The ongoing evolution of behavioral couples therapy: retrospect and prospect

Behavioral couples therapy (BCT) was first described thirty years ago, and the conceptual basis of the approach has been evolving ever since. Whilst BCT in its current form is a well established treatment for relationship problems, there are significant limitations to its efficacy, and there are a number of new developments intended to enhance the efficacy of the approach. Currently BCT primarily is a skills training therapy, targeting change in couple's interactions to promote greater relationship satisfaction. Current developments focus on broadening this traditional emphasis on changing couple interactions to greater attention to reducing negative emotional responses to partner behaviors (increasing acceptance), and increasing self-directed personal change efforts. Future developments of BCT are likely to pay greater attention to different types of couple interaction which are associated with sustained relationship satisfaction, the individual vulnerabilities partners bring to relationships, and the environmental stresses impinging upon the couple.     

The application of identity status and intimacy status research to counseling with couples.

Reviews the concepts of identity and intimacy as proposed by E. H. Erikson (1959) and discusses their clinical implications. Identity status and intimacy status models are outlined, and hypothetical case histories are presented within this developmental framework. It is concluded that an understanding of couple conflict at ages 21–35 yrs can be enhanced by use of the empirical model in order to prevent conflict and enhance growth. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating behavior therapy and psychotherapy in the treatment of agoraphobia.

Investigated the effects of treatment that combined behavior therapy, cognitive therapy, family systems therapy, logotherapy, and Gestalt therapy in the treatment of agoraphobia. Ss were 30 females and 5 males (mean age 35.18 yrs) who had been agoraphobic for a median of 7.05 yrs and who had applied for a 2-wk intensive treatment program (ITP). Ss were administered a battery of questionnaires including the Beck Depression Inventory and the State-Trait Anxiety Inventory. Ss either began treatment on a weekly basis while waiting for the ITP to begin (treatment Ss) or were placed on a waiting list (control Ss). Significant changes on self-reported avoidance behavior, panic attacks, social anxiety, depression, chronic anxiety, assertiveness, and fear of fear were observed in the treatment Ss up to 6 mo after beginning the ITP. No change had occurred on these measures during the same time in the controls. Results indicate that psychosocial treatment without drugs is effective for the majority of clients seeking treatment for agoraphobia. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The laser optometer and some implications for behavioral research.

Discusses the use of the laser optometer as a means of evaluating visual accommodation distances. Advantages of the laser procedure, which involves superimposing a speckle pattern reflected from a moving drum into the field of view where the observer reports the direction of movement of the pattern, are examined, and some experimental findings on the optometer are discussed. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and behavioral treatments of agoraphobia: Clinical, behavioral, and psychophysiological outcomes.

39 severe and chronic agoraphobics with panic attacks, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, were randomly assigned to 1 of 3 cognitive-behavioral treatments: paradoxical intention (PI), graduated exposure (GE), or progressive deep muscle relaxation training (RT). Treatment consisted of 12 2-hr weekly sessions conducted by experienced therapists whose treatment integrity was objectively monitored. All 31 23–63 yr old Ss who completed the program received an extensive rationale emphasizing self-directed exposure and programmed practice in addition to their primary treatment. A comprehensive assessment battery consisting of clinical ratings of severity, phobia, anxiety, depression, and panic, as well as direct measures of behavioral, psychophysiological, and cognitive response systems was administered at pre-, mid- (6 wks), and posttreatment (12 wks) and at 3-mo follow-up. Analyses revealed significant improvement for all Ss. GE and RT tended to evoke more rapid effects. At follow-up, GE and RT evidenced the greatest potency and stability, as compared with PI. The GE condition experienced twice the drop-out rate of PI and RT. The phenomenon of synchrony appeared to be associated with overall improvement at 12 wks and follow-up. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Personal therapy: A review of empirical research.

Many case studies list the benefits of personal therapy. The question that I have attempted to answer is whether the therapist who has undergone psychotherapy can be shown to be more effective than colleagues who have not received such treatment. This has been the subject of some research, but the evidence is contradictory and the findings remain ambiguous. Further research is needed in order to clarify this important training issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The application of infant research to psychoanalytic theory and therapy.

Five areas of influence of infant research on psychoanalytic therapy are outlined: (1) the interpersonal competency of newborns, (2) the progressive organization of development without points of fixation, (3) the nonpejorative conceptualization of dependency, (4) the potential for explaining psychic structure as interrelations of systems, and (5) the explanatory benefit of using state regulation, rather than drives, as motivation for behavior. The author presents clinical vignettes to show the applicability of infant research to work via a focus on the inner states of the participants and the development of a "recognition process" by which the specifics of a sense of self are developed. In addition, the applicability of this research is reviewed in 3 more circumscribed areas: the interactive nature of psychotherapy, the application of studies of attunement and "open space" in mother–infant interactions, and the usefulness of experimental paradigms for generation of clinical hypotheses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychophysiological outcome of behavioral and pharmacological treatments of agoraphobia.

62 severe and chronic agoraphobics (aged 18–65 yrs) participated in a 2?×?2 factorial investigation of the relative and combined effectiveness of behavior therapy (prolonged in vivo exposure) and pharmacotherapy (imipramine). Treatment was conducted in 12 weekly sessions. Imipramine or placebo was administered in 25-mg tablets at bed time, with 25-mg increases every 2nd day until the maximum tolerable amount was achieved. Tripartite assessments were conducted at pretreatment and at 4 wks, 8 wks, 12 wks, and 1-mo posttreatment. Differential temporal response and treatment patterns were identified across the psychophysiological domains. Ss receiving medication showed equivocal patterns of positive and negative responses. Decreases in arousal were noted with Ss who received prolonged exposure. Synchrony/desynchrony phenomena yielded significant findings with regard to both process and clinical outcome status. Exploratory analyses were performed to identify potential mediating factors in physiological outcome, and a psychophysiological comparison was also undertaken contrasting agoraphobics prior to and following treatment with normative (nonphobic) cohorts. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief couples therapy: Lessons from the history of brief individual treatment.

In the author's attempt to grasp the controversies facing brief couples therapy it was useful to apply the principles of brief individual psychotherapy, learned earlier by such pioneers as D. H. Malan, H. Davanloo, and J. P. Gustafson, to major, contemporary, couples treatment models: emotionally focused treatment, integrative behavioral couple treatment, nontraditional egoanalytic couples therapy, and the narrative, solution-focused, and strategic schools. This exercise illustrates that present-day couples therapy faces important theoretical and technical dilemmas that impede its development toward a mature system of brief treatment. When some resolution to these dilemmas can be gained, brief couples therapy can progress into a consolidation phase. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The marital repercussions of behavior therapy for agoraphobia.

Examined the effects of intensive behavior therapy on the husbands and marriages (mean length of 12.7 yrs) of 32 females with long-standing agoraphobia (mean length 9.5 yrs). Pre- and posttreatment assessments were made of Ss and their husbands to measure fear, hostility, experience, and husband's attitude. Further assessments were made at 3-, 6-, and 12-mo follow-up. In one pattern of marital interaction, couples had increased marital conflict and exposed problems relating to sex roles and wives' autonomy following rapid improvement in wives' phobias, assertiveness, and social confidence. 12 husbands developed psychological symptoms in relation to these problems, which also impeded wives' progress in the 1st 6 mo of follow-up. One year after treatment, marital systems had largely adapted, and both partners were more autonomous within the marriage. In the 2nd pattern of interaction, partners were protected from personal conflict in the 1st 6 mo followed by a mutual adherence to sex-role stereotypes. Husbands reported a marked decrease in psychological symptoms. In the last 6 mo of follow-up, conflict over sex-role stereotypes emerged, and the extent of the patient's continuing symptomatic improvement was determined mainly by the couples' success in resolving these conflicts. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of relationship dysfunction: An empirical evaluation of group and conjoint behavioral marital therapy.

Fifteen distressed couples were randomly assigned to group, conjoint, or waiting list conditions. A behavioral communication treatment package was administered over eight sessions and was evaluated via multidimensional assessments. Results revealed that behavioral communication therapy was a highly effective modality for the resolution of marital dysfunction. Both group and conjoint treatments were found to be superior to the waiting list condition. (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)     

Visceral afferent pathways to the thalamus and olfactory tubercle: behavioral implications

The goal of this study was to support the hypothesis that visceral signals may integrate and influence behavior by way of direct pathways from the nucleus tractus solitarii (NTS) to the olfactory tubercle and the midline/intralaminar thalamus. An anterograde tracer, biotinylated dextran amine (BDA) was iontophoresed bilaterally into the caudal NTS to optimize terminal labeling. NTS-cortical projections traversed both limbs of the diagonal bands providing heavy innervation, and terminated lightly within layer 3 of the olfactory tubercle. NTS-thalamic projections terminated within anterior and, as previously shown, posterior divisions of nucleus paraventricularis thalami and avoided the adjoining mediodorsal thalamic nucleus. Heretofore unrecognized projections were traced to the parafascicular and reuniens thalamic nuclei, and the peripeduncular nucleus. Control experiments identified the nucleus gracilis as the principal source of ascending projections to ventroposterior lateral, posterior and intralaminar thalamic nuclei. Our data corroborate the supposition that olfactory signals may integrate with visceral stimuli in the striatal compartment of olfactory tubercle. NTS projections encompass thalamic nuclei that project topographically to the prefrontal cortex, hippocampus and ventral (limbic) striatum, regions activated by visceral stimulation. Structural data support the idea that compartments of the non-discriminative thalamus may contribute to perception and behavioral responses to visceral stimulation.     

Self-regulation of response patterning: implications for psychophysiological research and therapy

This paper develops the basic premise that learning to self-regulate a pattern of responses can have different consequences from those observed when controlling individual functions alone. It is suggested that the self-regulation of patterns of responses can be a particularly sensitive and effective procedure for (a) uncovering biological linkages and constraints between responses in the intact human, (b) investigating how multiphysiological systems combine to produce unique subjective experiences and effects on performance, and (c) enhancing the clinical effectiveness of biofeedback procedures by training patients to integrate and coordinate voluntarily specific patterns of cognitive, autonomic, and motor responses. These hypotheses are illustrated by basic research involving biofeedback training for patterns of blood pressure, heart rate and EEG activity, related experiments on the cognitive self-regulation of patterns of physiological responses using affective imagery and meditation procedures, and case studies of patients treated with biofeedback. The concept of electronic biofeedback as an "unnatural act" is presented with the goal of placing self-regulation within a more biobehavioral perspective emphasizing the natural patterning of physiological processes.     

Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients.

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional assessment in behavioral consultation: A treatment utility study.

The primary purpose of the study was to examine the utility of functional assessment in comparison to a technological approach to treatment. Specifically, we investigated the treatment utility of functional assessment within a behavioral consultation framework to determine the effect of different uses of assessment data on child treatment outcome. Participants consisted of 19 preschool children enrolled in a Head Start program who demonstrated social and/or behavioral problems in the classroom. Their classroom teachers participated in the study as consultees who received help from trained consultants in identifying target behaviors and implementing classroom-based interventions. Participants were randomly assigned to two conditions: a consultation approach utilizing functional assessment methods to develop individualized behavioral interventions, or a consultation approach that used nonfunctional analytic assessment methods and a standard treatment package of self-help materials. The outcomes of the individual consultation cases were analyzed with case study methodology to determine behavior change and, in general, consultation resulted in positive treatment outcomes that were moderate in magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)