate the relationship between marital adjustment and depressive symptoms among husbands and wives. In a sample of 91 married couples, ratings of the anxious-ambivalent attachment style moderated the relationship between marital adjustment and depressive symptoms for both husbands and wives. Additionally, ratings of the secure attachment style moderated the relationship between marital adjustment and depressive symptoms for wives, with a trend for husbands. These findings suggest a relationship between insecurity and a predisposition to depressive symptoms in marital relationships.

Motivational interviewing as an intervention for at-risk couples

Thirty-one couples participated in a pilot, motivational interviewing, intervention for at-risk couples called the Marriage Checkup (MC). The MC consisted of thorough relationship assessment and individualized feedback. It attracted substantial numbers of at-risk couples who were not otherwise seeking treatment. Partners' marital satisfaction improved significantly from pre- to post-check-up and remained improved at 1-month follow up. Partners were no longer significantly different from a non-distressed comparison group following intervention. Although not addressing the efficacy of the MC, this study supports its viability as an indicated preventive intervention with couples at-risk for severe marital distress by addressing its attractiveness, tolerability, and safety.

Acceptance versus change interventions in behavioral couple therapy: impact on couples' in-session communication

Integrative Behavioral Couple Therapy (IBCT) attempts to improve Traditional Behavioral Couple Therapy (TBCT) by incorporating an emphasis on promoting acceptance into TBCT's emphasis on behavioral change. This study examined changes in couples' communication over the course of IBCT and TBCT. Early, middle, and late sessions were coded to measure couples' communication of acceptance. Results showed that IBCT couples expressed more nonblaming descriptions of problems and more soft emotions than TBCT couples during late stages of therapy. IBCT couples significantly increased their nonblaming description of problems and significantly decreased their expressions of hard emotions and their problematic communication over time. Results support the hypothesis that structural differences between the therapies affect initial levels of emotional expression in session. Increases in nonblaming descriptions of problems were significantly correlated with increases in marital satisfaction.

Negative reciprocity and communication in couples with a violent husband

To better understand the relationship dynamics of couples experiencing husband-to-wife violence, the interaction patterns of 29 domestically violent (DV), 15 distressed but nonviolent (DNV), and 13 happily married (HM) couples were examined using the Marital Interaction Coding System and lag sequential analyses. DV spouses were generally more often aversive and less often facilitative than nonviolent couples. DV couples were significantly more likely to engage in negative reciprocity than their DNV or their HM counterparts. DV wives were as likely as their husbands to reciprocate negative behavior. Furthermore, no support was found for a negative reinforcement hypothesis that husbands' aversiveness was shaped or maintained by wives' capitulation.

Negative reciprocity and communication in couples with a violent husband

To better understand the relationship dynamics of couples experiencing husband-to-wife violence, the interaction patterns of 29 domestically violent (DV), 15 distressed but nonviolent (DNV), and 13 happily married (HM) couples were examined using the Marital Interaction Coding System and lag sequential analyses. DV spouses were generally more often aversive and less often facilitative than nonviolent couples. DV couples were significantly more likely to engage in negative reciprocity than their DNV or their HM counterparts. DV wives were as likely as their husbands to reciprocate negative behavior. Furthermore, no support was found for a negative reinforcement hypothesis that husbands' aversiveness was shaped or maintained by wives' capitulation.