Distinctiveness of behavioral versus insight-oriented marital therapy: An empirical analysis.

The present study determined whether behavioral and insight-oriented marital therapy could be rendered in a distinct and uncontaminated fashion in manual-guided outcome research in which therapists were crossed with treatment condition. Results indicated that therapist interventions could be reliably coded into techniques specific to the respective approaches and into additional interventions not specific to either treatment modality. When provided with explicit treatment manuals and ongoing case supervision, therapists were able to administer both treatment conditions faithfully without contamination from techniques that were inconsistent with that theoretical approach. Behavioral marital therapy (BMT) was shown to be highly structured, with 93% of therapist interventions reflecting techniques specific to that approach. In contrast, insight-oriented marital therapy (IOMT) comprised a large percentage of nonspecific interventions (62%) compatible with but not unique to a psychodynamic orientation. Implications for the two treatment approaches and for future marital therapy outcome research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital therapy and spouse involvement in the treatment of depression, agoraphobia, and alcoholism.

Examines the literature on marital therapy and spouse involvement as treatments for major psychopathology. The focus is on three disorders that have attracted a sufficient number of empirical findings: depression, agoraphobia, and alcoholism. For each of these disorders, we first examine the relation between marital dynamics and the disorder and next discuss empirical efforts to evaluate the impact of marital therapy or spouse involvement on the disorder. In addition, we summarize trends and suggest methodological refinements for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital adjustment and outcome following treatments for depression.

Marital adjustment and treatment outcome were evaluated in the Treatment of Depression Collaborative Research Program, a multicenter clinical trial evaluating interpersonal psychotherapy, cognitive therapy, imipramine, and placebo. Marital adjustment and depression were assessed pre- and posttreatment, and depression was assessed at 6, 12, and 18 months after treatment. Results indicate that (1) there was a significant improvement in marital adjustment after treatment, (2) this effect was not moderated by treatment type, and (3) this effect was mediated by change in depression. Poor pretreatment marital adjustment was modestly associated with negative outcome, whereas poor posttreatment marital adjustment was strongly associated with negative outcome during follow-up. The findings suggest that poor marital adjustment at the end of active treatment is a risk factor for increases in depression severity during follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral versus insight-oriented marital therapy: Effects on individual and interspousal functioning.

Compared the effects of behavioral marital therapy (BMT) and insight-oriented marital therapy (IOMT) on both interspousal and intrapersonal functioning in a controlled outcome study. A total of 79 couples seeking treatment for relationship distress were randomly assigned to BMT, IOMT, or a treatment-on-demand (TOD) waiting-list control group. Results indicated the significance and general equivalence of behavioral and insight-oriented therapies in producing positive changes in individual and relationship functioning. Both treatment approaches produced significant effects from intake to termination that were substantially maintained at the 6-month follow-up. Behavioral and insight-oriented therapies resulted in significant improvements in self-reports of global marital accord and, to a lesser extent, in the reduction of overall psychological distress and in the enhancement of self-concept, with no significant differences between treatment conditions. The magnitude of these effects in comparison with those reported in previous marital outcome studies and in more general psychotherapy research is discussed, and possible mechanisms for the equivalence of these technically divergent treatment approaches are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to special section on couples and couple therapy.

Introduces the special section on couples and couple therapy, which brings together representative, state-of-the-art contributions from both basic and applied research on couples. Two contributions from the basic research domain attempt to better understand the interactional dynamics of normal marriages; both also have implications for marital and relationship distress. Two articles focus specifically on domestic violence. In the domain of clinical research, there are four articles that examine outcome and change mechanisms, the process of change within emotionally focused couple therapy, predictors of short- and long-term outcome after behavioral or insight-oriented marital therapy, and findings from a research program on preventing marital discord. The section closes with a commentary in which the articles are put into a broader context, and the interaction between basic and applied research is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process ratings forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults.

Conducted a meta-analysis of 56 outcome studies of psychotherapy and drug therapy in the treatment of unipolar depression in adults. Five types of psychotherapy were examined: behavioral; social learning-interpersonal; cognitive; a combination of cognitive, social learning, and behavioral; and marital. 35 types of drug therapy were examined; the 2 most common were imipramine and amitriptyline. Findings suggest that psychotherapy (mean effect size 1.22) was superior to drug therapy (mean effect size .61) in treating unipolar depression. This finding is discussed in relation to the relative strengths and weaknesses of narrative vs qualitative approaches to synthesizing the findings of many studies. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of a tiered therapy defibrillator system used to treat recurrent ventricular arrhythmias refractory to drugs

This study identified predictors of couples' response to marital therapy at termination and 4 years posttreatment for 55 couples receiving either behavioral or insight-oriented marital therapy. Couples were more likely to remain maritally distressed at termination if either spouse reported high levels of negative marital affect or depressive symptomatology at intake. Couples were more likely to be divorced or maritally distressed 4 years after completing therapy if spouses' intake measures reflected high levels of negative marital affect, poor problem-solving skills, low psychological resilience, high levels of depression, low emotional responsiveness, or if neither spouse was employed at a semiskilled or higher level position. Termination measures of negative marital affect and poor communication skills also predicted couples' status at 4-year follow-up. Joint contingency tables relating predictors to outcome were constructed.     

Couple discord and depression in couples during couple therapy and in depressed individuals during depression treatment.

The association between depression and relationship distress as well as the impact of treatment for the one on the other was examined across 2 treatment-seeking samples: individuals seeking treatment for depression (N = 120) and couples seeking marital therapy (N = 134 couples). Although there was a baseline association between depression and distress across the 2 samples, relationship distress was far more prevalent among those being treated for depression than was depression for those seeking marital therapy. There was a reliable association between changes in the primary problem (e.g., relationship distress in the couple therapy study) and changes in the secondary problem (e.g., depression in the couple therapy study). However, overall effects on secondary problems were quite small. Neuroticism played a complex, moderating role across the 2 samples, strengthening and weakening the association between depression and relationship distress depending on the sample and gender, replicating previous findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analytic review of marital therapy outcome research.

This meta-analytic review examines the findings of 15 methodologically rigorous marital therapy outcome studies reported in 19 journal articles. These findings were used to assess the efficacy of three treatment approaches in fostering change in spouses' relationship-related behavior, cognitions, affect, and general assessment of their relationship. Behavioral marital therapy (BMT), cognitive-behavioral marital therapy (CBMT), and insight-oriented marital therapy (IOMT) were all found to be more effective than no treatment in bringing change in spouses' behavior and in the general assessment of their relationship. IOMT was more effective than BMT or CBMT in bringing change in spouses' general relationship assessment, while CBMT was the only approach that induced significant change in spouses' posttherapy relationship-related cognitions. The role of meta-analytic reviews of marital therapy approaches is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting couples' response to marital therapy: A comparison of short- and long-term predictors.

Identified predictors of couples' response to marital therapy at termination and 4 yrs posttreatment for 55 couples receiving either behavioral or insight-oriented marital therapy. Couples were more likely to remain maritally distressed at termination if either spouse reported high levels of negative marital affect or depressive symptomatology at intake. Couples were more likely to be divorced or maritally distressed 4 yrs after completing therapy if spouses' intake measures reflected high levels of negative marital affect, poor problem-solving skills, low psychological resilience, high levels of depression, low emotional responsiveness, or if neither spouse was employed at a semiskilled or higher level position. Termination measures of negative marital affect and poor communication skills also predicted couples' status at 4-yr follow-up. Joint contingency tables relating predictors to outcome were constructed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of cognitive therapy.

Speculates about likely future directions for psychotherapy and the role that cognitive therapy (CGT) might play in these developments. Five predictions about psychotherapy are discussed, along with their implications for CGT. These include (1) questions of specificity vs nonspecificity; (2) greater emphasis on research and accountability; (3) cross-fertilization of different systems of psychotherapy; (4) diversification of delivery systems; and (5) pursuit of closer connections with basic psychological science. CGT appears to have attained its greatest documented achievement in treatment of unipolar depression. A better idea of its efficacy for treatment of panic disorders, eating disorders, marital distress, and personality disorders should be possible after 5–20 yrs of research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of success in emotionally focused marital therapy

This study examined client variables expected to predict success in emotionally focused marital therapy (EFT), now the second most validated form of marital therapy after the behavioral approaches. The relationship of attachment quality, level of emotional self-disclosure, level of interpersonal trust, and traditionality to the therapy outcome variables, marital adjustment, intimacy, and therapist ratings of improvement, was examined. These variables were chosen for their relevance to the theory and practice of EFT and to intimate relationships in general. Overall, therapeutic alliance predicted successful outcome; the task dimension of the alliance in particular predicted couples' satisfaction. More specifically, one dimension of female partners' trust, their faith in their partner, predicted couples' satisfaction at follow-up. Females' faith also significantly predicted males' level of intimacy at follow-up. Males who were most likely to be nondistressed at termination indicated higher levels of proximity seeking on an attachment measure at intake, and older males and males whose partners had higher levels of faith in them were more likely to be nondistressed at follow-up. Traditionality was not found to be significantly related to outcome. Couples who made the most gains at follow-up also indicated lower initial marital satisfaction and included males who indicated lower levels of use of attachment figure on the attachment measure at intake. Males who made the largest gains at termination were older and were rated as less expressive by their partner on self-disclosure measures at intake. Age was the only variable significantly related to males' gains in satisfaction at follow-up. Implications for the practice of marital therapy and future research are delineated.     

Effects of Behavioral Marital Therapy: A Meta-Analysis of Randomized Controlled Trials.

This meta-analysis summarizes results from 30 randomized experiments that compare behavioral marital therapy with no-treatment control with distressed couples. Results showed that behavioral marital therapy is significantly more effective than no treatment (d=.585). Although behavioral marital therapy research studies tend to be conducted under conditions that are less clinically representative than other samples of studies, representativeness was not significantly related to outcome. However, evidence also suggested that publication bias may exist in this literature whereby small sample studies with small effects are systematically missing compared with other studies. This bias may inflate the effects of behavioral marital therapies reported in previous meta-analyses, though we also explore a number of alternative explanations for this small sample bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in marital adjustment following marital therapy: A comparison of two outcome measures.

Comparability of treatment outcome as measured by the Dyadic Adjustment Scale and the Global Distress Scale (GDS) was examined for 49 couples who completed a behavioral marital therapy program. The GDS provided a more conservative estimate of treatment efficacy, as assessed by (1) computed effect sizes based on couple, husband, and wife scores and (2) clinical significance statistics based on couple and husband scores. This difference was hypothesized to be due in part to items on the GDS that assess historical dissatisfaction with marriage that are not affected by treatment. The GDS, however, continued to provide a more conservative estimate of treatment outcome even after controlling for the historical items. Implications of gender differences and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrative cognitive therapy for depression: A randomized pilot comparison.

This pilot study examined the efficacy of an integrative form of cognitive therapy (ICT) for depression that incorporates specific strategies for addressing alliance ruptures. Although a previous study on depression found that ICT was superior to a wait-list condition (L. G. Castonguay et al., 2004), the current study provides the 1st direct comparison between ICT and traditional cognitive therapy (CT). Twenty-two depressed adults were randomly assigned to ICT or CT (11 patients per condition), which were delivered by clinicians in training. Outcome was assessed with a specific depression measure and a global symptomatology measure. The groups were also compared on patient-perceived alliance quality and therapist empathy. Effect size estimates revealed that ICT patients evidenced greater posttreatment improvement on both outcome measures (with small to medium effects) and more clinically significant change than did CT patients. ICT patients also had higher alliance and empathy scores across treatment (with medium to large effects). The findings, albeit very preliminary, support the potential viability of ICT and the potential causal influence of the rupture-repair interventions on treatment process and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concepts for understanding marriage and developing techniques of marital therapy: Cognition über alles?

Comments on the work of F. D. Fincham et al (see record 1991-13304-001) on the role of cognition in marriage and marital therapy and compares that effort with research on understanding depression from a cognitive perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital distress, depression, and attributions: Is the marital distress-attribution association an artifact of depression?

We examined whether the association between marital distress and attributions is an artifact of depression. Study 1 showed that the attributions of 40 wives recruited from the community accounted for variance in their marital satisfaction after the effects of depression had been taken into account. Study 2 compared the attributions of 20 clinically depressed and maritally distressed wives (respondents to an advertisement offering therapy for depression and marital problems), 20 nondepressed but distressed wives (clients seeking marital therapy at a clinic), and a control group of 20 nondepressed and nondistressed wives (respondents to an advertisement for participants in a research project). The first two groups did not differ in attributions, but the attributions of both groups differed from those of the control group. Both studies therefore suggest that the association between attributions and marital satisfaction is not due to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)