Mindfulness‐Based Relationship Education For Couples Expecting Their First Child—Part 1: A Randomized Mixed‐Methods Program Evaluation

This article is Part 1 of a two‐part series, in which we report on our evaluation of a mindfulness‐based relationship enhancement program for couples who are expecting their first child. In this mixed‐methods randomized clinical trial, we assigned 33 couples to the 4‐week Mindful Transition to Parenthood Program treatment group (n = 16 couples) or to a waitlist control condition (n = 17 couples). Men in the treatment group significantly improved in relationship satisfaction, mindfulness, and negative affect; women had no significant treatment effects. Small to large effect sizes were present for treatment group men and women in multiple areas. Mixed‐methods analyses demonstrated that this intervention may be especially helpful for men because of differences in social support needs, effects of program enrollment, and relational processes in the prenatal period. Video Abstract     

Up and Down or Down and Up? The Process of Change in Constructive Couple Behavior during Traditional and Integrative Behavioral Couple Therapy

Observed positive and negative spouse behavior during sessions of Traditional (TBCT) and Integrative Behavioral Couples Therapy (IBCT) were compared for couples with successful outcomes and their unsuccessful counterparts. One hundred and thirty‐four married chronically and seriously distressed couples (on average in their forties and 80% Caucasian) were randomly assigned to TBCT or IBCT. Trained observers made ratings of 1224 segments from approximately 956 sessions sampled from the course of up to 26 sessions. Multilevel modeling was used to examine change over time. TBCT treatment responders demonstrated a boost‐drop pattern, increasing in constructive behaviors early (more positive behaviors and less negative behaviors) but decreasing later. IBCT responders demonstrated an opposite, drop‐boost pattern, decreasing in constructive behaviors early and increasing later. Patterns were significant for positive behaviors (p < .05) and approached significance for negative behaviors (p = .05). In both treatments, nonresponders showed a significant pattern of decline in positive and increase in negative behaviors over time, although a trend (p = .05) indicates that TBCT nonresponders initially declined in negative behaviors. This study helps clarify the different process of change in two behavioral couple therapies, which may assist in treatment development and provide a guide for therapists in considering behavioral markers of change during treatment.     

A Randomized Controlled Trial Assessing the Efficacy of Cognitive Behavioral Therapy for Substance‐Dependent Domestic Violence Offenders: An Integrated Substance Abuse‐Domestic Violence Treatment Approach (SADV)

The current study evaluates a therapy for substance‐dependent perpetrators of partner violence. Sixty‐three males arrested for partner violence within the past year were randomized to a cognitive behavioral substance abuse‐domestic violence (SADV; n = 29) or a drug counseling (DC; n = 34) condition. Seventy percent of offenders completed eight core sessions with no differences between SADV and DC conditions in the amount of substance or aggression at pretreatment. SADV participants had fewer cocaine‐positive toxicology screens and breathalyzer results during treatment, were less likely to engage in aggressive behavior proximal to a drinking episode, and reported fewer episodes of violence than DC participants at posttreatment follow‐up. SADV shows promise in decreasing addiction and partner violence among substance‐dependent male offenders.     

Psychosocial Correlates and Consequences of Adolescents’ Self‐Generated Academic Goals and Appraisals

The current study examined whether characteristics of adolescents (i.e., externalizing problems) and their environments (i.e., social support, adverse childhood experiences) relate to academic goal setting, appraisals, and outcomes. Adolescents (n = 99; 87% Black/African American) 13–16 years old completed baseline interviews, and 80% also completed follow‐up interviews. Adolescents with more externalizing problems set fewer academic goals, and youth with social networks characterized by greater support (and less strain) appraised their academic goals as more supported and achievable. Adolescents’ appraisals of their academic goals, but not how many academic goals they had, predicted grades at follow‐up. Increasing social support (and reducing social strain) may foster adolescents’ positive appraisals of their academic goals, which may promote academic achievement.     

A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family therapists (CFTs). The current study investigates the frequency and type of homework, as well as the influence of homework compliance, quality of compliance, and experience of barriers to compliance on CFTs' attitudes and beliefs toward barriers to homework completion for couples and families. Results indicated CFTs (N=226 AAMFT Clinical members) use homework more often with couples than with families, and CFTs report greater homework compliance and quality of compliance for couples when compared to families. A path analysis examining compliance, quality of compliance, and barriers to compliance as predictors of attitudes/beliefs toward barriers revealed no significant findings. A discussion presents implications for future research and practice for homework in couple and family therapy.     

The Effects of Briefly Interrupting Marital Conflict

This study examined couples’ (N = 94) behavior resulting from two proximal change interventions. One was a spousal “compliments intervention” to increase positivity, and the other was a “criticize intervention” to increase negativity. Participants were randomly assigned to one of the two intervention conditions or a control group. There was no main effect in affect from the pretest conflict discussion to the posttest conflict discussion between the interventions or control group. However, a manipulation check on how couples acted during either intervention produced a significant interaction effect. Pretest affect during conflict and marital satisfaction significantly predicted couples’ construal of the intervention. Professionals may need to monitor how couples use specific interventions and direct the processes how the intervention is construed by the couple.     

Group Cohesion and Homework Adherence in Multi‐Family Group Therapy for Schizophrenia

This study examined the relationship between levels of group cohesion, defined as whole group relationships, and between‐session therapeutic homework adherence in a multi‐family group therapy (MFGT) for people with schizophrenia. Participants from 18 consenting families attending MFGT groups completed weekly homework adherence ratings, group cohesion and spontaneous between‐session activity measures. Levels of group cohesion at each session were compared with measures of scheduled and spontaneous homework adherence reported at the next session. It was hypothesised that higher levels of group cohesion would be related to homework adherence and other spontaneous between‐session therapeutic activity completed by group members. Results show higher levels of group cohesion were associated with higher rates of spontaneous between‐session therapeutic activity. However, contrary to expectations no significant relationship between cohesion and scheduled homework completion was found. The implications of the findings for group processes and homework adherence are discussed.     

Randomized Controlled Trial of the Marriage Checkup: Depression Outcomes

The association between relationship functioning and depressive symptoms is well established. This study examined the effects of the Marriage Checkup, a brief two-session Assessment and Feedback relationship intervention, on depressive symptoms. Two hundred and nine married couples participated in the Marriage Checkup and were randomized into Treatment (N = 108) and Waitlist-Control Conditions (N = 101). Compared to the control condition, intervention participants reported significant improvements in depressive symptoms (d = 0.55), with an even greater effect for those who were reporting more severe baseline depression symptoms (d = 0.67). These outcomes are comparable to those within long-term individual psychotherapy, couple therapy, and pharmacology trials, making this the briefest intervention to date to demonstrate significant improvements in depressive symptoms. Clinical implications are discussed.     

The Efficacy of Emotionally Focused Couples Therapy and Behavioral Couples Therapy: A Meta‐Analysis

Behavioral couple therapy (BCT) and emotionally focused couples therapy (EFCT) are well‐established treatments to reduce couple distress. This meta‐analysis summarizes the current state of knowledge on the efficacy of these two therapy methods by focusing on randomized controlled trials only. A literature search revealed 33 suitable primary studies (2,730 participants in total), all of them measuring relationship satisfaction. Robust‐variance random‐effects meta‐analysis revealed medium effect sizes at post‐test (overall: g = 0.60; BCT: g = 0.53; EFCT: g = 0.73) and small effect sizes of 6 months after treatment (overall: g = 0.44; BCT: g = 0.35; EFCT: g = 0.66), but these gains were not maintained after 12 months (BCT only: g = 0.06). Between the two therapy methods, no significant effect size differences could be found. Results have to be interpreted with caution due to potential publication bias.     

Does the Risk Outweigh the Benefits? Adolescent Responses to Completing Health Surveys

The aim of this study is to describe the self‐reported experiences of adolescents in population‐based samples when completing health‐related surveys on topics with varying potential for evoking distress. Survey data were collected in three school‐based studies of bullying behaviors (N = 1,771, 12–14 years), alcohol use (N = 823, 12, 15, and 17 years), and electronic image sharing (N = 274, 13 years). Between 5% and 15% of respondents reported being upset at survey completion, but at most 1.4% were entirely negative in their evaluation. Age was not associated with being upset, but younger adolescents were more likely to see benefit in participation. Although concurrent mental health symptoms increased the risk of being upset, this was mostly mitigated by perceived benefits from participation.     

Therapists’ Assessments in Treating “Sex Addiction” and Their Relationship to Clients’ Gender,Relationship Status,and Exclusivity Status

A total of 208 therapists and therapists‐in‐training were surveyed to better understand if clinical assessments and recommendations regarding “sex addiction” changed based upon a client's gender, relationship status, or exclusivity status. Using clinical vignettes, this study examined the clinical assessment and recommendations of licensed mental health providers (n = 92) and mental health providers in‐training (n = 116). Results indicated that professional ratings differed based on relationship exclusivity and gender; specifically, female nonmonogamous behavior was rated more negatively than male nonmonogamous behavior, while male monogamous behavior was rated more negatively than female monogamous behavior. Recommendations for treatment varied, with higher addiction ratings leading to greater odds of recommending individual, group, and community support over relational therapy. Clinical and training implications are discussed. Video abstract accessible by clicking here .     

Twelve-Step Facilitated Versus Mapping-Enhanced Cognitive-Behavioral Therapy for Pathological Gambling: A Controlled Study

This study examined the efficacy of two group treatments for pathological gambling, a node-link mapping-enhanced cognitive-behavioral group therapy (CBGT-mapping) and twelve-step facilitated (TSF) group treatment. Forty-nine participants meeting criteria for pathological gambling were recruited from local newspaper advertisements. These participants were randomly assigned to one of three conditions: TSF (n = 11), CBGT-mapping (n = 18), and Wait-List control (n = 9); 11 refused treatment prior to randomization. Outcome measures included number of DSM-IV criteria met, perception of control/self-efficacy, desire to gamble, and frequency of gambling episodes. Analyses revealed a significant treatment group × time interaction (η2_partial = .39). Specifically, the group treatments resulted in significant improvements in the dependent measures, while the Wait-List group remained relatively stable. Overall, CBGT-mapping and TSF had no significant differences on any outcome measure at follow-up assessments. Analysis of post-treatment and 6-month follow-up reveal a significant improvement in gambling outcomes (i.e., fewer DSM-IV criteria met, greater self-efficacy, and fewer gambling episodes (η2_partial = .35), with treatment gains maintained at 6 months. These results are consistent with previous research for group treatment for pathological gambling and provide support for the utility of TSF and a mapping-based CBT therapy as viable intervention for pathological gambling.     

Social Work Student Learning Experiences of Family Therapy: Improving Competency in Pedagogy Through Qualitative Research

The purpose of this qualitative study is to evaluate graduate social work student experiences of pedagogy intended to improve competency in family therapy practice. Students from two classes (N = 37) completed open‐ended surveys assessing: perceptions of most helpful pedagogical practices; understanding of needed competencies; and perceived opportunities offered to them during their graduate training for learning about work with couples and families. Results, analysed using grounded theory methodology, revealed that students: (1) believed that experiential activities were especially critical for learning how to do clinical practice with couples and families; (2) understood important competencies related to professional development, therapeutic engagement with the family, and how to approach family practice; and (3) believed they were ‘somewhat prepared’ for practice. Implications include improving understanding of abstract skills in practice with couples and families, and emphasising relationship dynamics more in graduate social work education and training.     

Two‐Year Follow‐Up of the Efficacy of the PREP Training on Iranian Newlyweds

The aim of the present study was to replicate the efficacy of the Prevention and Relationship Education Program (PREP) training on marital satisfaction and dyadic adjustment among a group of Iranian newlyweds. One hundred and sixty heterosexual couples (N = 320 participants) were randomly assigned to an experimental or a wait list control group. Data from one hundred and forty‐eight couples were analyzed. Participants completed the ENRICH Marital Satisfaction Scale (The Family Journal, 1, 1993, 196–207) and Dyadic Adjustment Scale (The Journal of Sex Research, 39, 1976, 190–196) at pretest, posttest, 1‐year follow‐up, and 2‐year follow‐up. Results indicated that mean marital satisfaction and dyadic adjustment scores between the experimental and control groups were significantly different at posttest. Therefore, PREP training improved marital satisfaction and dyadic adjustment of couples at posttest. The data suggests that PREP training program can be introduced as an effective relationship education program for Iranian newlyweds.     

The potential of a couples approach to employment assistance: results of a nonexperimental evaluation

We present findings from a nonexperimental evaluation of an employment program in which both partners in young, low-income, primarily African-American couples simultaneously participated. Mothers participating in the couples program had larger immediate gains in employment and earnings and decreases in TANF receipt following their exit from the program relative to mothers who received employment assistance as individuals. Fathers showed similar although weaker results. These immediate benefits appeared to be driven by higher rates of program completion among couples’ participants. Couples in which both partners completed the program experienced the largest quarterly earnings gains, and couples with greater earnings’ gains were more likely to still be together one year after the program ended. Mothers’ earnings gains eroded in the two years following program completion and many reported new pregnancies and problems with child care. We suggest directions for future programs and encourage future studies to consider the range of mechanisms associated with a couples focus, including potential motivational benefits and unintended consequences.

Alcohol Use Among Concerned Partners of Heavy Drinking Service Members and Veterans

Heavy drinking in relationships is complex and we focus on an understudied sample of concerned partners (CPs) worried about their U.S. service member/veteran partner's drinking. We evaluated the link between CP drinking and their own mental health, and how CP drinking moderated the efficacy of a web‐based intervention designed to address CPs' mental health and communication. CPs (N = 234) were randomly assigned to intervention or control and completed assessments at baseline and 5 months later. CP drinking was associated with greater CP depression, anxiety, and anger independent of partner drinking. Moreover, the intervention was more efficacious in reducing depression for heavy drinking CPs. CPs are often an overlooked population and resources to help support them are needed.     

Incorporating Internet‐based Interventions into Couple Therapy: Available Resources and Recommended Uses

Although there are a number of highly efficacious in‐person treatments designed to ameliorate relationship distress, only a small proportion of distressed couples seek out in‐person treatment. Recently developed internet‐based interventions based on these in‐person treatments are a promising way to circumvent common barriers to in‐person treatment and give more distressed couples access to these efficacious interventions. The overarching aims of this review are to provide couple and family therapists with a broad overview of the available internet‐based interventions and provide suggestions about how these interventions might be utilized before, during, or after in‐person treatment. The majority of the review centres on internet‐based interventions for distressed couples and covers four distinct types of resources: relationship advice websites; assessment/feedback interventions; enrichment interventions for satisfied couples; and interventions targeting at‐risk or distressed couples. Included is a case study of one couple's journey through a newly developed intervention targeting at‐risk couples, OurRelationship.com . Internet‐based interventions targeting individual psychopathology (e.g. anxiety and depression) are also reviewed. These interventions would be particularly useful as an adjunctive resource for in‐person couple or family therapy when referrals for a concurrent in‐person individual therapist are not feasible (because of time, financial, or geographic constraints). We close with three appendices: two appendices with information on currently available internet‐based interventions; and one appendix with recommendations on how to incorporate these resources into in‐person therapy.     

A Social Network Comparison of Low‐Income Black and White Newlywed Couples

Relative to White families, Black families have been described as relying on extended social networks to compensate for other social and economic disadvantages. The presence or absence of supportive social networks should be especially relevant to young couples entering marriage, but to date there has been little effort to describe the social networks of comparable Black and White newlyweds. The current study addressed this gap by drawing on interviews with 57 first‐married newlyweds from low‐income communities to compare the composition and structure of Black and White couples' duocentric social networks. The results indicated that low‐income Black couples entered marriage at a social disadvantage relative to White couples, with more family relationships but fewer positive relationships and fewer sources of emotional support (for wives), fewer connections to married individuals, and fewer shared relationships between spouses. Black couples' relative social disadvantages persisted even when various economic and demographic variables were controlled.     

Briefly Noted

The U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school‐aged children and adolescents. However, there is not enough evidence to recommend tobacco‐cessation interventions in this population, according to the draft recommendation, released in June. The USPSTF is not part of the U.S. government, but its recommendations are taken into consideration by clinical and payer organizations. It only makes recommendations for interventions when it has found adequate evidence that the interventions do more good than harm. In the case of tobacco interventions, the task force found no evidence at all of harms of providing behavioral prevention interventions. However, once kids are already using nicotine, there is not enough evidence to recommend for or against cessation options. The recommendations were first published in the Annals of Internal Medicine and in Pediatrics in 2013; the final draft recommendations were issued in June, for public comment by July 22. For a link, go to https://www.uspreventiveservicestaskforce.org/Page/Document/draft‐recommendation‐statement/tobacco‐and‐nicotine‐use‐prevention‐in‐children‐and‐adolescents‐primary‐care‐interventions .