Dyadic Coping in Couple Therapy Process: An Exploratory Study

Forty Years of Couple Therapy Process Research and We Are Still Just Getting Started: A Review of Quantitative Research

Can empirical research guide clinicians in how to conduct effective couple therapy? While we know that couple therapy works, understanding the mechanisms of action-how and why it works-has been the focus of research for several decades. Using Doss's framework for understanding the key components of the change process-therapy change processes, client change processes, mediators, and outcomes-we reviewed 48 quantitative couple therapy process studies over a 40-year period. The results reveal a fragmented knowledge base. No single study examines the entire process of change, and although several findings show promise, none have been replicated. Additionally, only a limited number of hypothesized associations achieved statistical significance, with neither theory nor empirical evidence adequately explaining why some hypotheses were supported while others were not. Current couple therapy process research cannot yet guide clinicians on how to conduct effective therapy. Until it does, the divide between research and practice will persist.

Relationship between dyadic coping, resilience and fear of childbirth in expectant couples: An actor-partner interdependence model approach

BACKGROUND

Fear of childbirth is a common concern in pregnant women and their spouses due to the unpredictability of the process and outcome of a delivery, which results in adverse effects on mental health, birth outcomes and family intimacy. However, there is a lack of studies that explore the influencing factors of fear of childbirth among expectant couples from a dyadic perspective. The aim of this study is to explore the correlation of dyadic coping, resilience and fear of childbirth in pregnant couples and to construct an actor-partner interdependence model to verify dyadic effects.

METHODS

This cross-sectional survey included 420 couples and was conducted between November 2022 and March 2023 in the obstetric department at two hospitals in China. Convenience sampling and an actor-partner interdependence model was used.

FINDINGS

The prevalence of fear of childbirth among pregnant women and their spouses is 37.4 % and 33.1 %, respectively. Women's resilience and dyadic coping had a partner effect on spouses' fear of childbirth, in addition to an actor effect on their own fear of childbirth. Spouses' resilience and dyadic coping had only actor effects on themselves, and no partner effect was found on the pregnant women.

CONCLUSION

Women's fear of childbirth was positively associated with spouses' fear of childbirth. Interventions for fear of childbirth should include improving resilience and enhancing dyadic stress support and coping. This study provides empirical evidence for future clinical research and interventions on the psychological status of pregnant women and their partners during pregnancy.

Recognizing and Appreciating the Partner's Support Protects Relationship Satisfaction during Cardiac Illness

BACKGROUND

This study aimed to examine whether dyadic coping (DC) is associated with relationship satisfaction (RS) among couples facing cardiac diseases. Furthermore, the moderating role of both partners' anxiety and depression was tested.

METHODS

One hundred cardiac patients (81.5% men) and their partners (81.5% women) completed a self-report questionnaire during hospitalization. The Actor-Partner Interdependence Model (APIM) and moderation analyses were used to assess the above associations.

RESULTS

Results showed that positive DC was significantly related to higher levels of RS, and negative DC was related to lower levels of RS. Furthermore, patient and partner psychological distress significantly moderated the link between DC and RS: patient-perceived positive DC was associated with higher partner RS when partner depression was high; partner-perceived positive DC was associated with higher patient RS when patient anxiety was low; patient-perceived negative DC has associated with lower patient RS when patient anxiety and depression were high.

CONCLUSION

This study showed that positive DC is associated with a more satisfying relationship and identified under what conditions of cardiac-related distress this can happen. Furthermore, this study underlined the importance of examining DC in addition to the individual coping skills as a process pertaining to personal well-being and couple's outcomes.

Feasibility and acceptability of an online mental health intervention for pregnant women and their partners: a mixed method study with a pilot randomized control trial

BACKGROUND

Untreated perinatal mood and anxiety disorders (PMAD) have short- and long-term health and social consequences; online cognitive behavioral therapy (CBT) interventions can reduce symptoms. Despite partner support being protective online interventions rarely target couples. This study builds on research on an existing CBT-based intervention, the Mothers and Babies Online Course (eMB), by testing its feasibility with prenatal couples.

METHODS

We conducted a pilot, randomized, controlled feasibility trial using a 1:1 parallel design. To be eligible, participant dyads were pregnant people (between 13-30 weeks gestation and with a score of 10 or greater on either the GAD-7 or PHQ-9 scale indicating elevated symptoms of anxiety or depression) and their cohabitating partners, living in Missouri, with access to the internet; both in the dyad consented to participate. Recruitment occurred via Facebook ads, flyers, and a snowball approach. The intervention group received eMB, and the control group received a list of community resources. We examined retention and adherence data extracted from eMB analytics and study databases. All participants were given depression and anxiety scales at baseline, 4 and 8 weeks to test preliminary efficacy; satisfaction and acceptability were measured at trial end (i.e., eight weeks) and via interview.

RESULTS

There were 441 people who responded to recruitment materials, 74 pregnant people were screened; 19 partners did not complete enrolment, and 25 dyads were ineligible. There were 15 dyads per group (N = 30) who enrolled; all completed the study. The survey response rate was 90% but partners required nearly twice the number of reminders. No participant completed all lessons. Mean depression and anxiety scores dropped over time for dyads in control (M = -1.99, -1.53) and intervention (M = -4.80, -1.99). Intervention pregnant people's anxiety significantly decreased (M = -4.05; 95% CI [0.82, 7.27]) at time two compared to control. Twelve pregnant people and four partners participated in post-intervention interviews and suggested improvements for eMB.

CONCLUSION

Online dyadic interventions can potentially reduce PMAD symptoms. However, to feasibly study eMB with couples, strategies to increase program adherence are necessary. Tailoring interventions to overtly include partners may be advantageous.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05867680, 19/05/2023.

Associations of perceived and common dyadic coping with self-care in older couples with cardiovascular disease: A dyadic analysis

BACKGROUND

Dyadic engagement of patients and caregivers in self-care is essential for management of heart disease. However, little is known how dyadic coping at individual and partner levels is associated with self-care in couples living with cardiovascular disease.

OBJECTIVE

This study examined whether dyadic coping at self, partner, and common levels was associated with patients' engagement in self-care and spouses' contribution to self-care in older couples living with cardiovascular disease.

METHODS

In this cross-sectional study, 288 older patients and spouses were recruited from outpatient heart clinics in Qazvin, north of Iran. Data were collected using the Dyadic Coping Inventory, the Self-care of Coronary Heart Disease Inventory, and the Caregiver's Contribution to Self-care of Coronary Heart Disease. Dyadic data were analyzed using the actor-partner interdependence model.

RESULTS

The results showed that patients' engagement in self-care maintenance was associated with partner dyadic coping in patients, self and common dyadic coping in spouses. Patients' engagement in self-care monitoring was only associated with self dyadic coping in spouses. Dyadic analysis also showed that self-care confidence in patients was only associated with by partner dyadic coping in spouses.

CONCLUSIONS

This study revealed that self-care was associated with dyadic coping employed by each member of the dyad at self, partner and common levels. Findings of this study suggest that perceived and provided levels of dyadic coping can be employed for maintaining or restoring self-management in older couples living with cardiovascular disease.

When Love Just Ends: An Investigation of the Relationship Between Dysfunctional Behaviors, Attachment Styles, Gender, and Education Shortly After a Relationship Dissolution

Much information is known about the long-term consequences of separation and divorce, whereas there is a paucity of studies about the short-term consequences of such experiences. This study investigates the adoption of dysfunctional behaviors (e.g., insistent telephone calls and text messages, verbal threats, and sending unwanted objects) shortly after a relationship dissolution. A total of 136 participants who declared to have been left by their former partner in the previous 6 months were included in this study (i.e., females: n = 84; males: n = 52; mean age = 30.38; SD = 4.19). Attachment styles were evaluated as explanatory variables when facing a relationship dissolution, in connection with a set of (1) demographic variables (i.e., gender, education, and current marital/relationship status), (2) dysfunctional behaviors, and (3) motivations on the basis of those behaviors. Results showed that a secure or dismissing attachment style, a higher education, and currently married (but awaiting separation) status were the protective factors in adopting such dysfunctional behaviors, while the preoccupied and fearful-avoidant subjects, especially females, tended to adopt dysfunctional behaviors (i.e., communication attempts and defamation) and reported fear of abandonment and need for attention as underlying motivations. Future study on longitudinal aspects of the relationship dissolution processes is required to have deeper insights into this phenomenon. This study sheds light on the relationship between adult attachment styles and the motivations behind the adoption of dysfunctional behaviors after a relationship dissolution.

Moment-by-moment interpersonal behaviors in poor vs. good psychodynamic psychotherapy outcomes: Does complementarity say it all?

Can patient-therapist moment-by-moment transactions uncover contrary treatment outcomes? The current study answers this question by analyzing the transcripts from eight therapy sessions of 20 patients each, for a total of 160 sessions and nearly 30,000 units of analysis. Patients were matched into ten pairs, each having the same diagnosis and the same clinician but with opposite treatment results: Ten patients were classified as responders (i.e., good-outcome patients) and as many as nonresponders (i.e., poor-outcome patients). Patient and therapist behaviors were coded using the Structural Analysis of Social Behavior (SASB) model. Overall, patients and therapists engaged in complementary relational patterns: Good-outcome patients tended to adopt loving and protecting interaction styles, similarly, therapists treating good-outcome cases employed protection and self-disclosure behaviors. In contrast, poor-outcome patients tried to interpersonally separate from the therapist, and both-patients and therapists alike-exhibited attacking and recoiling behaviors. However, when taking a closer look, i) separation appeared to be disruptive per se, that is, beyond any evidenced interpersonal asymmetry; ii) self-disclosure on the therapist side turned out to be supportive of therapeutic complementarity; iii) when facing failure, highly experienced therapists seemed to indulge into noncomplementary or even hostile behaviors. Findings confirm that the target of the patient- therapist transferential transactions should be distinguished from transactions regarding other people or other life circumstances in order to avoid misleading interpretation of data and, consequently, conducting therapy based on misleading grounds.

Till the ocean do us part: Italian and American therapists' representations of stepfamilies in treatment

Research often focuses on the characteristics of stepfamilies and their differences with first-union families; however, few studies take into account the therapist's perspective with regards to the treatment of such families. Also, cross-cultural research on the topic is limited. To fill these gaps, a content analysis of responses from 125 Italian and 45 American therapists regarding their representations of stepfamilies and stepfamily therapy was undertaken. Results show that American therapists emphasized specific stepfamily characteristics (e.g., the lack of a shared family history, the occurrence of conflict between former spouses, the presence of unrealistic expectations towards treatment) to a greater extent if compared to Italian therapists. By contrast, besides being more general in their definition of stepfamilies, Italian therapists focused more on themselves, their theoretical models, and their professional and personal skills. The study provides insights on both the differences in the clinical cultures of the two countries and implications for stepfamily therapy and training.