Traditional Versus Integrative Behavioral Couple Therapy for Significantly and Chronically Distressed Married Couples.

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infidelity and Behavioral Couple Therapy: Optimism in the Face of Betrayal.

Infidelity is a common issue with which distressed couples and their therapists grapple. However, there are no data on the efficacy of commonly used therapies to treat couples in which there has been an affair. In the present exploratory study, the authors examined the therapy outcomes of a sample of infidelity couples (n=19) who had participated in a randomized clinical trial of marital therapy (N=134). Results show that infidelity couples began treatment more distressed than noninfidelity couples; however, evidence suggests that couples who had an affair and who revealed this affair prior to or during therapy showed greater improvement in satisfaction than noninfidelity couples. Implications for therapy with infidelity couples are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observed communication in couples two years after integrative and traditional behavioral couple therapy: Outcome and link with five-year follow-up.

Objective: To examine changes in observed communication after therapy termination in distressed couples from a randomized clinical trial. Method: A total of 134 distressed couples were randomly assigned to either traditional behavioral couple therapy (TBCT; Jacobson & Margolin, 1979) or integrative behavioral couple therapy (IBCT; Jacobson & Christensen, 1998). Videotaped samples of each couple's interactions were coded from pre-therapy, post-therapy, and 2-year follow-up assessments. At these 3 time points, each partner chose 1 current relationship problem to discuss. Relationship satisfaction was assessed at 2-year follow-up, and clinically significant treatment response and marital status were assessed 5 years after treatment. Results: Observed negativity and withdrawal decreased from therapy termination through the 2-year follow-up as expected, but problem solving did not change, and observed positivity decreased. IBCT produced superior changes from post-therapy to the 2-year follow-up assessment compared with TBCT. Post-therapy levels and changes in communication over follow-up were associated with wife satisfaction at 2-year follow-up; only post-therapy to 2-year follow-up changes in communication were associated with husband satisfaction at 2-year follow-up. Post-therapy levels of problem solving and changes in wives' positivity from pre-therapy to post-therapy were associated with 5-year relationship outcomes. We found some counterintuitive results with positivity, but they were no longer significant after controlling for withdrawal. Conclusions: We found support for improvements in observed communication following treatment termination, with IBCT demonstrating greater maintenance of communication improvement over follow-up. We found limited evidence of associations between communication and relationship outcomes at 5-year follow-up. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Change Process Research in Couple and Family Therapy: Methodological Challenges and Opportunities.

In our field, the study of therapeutic change processes lags behind the study of treatment efficacy. Nonetheless, in the past 10 years major strides have been made in delineating change process mechanisms in couple and family therapy. To focus the efforts of future change process researchers, the authors discuss 5 critical needs: (a) more well-articulated, midrange theory about systemic change processes; (b) more attention to client change processes; (c) more attention to covert intrapersonal processes (emotion, cognition, and clients' experience of the alliance); (d) better articulation of strategies for analyzing data from multiple participants; and (e) more focus on the degree to which various change processes work similarly (or not) for diverse couples and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

FACT: The Utility of an Integration of Functional Analytic Psychotherapy and Acceptance and Commitment Therapy to Alleviate Human Suffering.

Functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT) are 2 contemporary behavioral therapies designed to address complex clinical problems. The 2 therapies are described, and areas of convergence and divergence are discussed. A new psychotherapy integrating the 2-functional-analytic acceptance and commitment therapy (FACT)-is defined. It is argued that FACT enhances the utility of FAP or ACT alone by expanding the target of therapy to include both interpersonal and intrapersonal client behaviors. In addition, the authors posit that the intervention technologies used in FAP and ACT enhance one another. The authors also address the following topics: populations for whom FACT would be most beneficial, supervision and training issues, current empirical research on FACT, and FACT's applicability and generalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing Nonindependent Outcomes in Couple Therapy Using the Actor-Partner Interdependence Model.

The nonindependent components of couple data require data-analytic strategies tailored to the interpersonal processes occurring between relationship partners. This article examines the benefits of a specifically dyadic analytic method, the actor-partner interdependence model (APIM), for evaluating interpartner influence across time. Both conceptual and methodological features of the APIM are exemplified by applying this model to observations of negative and positive affect and global distress in spouses participating in a randomized trial of couple therapy. In addition to elucidating specific advantages of the APIM relative to alternative data-analytic strategies, the current results shed new light on previous findings from a comparative treatment outcome study evaluating behavioral and insight-oriented approaches to couple therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple therapy from the perspective of self psychology and intersubjectivity theory.

[Correction Notice: An erratum for this article was reported in Vol 25(2) of Psychoanalytic Psychology (see record 2008-03991-018). Throughout the article, "Couples therapy" should read as "couple therapy," and "self-psychology" should read as "self psychology."] Central tenets of self-psychology and intersubjective systems theory (e.g., Stolorow & Atwood, 1992) are applied to the understanding and treatment of couple. The concepts of selfobject needs, unconscious organizing principles, and learned relational patterns are used to conceptualize common couples difficulties. A treatment approach is outlined, involving: (1) listening from within each partner's subjective perspective; (2) establishing a therapeutic dialogue through which each partner's selfobject needs, ways of organizing experience, and patterns of relating can gradually be empathically illuminated and transformed; and (3) facilitating new relational experiences with the couples therapist and eventually between the partners. Four concepts of self psychology that are particularly useful with some of the most challenging aspects of couples work are then discussed. Finally, the judicious use of directive interventions with couples is discussed as consistent with this perspective. A case example is used throughout the paper to illustrate key points. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple communication and female problem drinking: A behavioral observation study.

Couples with alcohol and relationship problems often report poor communication, yet little is known about the communication of maritally distressed couples in which the woman abuses alcohol (MDWA couples). Compared with maritally distressed couples without alcohol problems (MDNA) and couples with neither problem (NDNA), MDWA couples showed a distinctive pattern of negative communication. Similar to MDNA men, MDWA men spoke negatively to their partners but listened positively to their partners much like NDNA men. MDWA women listened negatively, much as MDNA women did, but spoke positively, like NDNA women did. The interactions of MDWA couples can be characterized as a male-demand-female-withdraw pattern, which is a gender reversal of the female-demand-male-withdraw pattern often observed in MDNA couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy.

Reviews the book, A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy by Joseph V. Ciarrochi and Ann Bailey (2008). The “third wave” of cognitive behavioural therapy (CBT), with its emphasis on mindfulness and acceptance as core skills to facilitate psychological health, has spurred the development of a number of unique and often provocative therapeutic approaches. Amongst these, acceptance and commitment therapy (ACT) is one that has generated especially fervent support amongst its adherents. The rise of ACT has been ushered in part by a plethora of treatment manuals and self-help materials; however, few of these are explicitly targeted toward professionals well-versed and comfortable with CBT who are not interested in, or ready for, a full conversion to a new therapeutic framework. It is to this audience that Ciarrochi and Bailey have targeted their book, and their successful result is a practical, easy-to-read guidebook that presents a relaxed introduction to the approach. Ciarrochi and Bailey have provided an engaging and user-friendly introduction to ACT in a fashion that will allow experienced therapists to integrate it into their work while retaining much of a basic CBT framework. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-Behavioral Therapy for Insomnia: Comparison of Individual Therapy, Group Therapy, and Telephone Consultations.

Forty-five adults with primary insomnia received cognitive-behavioral therapy (CBT) implemented in a group therapy format, in individual face-to-face therapy or through brief individual telephone consultations. The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation, and there was no significant difference across methods of implementation. All 3 treatment modalities produced improvements in sleep that were maintained for 6 months after treatment completion. These results suggest that group therapy and telephone consultations represent cost-effective alternatives to individual therapy for the management of insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Integrative Therapy Framework: Research and Practice.

Research in human development and studies on therapy process and outcome respectively address similar questions: How does change come about and what influences it? Very similar answers emerge from these two research domains. Both have much to offer to the contemporary endeavors for therapy integration. The comparisons of the findings combined with clinical experience provide a basis for an integrative framework for therapeutic practice that can be applied to any therapy model. The components of the framework are used to discuss differences and similarities among 3 major therapeutic models. Practice is seen as a starting point for integration, which ultimately happens at an individual level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rational-Emotive Behavior Therapy: A Behavioral Change Model for Executive Coaching?

The authors suggest the use of A. Ellis's (1971, 1994) rational-emotive behavior therapy (REBT) as a tool to help clients effect behavioral change in the context of a coaching relationship. The article begins with a brief overview of REBT followed by an argument for its usefulness in an executive coaching context. The authors outline the therapeutic components of REBT that may facilitate executive coaching and discuss the circumstances under which REBT may not be appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance and commitment therapy for smoking cessation: A preliminary study of its effectiveness in comparison with cognitive behavioral therapy.

This controlled preliminary trial determined the feasibility and initial effectiveness of a promising behavioral intervention for smoking: Acceptance and Commitment Therapy (ACT). In a quasi-experimental design, the ACT intervention condition used metaphors and experiential exercises focused on personal values to motivate quitting smoking and enhancing the willingness to experience internal cues to smoke (e.g., urges) and abstinence-related internal distress. The comparison condition was cognitive behavioral therapy (CBT)—the current standard in behavioral intervention for smoking cessation. Each treatment was delivered in seven weekly 90-min sessions in a group format to 81 (43 in ACT; 38 in CBT) adult smokers. Results show that the ACT treatment was as feasible as the CBT treatment. They also demonstrate promising evidence of ACT’s effectiveness: 30.2% intent-to-treat biochemically-supported 30-day point prevalence at twelve month follow-up, compared with 13.2% in the CBT condition (odds ratio = 5.13; p = .02). Replication in a well-powered, randomized, controlled trial is now needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Needs ABC: Needs acquisition and behavior change--An integrative model for couples therapy.

This article addresses the application of the needs acquisition and behavior change (Needs ABC) approach to providing therapy for couples. The Needs ABC model was originally developed at the McGill Domestic Violence Clinic. It uses an integrated therapeutic approach combining observation and elucidation of client and group process, using concepts also described in cognitive-behavioral, motivational, narrative, and emotion-focused models. The Needs ABC model is distinguished by its emphasis on the relational needs behind maladaptive behaviors rather than on the behaviors themselves and by its flexibility in terms of application to clients in a range of personal and therapeutic settings. In the context of providing therapy for couples, it provides a unique approach that helps clients to understand the origins of their behavior individually and in the context of their dyad and to formulate more constructive ways to react to stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A validity study of functionally-based behavioral consultation with students with emotional/behavioral disabilities.

Eighteen students (K-11th grade) with emotional/behavioral disorders who were at-risk for change of placement to more restrictive settings participated. Construct validity of functional behavioral assessment (FBA) was assessed with a multifunction-multimethod matrix that showed excellent convergent and divergent agreement with combined FBA methods and functional analysis results. Treatment validity was assessed with random assignment to either a FBA with consultation condition (FBC) or to a behavioral consultation without FBA condition (BC). Growth curve analysis showed a significant decrease in inappropriate behavior from baseline to treatment for both treatment groups compared to a control group. The efficiency of teachers' implementation effected treatment validity. Effect sizes showed that regardless of treatment condition that interventions with good fidelity realized the largest effect (d = -1.14). Social and habilitative validity was assessed with telephone interviews conducted a year after treatment. Sixty-five percent attributed the students' problem behaviors to their thoughts or feelings, whereas only 25% attributed it to classroom variables. Many (57%) indicated the most helpful intervention would be individual counseling, whereas only 14% indicated a more involved classroom management plan would be useful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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)     

Supervisory guidance and behavioral integrity: Relationships with employee citizenship and deviant behavior.

The authors examined the effects of supervisory guidance (providing instruction to employees) and behavioral integrity (a pattern of word-deed alignment) on employee organizational citizenship behavior (OCB) and deviant behavior. Results revealed a pattern of Supervisory Guidance x Behavioral Integrity interaction effects, such that relationships between guidance and outcome variables were dependent on the level of behavioral integrity exhibited by supervisors. The interactions suggest a positive relationship between supervisory guidance and OCBs when behavioral integrity is high but also a positive relationship between guidance and deviant behavior when behavioral integrity is low. These results were consistent across 2 independent field samples: 1 assessing individual employee perceptions of supervisory behavior and the other assessing aggregate perceptions of supervisory behavior among employees in bank branches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)