Behavioral couples therapy for male substance-abusing patients: Effects on relationship adjustment and drug-using behavior.

Married or cohabitating substance-abusing patients (n?=?80) who were entering individual outpatient treatment, most of whom were referred by the criminal justice system (n?=?68; 85%), were randomly assigned to a no-couples-treatment control group (n?=?40) or to 12 weekly sessions of adjunctive behavioral couples therapy (BCT; n?=?40) . Drug use and relationship adjustment measures were collected at pretreatment, posttreatment, and at 3-, 6-, 9-, and 12-month follow-ups. Couples who received BCT as part of individual-based treatment had better relationship outcomes, in terms of more positive dyadic adjustment and less time separated, than couples in which husbands received individual-based treatment only. Husbands in the BCT condition also reported fewer days of drug use, longer periods of abstinence, fewer drug-related arrests, and fewer drug-related hospitalizations through the 12-month follow-up period than husbands receiving individual-based treatment only. However, some of the drug use and relationship adjustment differences between these groups dissipated over the course ofthe follow-up period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital interactions of alcoholic couples: Comparison with depressed and nondistressed couples.

The marital interactions of 107 couples were observed as they engaged in discussions of personally relevant problems. For 38 couples the husband was alcoholic, for 35 couples the husband was depressed, and for 34 couples neither spouse had a diagnosed psychopathology. Observations were conducted during sessions when alcohol was consumed by spouses and during nondrinking sessions. Nondistressed couples were differentiated from both groups of clinically diagnosed couples through their increased rates of congeniality and positive behavior. Alcoholic couples tended to be more negative (more critical and disagreeable) than depressed and nondistressed couples when drinking but were indistinguishable from other couples when not drinking. The consumption of alcohol led to the increased expression of affective behavior, both positive and negative. Unanticipated three-way interaction effects also differentiated the alcoholic couples and are considered in terms of sex of the participating child and pattern of drinking manifested by the husband (episodic vs steady). The applicability of these results to a family-systems approach to alcoholism is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital communication: Differences among maritally distressed, depressed, and nondistressed-nondepressed couples.

Explored differences in communication and perception of communication among 3 types of married couples: maritally distressed, in which the wife was depressed; maritally distressed only couples; and nondistressed-nondepressed couples. Findings revealed differences both in the patterns of communication and in the meanings these patterns have for the relationship. The results suggested that depression within the context of a distressed marriage is related to (1) more negative communication both toward and from the depressed person and (2) spouses' lower comprehension of each other's messages. Among the nondistressed couples, the more negative their communication, the more maritally satisfied they were. The suggestion is made that "negative communication" might be used in a constructive way by nondistressed couples, whereas negative communication might be detrimental to distressed couples. (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)     

Procedures for evaluating the dyadic adjustment of drug-abusing patients and their intimate partners. A multimethod assessment approach

Renal disease is characterized by the influx of leukocytes into the injured tissue. Before leukocytes can exert their effects on renal damage or repair, they have to reach the site of injury. To recruit specific populations of leukocytes during inflammation is the role of a family of cytokines called chemokines. The characterization of this family has emerged within the past years, yet chemokines have already been the subject of thousands of scientific reports and promise to have many clinical applications. There is good evidence that chemokines contribute to leukocyte infiltration in glomeruli and interstitium and that they play a pivotal role in various renal diseases. The fact that there exist so many chemokines suggests the biological need for redundancy to effect recruitment of immune cells. Although they were originally defined as host defense proteins, chemokines clearly have other functions that extend well beyond the regulation of leukocyte migration. The recent suggestion that chemokines may contribute to a slow progression of the human immunodeficiency virus (HIV) infection and the very recent identification of chemokine receptors as docking molecules for HIV infection add another aspect to chemokine research. The speed at which researchers are exploring the HIV-chemokine connection is evident in the large number of publications on this topic as well as the rapid translation of publications into possible therapeutic applications. Delineating a precise role for chemokines in mediating pathologic changes is an area of fruitful investigation.     

Predictors of relationship functioning for patients with bipolar disorder and their partners.

Previous investigations have examined family functioning, including marital functioning, as an important predictor of the course of bipolar disorder, but limited research exists identifying the factors that influence relationship functioning in patients with bipolar disorder. In the current study, 56 patients with bipolar disorder and their partners were assessed for Axis II pathology, general family functioning, and relationship distress. Patient mood symptoms and Axis II pathology variables were examined as predictors of general relationship functioning (Family Assessment Device, McMaster Clinical Rating Scale, and Dyadic Adjustment Scale) in regression models. Analyses indicated that patients' depressive symptomatology was associated with patient ratings of general family functioning and couple functioning, while patients' manic symptoms were associated with partners' ratings of the romantic relationship. Partners' total Axis II pathology, but not patients' Axis II pathology, was associated with patient and partner perception of the couple's relationship. These findings highlight the importance of mood and personality pathology to relationship functioning, and represent one of the first investigations to verify the impact of personality pathology on patients' and partners' perceptions of relationship functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demand-withdraw communication in severely distressed, moderately distressed, and nondistressed couples: Rigidity and polarity during relationship and personal problem discussions.

This study investigated demand-withdraw communication among 68 severely distressed couples seeking therapy, 66 moderately distressed couples seeking therapy, and 48 nondistressed couples. Self-report and videotaped discussions replicated previous research, demonstrating that greater demand-withdraw during relationship problem discussions was associated with greater distress and that overall, wife-demand/husband-withdraw was greater than husband-demand/wife-withdraw. Results extended the conflict structure view of demand-withdraw by indicating that this gender polarity in demand-withdraw roles varied in strength and direction depending on who chose the topic for discussion, distress level, and marriage length. Further, in videotaped personal problem discussions, typical gender patterns of demand-withdraw were reversed. Across the relationship and personal problem discussions, a pattern of gender polarity emerged when husbands held the burden of changing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and behavioral interventions: A comparative evaluation with clinically distressed couples.

Compared the effects of communication skills training (CST) and cognitive therapy (CGT) in 32 severely distressed couples. Ss receiving CST showed significant improvement on main targets, the Communication Questionnaire, and a relationship beliefs inventory. CGT resulted also in significant improvements on these measures. On the direct behavioral observation measure, CST was superior to CGT. A direct comparison between both conditions indicated that CGT was more effective on the main targets, whereas CST was more effective on direct behavioral observation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital violence: Characteristics of abusive couples.

The Short Marital Adjustment Test, short form of the Attitudes Toward Women Scale, Short Michigan Alcoholism Screening Test, and measures of assertion were administerd to 52 abused wives (AWs) and 20 abusive husbands (AHs) who were seen at a center that specializes in domestic violence problems. Comparison data were collected from 20 couples with satisfactory marriages and 20 maritally dysfunctional nonviolent couples. Results show that although AWs and AHs were differentiated from satisfactorily married couples on almost every measure, when comparisons were made with nonabused wives in marital therapy, no measures yielded significant between-group differences. Three variables differentiated AHs from nonabusive husbands with marital difficulties: (a) AHs were less assertive with their wives, (b) they were more likely to have been abused children, and (c) they were more likely to have witnessed parental spouse abuse in their families of origin. Alcoholism and conservatism characterized the men who would not come for therapy with their AWs. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Before children: Preparenthood cognitions of distressed and husband-to-wife aggressive couples.

Positive and negative cognitions about parenthood were assessed in a sample of recently married childless spouses who were in nondistressed, distressed, and husband-to-wife (H-to-W) aggressive marriages (328 husbands and 331 wives). As predicted, maritally distressed spouses held more negative cognitions about parenthood than did nondistressed spouses. Results indicated that spouses in H-to-W aggressive marriages expected parenthood to be a more unpredictable and difficult job than spouses in marriages not involving H-to-W aggression. Wives also reported more fears that having a child would result in a loss of freedom than did husbands. No distress, H-to-W aggression level, or gender differences were obtained for positive preparenthood cognitions. Finally, wives' but not husbands' positive and negative preparenthood cognitions at 6 months of marriage were able to predict parenthood status at 30 months of marriage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological profiles of violent and nonviolent maritally distressed couples.

Compared 42 couples seeking counseling who had equal levels of marital distress but different levels of violence. 32 couples had experienced at least 1 episode of physical assault in the last year. Measures included the Profile of Mood States, the Index of Self-Esteem, assessments of violence in family and peer milieus, and assessment of alcohol use. More violent males reported alcohol problems than distressed males. Women in violent couples were significantly more anxious, confused, fatigued, and marginally more depressed than maritally distressed women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of distressed and aggressive behavior.

Two studies examined the hypothesis that distressed behavior induces negative emotions in others but also prompts solicitousness and deters aggression. In Study 1, 48 marital dyads rated various behaviors in terms of their feelings and reactions toward a spouse engaging in each behavior. Distressed behavior prompted both negative and solicitous emotions, but deterred hostile reactions. Aggressive behavior prompted negative feelings and hostile and argumentative reactions. In Study 2, 41 couples rated videotaped examples of a woman engaging in distressed, aggressive, or neutral behavior, with variations in verbal content and nonverbal affect. Examples of distressed behavior prompted more negative feelings and more solicitous feelings than neutral behavior. Aggressive examples prompted more negative feelings and hostile reactions. The studies indicate the importance of distinguishing between distressed and aggressive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communication patterns and response to treatment among depressed and nondepressed maritally distressed couples.

Compared 35 maritally distressed couples assigned to 1 of 3 cognitive behavioral marital therapy (BMT) groups. Groups represented (1) couples in which 1 spouse was depressed at pretest, (2) couples in which 1 spouse showed psychopathology other than depression, and (3) couples who showed no symptoms of individual psychopathology. Ss were administered, pre- and posttreatment, the Dyadic Adjustment Scale and the Minnesota Multiphasic Personality Inventory (MMPI). Pretreatment couples in Group 1 were the oldest and the least maritally satisfied, and expressed the most negative communication. 12 wks of BMT was an effective treatment modality for all groups when compared with a group of 12 couples on a wait list. BMT significantly increased marital adjustment for all 3 treatment groups and decreased the rates of negative communication. BMT significantly decreased the level of depression in Group 1 and the level of psychopathology in Group 2. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug-abusing patients and their intimate partners: Dyadic adjustment, relationship stability, and substance use.

The dyadic adjustment and substance use of couples with a drug-abusing husband (n?=?94), couples with a drug-abusing wife (n?=?36), couples in which both partners abused drugs (n?=?87), and non-substance-abusing conflicted couples (n?=?70) were examined. For couples with 1 drug-abusing partner, a higher percentage of days abstinent during the year before treatment for drug abuse was associated with a higher level of relationship satisfaction. When both partners abused drugs, the relationship between percentage of days abstinent and relationship satisfaction became stronger and more negative as the time partners spent together using drugs increased. A higher percentage of days abstinent was associated with relationship stability for couples with 1 drug-abusing partner during and 1 year after treatment; for couples in which both partners abused drugs, a higher percentage of days abstinent was associated with relationship instability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Support behavior and relationship satisfaction in couples dealing with diabetes: Main and moderating effects.

This study examined associations between support behavior, i.e. active engagement and protective buffering, and relationship satisfaction in both patients with diabetes and their partners. Active engagement refers to supportive behavior characterized by involving one's partner in discussions, asking how the other feels, and problem solving strategies. Protective buffering refers to less supportive behavior characterized by denying fears and worries, and by pretending everything is fine. Furthermore, we examined whether there were interactive effects of these two support behaviors on patients' and partners' relationship satisfaction. At baseline (T1), 205 couples rated to which degree they received active engagement and protective buffering from their partners, and completed a measure of relationship satisfaction. At three follow-up assessments, couples were asked to fill out the same measures. Using dyadic data analytic approaches, we found relationship satisfaction to be positively associated with active engagement, and negatively with protective buffering, in both patients and partners. Moreover, we found a moderating effect, in that the negative association between protective buffering and relationship satisfaction was only present when levels of active engagement were relatively low. Again, these results were found for patients as well as their partners. We were able to replicate the T1 results at the other three assessment points. Our findings illustrate the need to consider adequate and less adequate support behaviors simultaneously, and to study the effects on both patients and partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution processes in distressed and nondistressed couples: II. Responsibility for marital problems.

Examined attributions for marital difficulties in 18 couples seeking therapy and in 19 couples not seeking therapy; husbands' and wives' average ages were 31.7 and 30.6 yrs, respectively, in the therapy-seeking group and 37.1 and 34.8 yrs, respectively, in the control group. Ss were asked to rate their 2 most important marital difficulties on several dimensions and indicate the extent to which they blamed their spouse for the difficulties. Findings show that distressed spouses were more likely than controls to see their partner and the relationship as the source of their difficulties, perceive the causes of their difficulties as more global, and consider the causes as more reflective of their spouses' negative attitude toward them. Results support the contention that variations in attributional patterns within marriage are related to differences in marital satisfaction. Implications for marital therapy are outlined. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and treatment of couples with abusive male partners: Guidelines for Therapists.

The literature on domestic violence and couple's therapy currently offers few clear guidelines about assessment and treatment with couples with abusive male partners. This article addresses these gaps in the literature, attempts to integrate the divergent feminist, systems, psychodynamic, and behavioral perspectives on working with these couples, integrates an ecological perspective on violence into our framework, and finally, addresses process issues within the therapeutic relationship. Guidelines for assessment include written measures and interviews of each member of the couple separately as the first step in deciding whether or not to work with the couple, depending on the severity of the violence. Treatment should begin only when therapists have thoroughly assessed for violence in the relationship. Finally, it is critical that therapists pay attention to their attitudes and reactions to couples with abusive male partners, and honestly evaluate whether they feel comfortable and competent working with these couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and childhood abuse in battered women: Comparisons with maritally distressed women.

In the present study, posttraumatic stress disorder (PTSD) prevalence rates were compared among 50 battered women and 37 maritally distressed women who had not experienced battering (N?=?87). Participants were administered R. Spitzer and I. B. S. Williams's (1985) Structured Clinical Interview for the DSM-III—R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) to assess PTSD status and previous traumatic experiences in addition to other standardized measures of PTSD and violence exposure. Battered women exhibited significantly higher rates of PTSD than maritally distressed women (58% vs. 18.9%). Although both groups had similar rates of previous trauma experiences, women with a PTSD-positive status (both battered women and maritally distressed women) were significantly more likely to have experienced self-reported childhood sexual abuse and a higher overall number of previous traumas than those with a PTSD-negative status. Battering exposure and childhood sexual abuse predicted 37% of the variance in overall PTSD intensity levels. (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)     

Sequential analysis of conflict and accord in distressed and nondistressed marital partners.

Compared the interactional patterns of 22 distressed (mean age 34.6 yrs) and 17 nondistressed (mean age 35.6 yrs) couples through base rate and sequential analyses of communication samples that were coded with the Marital Interactional Coding System. Nondistressed couples emitted higher rates of problem-solving, verbal and nonverbal positive, and neutral behaviors. Sex differences were found for Nonverbal Positive and Neutral behaviors. The sequential analyses provided support, but of limited duration, for positive and negative reciprocity and negative reactivity. The combination of sequential and base rate variables, contrasted with base rate variables alone, made a moderate contribution to the prediction of marital satisfaction. The importance of sequential analyses for examining marital interactional processes is discussed, and several methodological considerations in conducting sequential analyses are examined. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)