Integrating Dialectical Behavior Therapy and Cognitive-Behavioral Couple Therapy: A Couples Skills Group for Emotion Dysregulation

The Role of Irritability in the Treatment of Behavior Disorders: A Review of Theory, Research, and a Proposed Framework

Research provides strong evidence that the symptoms of Oppositional Defiant Disorder (ODD) are comprised of at least two dimensions: irritability and defiance. Given that these two dimensions have distinct etiologies and long-term risk profiles, they may also warrant different treatment approaches. In particular, impaired emotion regulation plays a central role in the irritable dimension of ODD. As such, this subgroup of youth and their families may benefit from greater consideration of and attention to emotion-focused strategies than is standard in traditional Behavioral Parent Training (BPT) approaches. In support of this hypothesis, this review will (1) examine the etiological models guiding the theoretical approach to standard BPT; (2) evaluate theory and research on emotion socialization broadly and its role in the etiology and maintenance of irritability in children with BDs; (3) propose an emotion socialization-based etiological model for the irritable dimension of child oppositionality; and (4) argue for the use of emotion-focused parent training in the treatment of such youth. Clinical implications, gaps in the current state of the literature, and future directions for research will also be discussed.

Investigation of a New Couples Intervention for Individuals With Brain Injury: A Randomized Controlled Trial

OBJECTIVES

This study aimed to (1) examine the efficacy of a treatment to enhance a couple's relationship after brain injury particularly in relationship satisfaction and communication; and (2) determine couples' satisfaction with this type of intervention.

DESIGN

Randomized waitlist-controlled trial.

SETTING

Midwestern outpatient brain injury rehabilitation center.

PARTICIPANTS

Participants (N=44; 22 persons with brain injury and their intimate partners) were randomized by couples to the intervention or waitlist-controlled group, with 11 couples in each group.

INTERVENTIONS

The Couples Caring and Relating with Empathy intervention is a 16-week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition, empathy training, cognitive-behavioral and dialectical-behavioral strategies, communication skills training, and Gottman's theoretical framework for couples adjusted for individuals with brain injury.

MAIN OUTCOME MEASURES

The Dyadic Adjustment Scale, Quality of Marriage Index (QMI), and the Four Horsemen of the Apocalypse communication questionnaire were implemented. Measures were completed by the person with brain injury and that person's partner at 3 time points: baseline, immediate postintervention, 3-month follow-up.

RESULTS

The experimental group showed significant improvement at posttest and follow-up on the Dyadic Adjustment Scale and the Horsemen questionnaire compared to baseline and to the waitlist-controlled group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable.

CONCLUSIONS

Results suggest this intervention can improve couples' dyadic adjustment and communication after brain injury. High satisfaction ratings suggest this small group intervention is feasible with couples following brain injury. Future directions for this intervention are discussed.

Terapia de Casal e Estratégias de Resolução de Conflito: Uma Revisão Sistemática

Resumo O objetivo deste estudo foi realizar uma revisão sistemática de artigos científicos sobre psicoterapia de casal e estratégias de resolução de conflito e identificar variáveis envolvidas no processo terapêutico. Foram consultadas oito bases de dados: Academic Search Complete, Biblioteca Cochrane, Ibecs, Lilacs, Medline, PsycINFO, SciELO e Web of Science, no período de 2006 a 2015. Foram encontrados 238 artigos, sendo incluídos 13 estudos após a avaliação de três juízes independentes. As abordagens comportamental e cognitivo-comportamental se destacaram em relação à sistêmica e à psicodinâmica. Observou-se consenso sobre o papel da comunicação, da empatia, do perdão, do apoio mútuo e da confiança para a resolução dos conflitos conjugais. Por outro lado, há falta de homogeneidade e de clareza na utilização de conceitos e técnicas. A análise da literatura forneceu um panorama internacional, composto por perspectivas de consenso já estabelecidos, inconsistências que devem ser superadas e carência de estudos, especialmente no Brasil, contexto potencial de investigação da temática.

Attention-deficit/hyperactivity disorder symptom levels and romantic relationship quality in college students

OBJECTIVE

The purpose of this study was to examine whether attention-deficit/hyperactivity disorder (ADHD) symptom levels in college undergraduates are associated with poorer romantic relationship quality, and to test whether emotion regulation difficulties, perceived stress, and hostile relationship conflict mediate this association.

PARTICIPANTS

The sample consisted of 189 undergraduate students aged 18 to 25.

METHODS

Self-report measures of ADHD symptoms, relationship quality, and the proposed mediators were collected via online survey from May through August 2011.

RESULTS

Participants who reported clinically significant levels of both hyperactivity-impulsivity and inattentiveness (consistent with ADHD-C) had lower relationship quality than those whose self-reported symptoms indicated no ADHD diagnosis. Further, for women only, both hyperactive-impulsive and inattentive symptom levels were negatively associated with relationship quality. Emotion regulation problems and hostile relationship conflict mediated this association.

CONCLUSION

Findings suggest that ADHD impairs relationship quality among young adults and suggest mechanisms through which this impairment might occur.

Dating Violence Prevention Programming: Directions for Future Interventions

Dating violence among college students is a widespread and destructive problem. The field of dating violence has seen a substantial rise in research over the past several years, which has improved our understanding of factors that increase risk for perpetration. Unfortunately, there has been less attention paid to dating violence prevention programming, and existing programs have been marred with methodological weaknesses and a lack of demonstrated effectiveness in reducing aggression. In hopes of sparking new research on dating violence prevention programs, the current review examines possible new avenues for dating violence prevention programming among college students. We discuss clinical interventions that have shown to be effective in reducing a number of problematic behaviors, including motivational interventions, dialectical behavior therapy, mindfulness, and bystander interventions, and how they could be applied to dating violence prevention. We also discuss methodological issues to consider when implementing dating violence prevention programs.

Treating Anorexia Nervosa in the Couple Context

Anorexia nervosa is a serious mental illness that affects women and men of all ages. Despite the gravity of its chronic morbidity, risk of premature death, and societal burden, the evidence base for its treatment-especially in adults-is weak. Guided by the finding that family-based interventions confer benefit in the treatment of anorexia nervosa in adolescents, we developed a cognitive-behavioral couple-based intervention for adults with anorexia nervosa who are in committed relationships that engages both the patient and her/his partner in the treatment process. This article describes the theoretical rationale behind the development of Uniting Couples in the treatment of Anorexia nervosa (UCAN), practical considerations in delivering the intervention, and includes reflections from the developers on the challenges of working with couples in which one member suffers from anorexia nervosa. Finally, we discuss future applications of a couple-based approach to the treatment of adults with eating disorders.