Physical violence and other forms of marital aggression: Links with children's behavior problems.

Two studies examined whether physical marital violence and other forms of marital aggression (e.g., threats, throwing objects) correlate with children's behavior problems in families marked by recent spousal violence. Study 1 included 55 families seeking marital therapy. Study 2 included 199 families at battered women's shelters. In the marital therapy sample, both physical marital violence and other forms of marital aggression correlated positively with children's externalizing problems. In the women's shelter sample, physical violence and other forms of marital aggression correlated positively with children's externalizing and internalizing problems. After accounting for the frequency of physical marital violence, forms of marital aggression other than physical violence still related to children's externalizing problems in the marital therapy sample and to children's internalizing problems in the women's shelter sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating models of interdependence with treatment evaluations in marital therapy research.

Clinical intervention may not be the only source of change in the behavior of husbands and wives during marital therapy. Spouses may continue to influence each other, though perhaps in ways different than they did before treatment. Viewed as a short longitudinal study of marital interaction, a pretest-posttest trial of marital therapy can provide information on the short-term processes of interpersonal influence or interdependence that occur over the course of treatment. Moreover, interpersonal processes and treatment processes may combine to produce unique clinical outcomes. This article presents 3 structural equation models of marital interdependence that can be applied to pretest-posttest data from clinical trials of marital therapy. Modifications of these models that include a treatment variable are also presented. These models provide tests for treatment effects that are unique to interventions into relationship systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital violence before and after alcoholism treatment.

The prevalence and frequency of marital violence were assessed for 88 male alcoholics and their wives at entry to and 1 year after completing a behavioral marital therapy (BMT) program. In the year before BMT, both the alcoholics and their wives had a significantly and substantially higher prevalence and frequency of marital violence than reported by a demographically matched, nonalcoholic comparison sample. Although violence decreased significantly in prevalence and frequency in the year after BMT it remained significantly elevated relative to the matched controls when the entire sample of alcoholics was considered. However, extent of violence after BMT was significantly associated with the alcoholics' drinking outcome status: After treatment, remitted alcoholics no longer had elevated marital violence levels whereas relapsed alcoholics did. Implications for understanding the marital violence and alcoholism connection and cautions that should be exercised in interpreting the results are discussed. (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)     

Attribution processes in distressed and nondistressed couples: IV. Self–partner attribution differences.

The importance of the self–other distinction for understanding the relation between attributions and marital satisfaction is examined in two studies. In Study 1, causal attributions for naturally occurring behavior by the self and spouse were investigated. Study 2 examined both causal and responsibility attributions for hypothetical behaviors. In both studies, the attributions of spouses seeking therapy were investigated in relation to those of happily married persons in the community. The results showed that self–other attribution differences varied as a function of marital distress. Nondistressed spouses showed a positive attribution bias by making more benign attributions for partner behavior as opposed to self-behavior, whereas distressed spouses showed a negative attribution bias by making less benign attributions for partner behavior than for self-behavior. These findings suggest that self-attributions may, in part, determine the impact of attributions for spouse behavior on marital satisfaction. The clinical relevance of the results and their implications for research on actor–observer attribution differences are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contributions of affect, attitudes, and behavior to marital satisfaction.

Examined the value of assessing affect and attitudes in addition to daily behavior in the prediction of marital satisfaction in 30 distressed couples, self-referred to marital therapy, and 25 community couples. Measures of positive feelings toward spouse, commitment, and exchange orientation were obtained along with 7 days of behavioral records. All of these variables were significantly associated with marital satisfaction. However, multiple regression analyses and semipartial correlations indicated that the affective and attitudinal variables accounted for more unique variance in marital satisfaction than did the behavioral variables. It is suggested that affective and attitudinal variables be addressed in marital therapy to better individualize treatments and optimize the ability to predict responsiveness to therapy. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex role identity, marital satisfaction, and response to behavioral marital therapy.

Explored the relationships among masculinity, femininity, marital satisfaction, and response to behavioral marital therapy (BMT) using 44 married nonclinic couples (mean ages of males and females 33.7 and 31 yrs, respectively), 54 maritally distressed clinic couples receiving BMT, and 18 maritally distressed clinic couples placed on a waiting list; the mean ages of males and females in both distressed clinic groups were 32.1 and 29.9 yrs, respectively. Ss completed the Marital Adjustment Scale and masculinity and femininity scales derived from the California Psychological Inventory. Results indicate that for each sex, both femininity and masculinity were significantly correlated with self-reported marital satisfaction; the magnitude of the correlations between femininity and marital satisfaction was higher than the correlations between masculinity and marital satisfaction. Among clinic couples, androgyny was the least frequent sex-role identity for either husbands or wives; conversely, among nonclinic couples, there were more androgynous husbands and wives than there was any other sex-role type. In the clinic group, both husbands and wives showed statistically significant but small increases in masculinity after receiving 10 wks of BMT. Masculinity and femininity level prior to treatment also significantly predicted response to BMT. The potential importance of both masculinity and femininity in successful marriages is highlighted, and treatment implications are discussed. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology and marital distress: The positive side of positive symptoms.

Levels of marital satisfaction reported by spouses of schizophrenic and affectively disordered patients were examined, and several hypotheses based on an attribution model of symptom controllability were tested. This model holds that patients' florid symptoms and marked behavioral excesses are more likely to be perceived by their spouses as illness-caused and, consequently, will be associated with less marital discord than negative symptoms or symptoms that involve behavioral deficits. Consistent with this model, the classification of patients on the basis of their predominant symptom profiles revealed significant differences in the marital satisfaction ratings of their spouses. Spouses of patients with negative symptoms and impulse-control deficits reported significantly lower levels of marital satisfaction than spouses of patients with positive symptoms. The results suggest that the symptoms that are most salient to clinicians and diagnosticians may not be the symptoms that are most salient to the families of the mentally ill. (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)     

Effects of directionality of significance tests on the bias of accessible effect sizes.

The proportion of studies that use one-tailed statistical significance tests (π) in a population of studies targeted by a meta-analysis can affect the bias of the sample effect sizes (sample ESs, or ds) that are accessible to the meta-analyst. H. C. Kraemer, C. Gardner, J. O. Brooks, and J. A. Yesavage (1998) found that, assuming π?=?1.0, for small studies (small Ns) the overestimation bias was large for small population ESs (δ?=?0.2) and reached a maximum for the smallest population ES (viz., δ?=?0). The present article shows (with a minor modification of H. C. Kraemer et al.'s model) that when π?=?0, the small-N bias of accessible sample ESs is relatively small for δ?≤?0.2, and a minimum (in fact, nonexistent) for δ?=?0. Implications are discussed for interpretations of meta-analyses of (a) therapy efficacy and therapy effectiveness studies, (b) comparative outcome studies, and (c) studies targeting small but important population ESs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression.

This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bias in meta-analytic estimates of the absolute efficacy of psychotherapy.

Meta-analytic estimates of the absolute efficacy of psychotherapy indicate an effect size of approximately 0.80. However, various biases in primary and meta-analytic studies may have influenced this estimate. This study examines 4 nonsystematic biases that increase error variance (i.e., nonrandomized designs, methodological deficiencies, failure to use the study as the unit of analysis, and violations of homogeneity), 4 underestimation biases that primarily concern psychometric issues (i.e., unreliability of outcome measures, failure to report nonsignificant effect sizes, nonoptimal composite outcome measures, and nonstandardized outcome measures), and 8 overestimation biases (i.e., excluding nonsignificant effects from calculations of effect size estimates, failure to adjust for small sample bias, failure to separate studies using single-group pre-post designs vs. control group designs, using unweighted average effect sizes, analyzing biased partial samples that reflect treatment dropout and research attrition, researcher allegiance bias, publication bias, and wait-list control group bias). Wherever possible, evidence regarding the magnitude of these biases is presented, and methods for addressing these biases separately and collectively are discussed. Implications of the meta-analytic evidence on psychotherapy for the effect sizes of other psychological interventions are also considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital and family therapy of alcohol use disorders: Bridging the gap between research and practice.

Clients with alcohol and other substance use disorders are routinely encountered by practitioners in various treatment settings. This article traces the rationale for using marital and family therapy with alcoholics and describes an ongoing behavioral marital therapy program that exemplifies an integration of clinical practice and research in this area. Specific treatment suggestions are offered and practical considerations for therapists working with families struggling with alcoholism are discussed, including the role of self-help groups in family treatment, the danger of having preconceived notions about "alcoholic families," and the necessity for clinics and clinicians to possess the capacity to assess and treat comorbid psychological disorders as well as addictive behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of different sensitivity, specificity and cause-specific mortality fractions on the estimation of differences in cause-specific mortality rates in children from studies using verbal autopsies

BACKGROUND: Verbal autopsies (VA) are increasingly being used in developing countries to determine causes of death, but little attention is generally given to the misclassification effects of the VA. This paper considers the effect of misclassification on the estimation of differences in cause-specific mortality rates between two populations. METHODS: The bias in the percentage difference in cause-specific mortality between two populations has been explored under two different models: i) assuming that mortality from all other causes does not differ between the two populations; ii) allowing for a difference in mortality from all other causes. The bias is described in terms of the sensitivity and specificity of the VA diagnosis and the proportion of mortality due to the cause of interest. Methods for adjustment of sample size and adjusting the estimate of effect are also explored. RESULTS: The results are illustrated for a range of plausible values for these parameters. The bias is more extreme as both sensitivity and specificity fall, and is particularly affected even by a small loss of specificity. The bias also increases as the proportion of all deaths due to the cause of interest decreases, and is affected by the size of the true change in mortality due to the cause of interest relative to the change in mortality from other causes. Calculations from existing data suggest prohibitively large sample sizes may often be required to detect important differences in cause-specific mortality rates in studies using existing VA. CONCLUSIONS: Highly specific VA tools are needed before observed differences in cause-specific mortality can be interpreted. Loss of power due to misclassification may obscure real differences in cause-specific mortality.     

Is there an association between hormone replacement therapy and breast cancer?

The fear of breast cancer has been suggested as a potential reason why only a relatively small percentage of postmenopausal women who would benefit from hormone replacement therapy (HRT) are current users. The equivocal results from a large number of epidemiologic studies make it difficult to evaluate whether an association does indeed exist between the use of HRT and the incidence of breast cancer. The inability to provide conclusive evidence for or against this relationship may be attributed to methodologic problems in these studies, including small sample sizes, lack of information on specific hormonal preparations (e.g., dose and type), failure to control for the type of menopause, and surveillance bias. In an attempt to generalize results from different studies in a systematic manner, several meta-analyses have been conducted of the effects of estrogen replacement therapy (ERT) or HRT on the risk of breast cancer. This article summarizes the data from these meta-analyses and incorporates data from studies published after these meta-analyses that have addressed this question. Data from ongoing studies that use a randomized, controlled, longitudinal design on large numbers of women are necessary before a possible association between the use of HRT and breast cancer can be ascertained.     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reactivity to positive and negative behavior in distressed and nondistressed married couples.

Tested the reactivity hypothesis that distressed married couples react more to recent, high-valence events (positive or negative) than their nondistressed counterparts. 21 happily married couples and 20 couples seeking marital therapy collected nightly data in the home for 2 wks, recording both the frequency of positive, negative, and neutral events and global daily satisfaction ratings. Ss also completed the Dyadic Adjustment Scale. As in past studies, and consistent with a behavioral model of marital distress, distressed couples reported lower rates of positive behavior and higher rates of negative behavior than did nondistressed. Consistent with the hypothesis, distressed spouses were more reactive to recent events than were nondistressed. Their subjective satisfaction with the relationship depended to a greater degree on the frequency of recent positive or negative events than was the case for happily married couples. Evidence is provided that these reactivity differences were not simply a function of differences in behavioral frequencies and that the process reactivity is separable—both experimentally and statistically—from the frequency of positive and negative exchanges. The relationship between reactivity and other variables of interest is examined. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Siblings' differential experiences of marital conflict and differences in psychological adjustment.

The present study examined whether siblings experience marital conflict differently and whether such differences, if present, were associated with differences in their adjustment. Self-report data about marital conflict, children's depressed mood, behavioral conduct, and externalizing problems were obtained from 122 sibling pairs (mean ages = 10 and 12 years) and their parents. Results indicated that siblings were significantly different in exposure to and appraisals of marital conflict. Differences in siblings' exposure to marital conflict were significantly correlated with differences in their depressed mood, behavioral conduct, and externalizing problems. Differences in siblings' feelings of self-blame for marital conflict were significantly correlated with differences in their depressed mood and behavioral conduct. Children who experienced more marital conflict than their siblings had more adjustment problems than their siblings. These results highlight the importance of studying siblings' unique experiences of marital conflict to better understand its impact on children's adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive illusions about marriage among married and single individuals.

The common tendency to describe one's marriage in unrealistic terms has been conceptualized as a positive illusion about marriage. Studies of positive illusions have relied on the logical argument that these perceptions are unreasonably positive. This reasoning is insufficient, because previous studies have relied on volunteer samples with high marital satisfaction and long marital duration, both of which could explain rosy evaluations of one's marriage. The current series of studies examined whether positive marital illusions are an artifact of marital satisfaction and duration. Married and single individuals' estimates of their divorce likelihood and other measures of positive marital illusions revealed that illusions about marriage are not dependent on a volunteer bias, marital satisfaction, or duration. The presence of illusions about a future marriage among single individuals suggests that positive marital illusions are a cultural phenomenon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A warning about median reaction time.

When used with positively skewed reaction time distributions, sample medians tend to overestimate population medians. The extent of overestimation is related directly to the amount of skew in the reaction time distributions and inversely to the size of the sample over which the median is computed. Simulations indicate that overestimation could approach 50 ms with small samples and highly skewed distributions. An important practical consequence of the bias in median reaction time is that sample medians must not be used to compare reaction times across experimental conditions when there are unequal numbers of trials in the conditions. If medians are used with unequal sample sizes, then the bias may produce an artifactual difference in conditions or conceal a true difference. Some recent studies of cuing and stimulus probability effects provide examples of this potential artifact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)