Exploring the effectiveness of emotionally focused therapy for depressive symptoms and relationship distress among couples in Taiwan: A single-arm pragmatic trial

This is the first study to explore the effectiveness of emotionally focused couple therapy (EFT) for depressive symptoms and relationship distress among couples in Taiwan. This one-arm pragmatic trial assessed the clinical outcomes of 17 couples using multilevel modeling to investigate changes in depressive symptoms and relationship distress throughout treatment. Over half of the participants were moderately depressed and moderately distressed at baseline. Multilevel models revealed decreased depressive symptoms over time, with a small increase toward the end of treatment. However, no significant changes were observed in relationship distress over time. The study was limited by the low "dose" of EFT (M = 7 sessions) received by participants and the small sample size (n = 17). A comprehensive discussion of the findings from a cultural perspective was provided. Future research is needed to further examine the effectiveness of EFT for couples in Taiwan and Asia.

Overlap of relationship distress and intimate partner violence in community samples

Mixed-gender couples presenting for couple therapy are at 2-3 times higher risk for physical intimate partner violence (IPV) than community couples. However, it is unclear if this elevation of relative risk is the same in the general population because relationship distress and treatment-seeking are often confounded. We used archival data from three representative U.S. civilian samples and one representative U.S. Air Force sample to test the hypothesis that clinically significant relationship distress is associated with increased risk of various forms of IPV. In these community samples, those in mixed-gender distressed relationships were at 2-3 times higher risk than those in nondistressed relationships for any physical IPV during the past year and at 3-6 times higher risk for clinically significant psychological and physical IPV during the past year. Given that the increase in IPV risk is similar for individuals in distressed community relationships and therapy-seeking relationships, the prior findings of the elevated rates of IPV in clinical samples are unlikely to be due to therapy-seeking. Although epidemiological risk involves statistical, not causal, associations, the increased co-occurrence of IPV in distressed mixed-gender couples fits with numerous theories of IPV and has implications for both screening and future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The development and evaluation of a brief intervention for male partners of women hospitalized for perinatal distress

BACKGROUND

Perinatal distress (PD) is a term used to describe mood and anxiety disorders experienced during pregnancy or in the postpartum period. In acute cases of PD, inpatient hospitalization may be indicated. Although hospitalization tends to result in improved immediate safety outcomes, many patients are discharged when they are still experiencing acute symptomology. Interpersonal and environmental factors, particularly those that exist within intimate relationships, can significantly help or hinder patient progress. Partners are also affected by the patient's symptoms and often lacks the skills or knowledge to offer support.

METHODS

The aim of the present investigation is to address PD through a dyadic lens by integrating partners into treatment. In this feasibility study, 20 partners of women hospitalized for PD were recruited to participate in an individually delivered, 90-minute intervention designed to improve partner understanding and support behaviors.

RESULTS

Qualitative feedback from partners suggests that the intervention was acceptable and the high recruitment rates demonstrate strong feasibility. Additionally, partners reported significant gains in the context of their support self-efficacy for assisting patients to cope with distress. Patients reported that they were significantly more satisfied with the support that their partners were providing.

LIMITATIONS

This was a feasibility study and as such, there was no control group, thereby limiting causal inferences about the intervention.

CONCLUSIONS

These findings suggest that this intervention may serve to enhance the recovery of women hospitalized for PD by empowering partners through offering psychoeducation and skills for offering support.

Interpersonal behavior in couple therapy: Concurrent and prospective associations with depressive symptoms and relationship distress

Objective: This study investigated associations between couples' interpersonal behavior, depressive symptoms, and relationship distress over the course of couple psychotherapy. Method: After every other session of Integrative Systemic Therapy (M = 13 sessions), N = 100 individuals within 50 couples rated their in-session affiliation and autonomy behavior using the circumplex-based Structural Analysis of Social Behavior Intrex. Concurrent and prospective associations of interpersonal behavior with depressive symptoms and relationship distress were evaluated via multivariate multilevel modeling using the Actor-Partner Interdependence Model. Results: An individual's hostility, as well as the partner's hostility, positively predicted an individual's concurrent depressive symptoms and relationship distress, as well as his or her relationship distress at the following session. Partner hostility during one session predicted an individual's subsequent depressive symptoms. During sessions in which individuals controlled the partner, and separated themselves from the partner, they reported more concurrent depressive symptoms and relationship distress, and more subsequent relationship distress. When partners separated themselves, individuals reported more concurrent depressive symptoms and relationship distress, and more subsequent relationship distress. Conclusions: Results underscore the importance of couples' in-session affiliation and autonomy behavior in the treatment of depressive symptoms and relationship distress within couple therapy.

Mechanisms of change in a brief, online relationship intervention

[Correction Notice: An Erratum for this article was reported online in Journal of Family Psychology on Nov 14 2019 (see record 2019-69050-001). In the article, the effect sizes listed in the "Mech. slope the effect sizes listed in the "Mech. slope →CSI slope" and "Indirect effect of treatment" columns of Table 2 were calculated incorrectly and mistakenly reported as Cohen's d values. These errors do not change any of the conclusions of the study. However, the correct values, column heads, and associated footnote CSI slope" and "Indirect effect of treatment" columns of Table 2 were calculated incorrectly and mistakenly reported as Cohen's d values. These errors do not change any of the conclusions of the study. However, the correct values, column heads, and associated footnote are presented in the erratum.] Internet delivery of couple interventions is becoming increasingly popular; however, little is known about mechanisms of change during these interventions. One online, self-help relationship intervention-the OurRelationship program-has been shown to improve relationship satisfaction (Doss et al., 2016) during the intervention and to maintain gains through 12-months follow-up (Doss, Roddy, Nowlan, Rothman, & Christensen, 2019). This study seeks to understand mechanisms during and following this program using the same sample of 300 couples (600 individuals) randomly assigned to the program or a waitlist control group. Results from the bivariate growth curves revealed that greater increases in relationship satisfaction during the intervention were explained by improvements in negative communication, emotional intimacy, as well as target problem confidence and severity. However, changes in acceptance of targeted relationship problems, positive communication, and self-protective orientation were not related to changes in satisfaction during the intervention. Additionally, in a multivariate model, relationship target problem severity alone remained significant in the presence of other mechanisms. Improvements in positive and negative communication during the intervention and level of negative communication at the end of the intervention predicted maintenance of gains in satisfaction over 12-month follow-up. Results replicate previous findings that communication (Doss, Thum, Sevier, Atkins, & Christensen, 2005) and emotional intimacy (Doss et al., 2005; Hawrilenko, Gray, & Córdova, 2016) are key components in initial decreases in relationship distress. Furthermore, results suggest that improvements in communication may help couples more effectively navigate problems following the intervention-above and beyond its associations with prepost improvements in satisfaction. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Marital Status, Relationship Distress, and Self-rated Health: What Role for "Sleep Problems"?

This paper analyzes data from a nationally representative survey of adults in the United Kingdom (Understanding Society, N = 37,253) to explore the marital status/health nexus (using categories that include a measure of relationship distress) and to assess the role that sleep problems play as a potential mediator. Findings indicate how it is not just the "form" marital status takes but also the absence or presence of relationship distress that is essential to self-rated health. We demonstrate two further findings that: (1) sleep problems act as a mediator of the link between marital status/relationship distress and self-rated health, most notably for those in cohabiting relationships with medium/high distress or who have a history of relationship loss, and (2) the mediating role of sleep problems differs for divorced men and women.

Hard Times and Heart Break: Linking Economic Hardship and Relationship Distress

We used the Fragile Families and Child Well-Being Study to examine an integrated mediational model linking economic hardship to relationship distress. Depressive symptoms, partner's discord, parenting stress, and coparenting are combined into a joint model linking economic hardship to relationship distress among mothers and fathers in intimate relationships. Although economic hardship is significantly associated with each mediating factor, only discord is associated with both relationship distress and dissolution in the full model. Moreover, comparisons using multigroup structural equation modeling indicate that while economic hardship is associated with higher discord among both mothers and fathers, the influence is substantially larger among fathers. We suggest that the link between hardship and relationship distress is largely contingent on interactional processes (i.e., discord) and how mothers perceive their child's father in the midst of economic hard times.

Immediate effect of couple relationship education on low-satisfaction couples: a randomized clinical trial plus an uncontrolled trial replication

Couple relationship education (RE) usually is conceived of as relationship enhancement for currently satisfied couples, with a goal of helping couples sustain satisfaction. However, RE also might be useful as a brief, accessible intervention for couples with low satisfaction. Two studies were conducted that tested whether couples with low relationship satisfaction show meaningful gains after RE. Study 1 was a three-condition randomized controlled trial in which 182 couples were randomly assigned to RELATE with Couple CARE (RCC), a flexible delivery education program for couples, or one of two control conditions. Couples with initially low satisfaction receiving RCC showed a moderate increase in relationship satisfaction (d=0.50) relative to the control. In contrast, couples initially high in satisfaction showed little change and there was no difference between RCC and the control conditions. Study 2 was an uncontrolled trial of the Couple Coping Enhancement Training (CCET) administered to 119 couples. Couples receiving CCET that had initially low satisfaction showed a moderate increase in satisfaction (g=.44), whereas initially highly satisfied couples showed no change. Brief relationship education can assist somewhat distressed couples to enhance satisfaction, and has potential as a cost-effective way of enhancing the reach of couple interventions.

Partner distress in the context of adult anorexia nervosa: the role of patients' perceived negative consequences of AN and partner behaviors

OBJECTIVE

Romantic partners can play an important role in the recovery from anorexia nervosa (AN). It is important to understand partners' behaviors and variables associated with their own distress. The aim was to examine associations of patients' perceived negative consequences of AN, behavioral strategies employed by partners, and partner distress.

METHOD

We used a cross-sectional design to assess associations between self-reports of patients' perceived negative consequences of AN, partners' caregiver distress, negative affect, relationship satisfaction, and observational coding measures of partners' behavioral strategies of change promotion and acceptance/validation. Sixteen adult patient-partner dyads in committed relationships were assessed at baseline of a couple-based intervention for AN.

RESULTS

Partners' change promotion moderated the association between patients' perceived negative consequences of AN and partners' caregiver distress. Partners' acceptance/validation was associated with partners' negative affect.

DISCUSSION

This report represents the first description of specific partner behaviors in the context of AN. Partners who reported the least distress were those who were trying to promote changes in AN behaviors in patients who reported high negative consequences of AN, and partners who were trying to show understanding of the patients' experience. Future studies should examine the impact of partner behaviors on AN treatment outcome.

Comparing the interpersonal behavior of distressed couples with and without depression

OBJECTIVE

This study compared the interpersonal behavior of distressed couples with depression in one partner (n = 23) to distressed couples without depression in either partner (n = 38).

METHOD

Participants (mean age = 44 years old) were recruited at an urban outpatient mental health center. Couples discussed the three best things in their relationship, and their interactions were coded using Structural Analysis of Social Behavior (Benjamin, 1987).

RESULTS

Self- and partner-focused hostility were associated with actors' and partners' relationship distress. Actors' hostility towards partners was positively associated with partners' depression status, but negatively associated with partners' depression symptoms. Actors' control behavior was positively associated with their relationship distress. Whereas the behavior of depressed individuals did not differ from a control sample of nondepressed individuals, partners of depressed individuals displayed more partner-focused hostility and submissiveness than controls.

CONCLUSIONS

Results underscore the importance of considering partner effects when conceptualizing depression within distressed relationships.

Conceptualization and Assessment of Disengagement in Romantic Relationships

Research examining relationship distress and dissolution highlights the importance of romantic disengagement. However, prior conceptualizations and measures of romantic disengagement have tended to combine disengagement with related but distinct constructs hindering the study of romantic disengagement. In the present study we conducted exploratory factor analyses to demonstrate that disengagement is a relatively distinct construct and to clarify the conceptualization of romantic disengagement. More importantly, we developed a novel measure- the Romantic Disengagement Scale (RDS). The RDS demonstrated adequate fit across samples of dating individuals, married couples and women in physically aggressive relationships. The RDS also demonstrated strong divergent and incremental validity. Implications for enhancing conceptual models, research methodology, and clinical interventions are discussed.

Prevention and treatment of relationship distress

Relationship distress is likely to be a pervasive problem among patients seen by the primary care physician. Further, it can influence the patient's mental and physical health and well-being. The physician should play a role in the prevention and the alleviation of relationship distress. The author suggests how the physician can help prevent relationship distress by providing anticipatory counselling. In addition, some guidelines for effective physician intervention in cases of mild distress and for successful referral in cases of significant distress are outlined.