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Caiada M, Felix S, Guionnet S, Valery KM, Bonilla-Guerrero J, Destaillats JM, Prouteau A. Promoting Intimate Relationships in Mental Illness: A Systematic Review of Interventions. Community Ment Health J 2024; 60:536-551. [PMID: 38015269 DOI: 10.1007/s10597-023-01204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
Although persons with Serious Mental Illness (SMI) express a need for intimate relations with others, they still suffer from a severe lack of social participation in this domain. However, these unmet needs have received little attention until recently. This study reviews interventions that aim to facilitate the development and the maintenance of intimate relationships (IR) of persons with schizophrenia, bipolar disorder and major depression. A systematic review following PRISMA guidelines was conducted. Studies published in Scopus, PubMed, EBSCO (Psych INFO, Psych ARTICLES, Psychology and Behavioral Sciences Collection) from January 1, 2000, to December, 2021, were screened. The search using terms referring to "schizophrenia", "bipolar disorder", "major depression", "IR" and "interventions" revealed 11 studies. Among them, 10 reported interventions for persons with depression, including 9 for couple therapy. Most interventions targeted satisfaction with couple relationships as the main therapeutic objective. Heterogeneity in study design precludes any firm conclusions about their efficacy. Interestingly, only one intervention focused on single persons interested in developing IR. The results highlight the lack of interventions: (i) aimed at promoting IR, (ii) designed for single persons, and (iii) targeting persons with psychotic disorders. This result may reflect the persisting stigmatization of persons with psychotic disorders, and the taboo associated with the IR and sexuality of persons with mental illness. Further studies are needed to develop inclusive interventions promoting the development of IR in persons with mental illness.
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Affiliation(s)
- Meryl Caiada
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France.
| | - Simon Felix
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
| | - Sarah Guionnet
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | - Kevin-Marc Valery
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | | | | | - Antoinette Prouteau
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
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2
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Mitchell EA, Roberson PNE, DiPillo M, Cordova JV, Gordon KC. Improvements in depressive symptoms following a brief relationship intervention. JOURNAL OF MARITAL AND FAMILY THERAPY 2024; 50:120-135. [PMID: 37890047 DOI: 10.1111/jmft.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/29/2023]
Abstract
In the United States, 21 million adults are diagnosed with depression. Couple therapy effectively treats depression, however, couples encounter access barriers. The Relationship Checkup is an assessment and feedback intervention delivered in participants' homes. The current study examines changes in relationship satisfaction and depressive symptoms, and moderators and mechanisms of change in a community sample (N = 85 couples). Changes in depressive symptoms and satisfaction, and the association between changes in satisfaction and depressive symptoms were examined with multilevel modeling. Depressive symptoms (Cohen's d = 0.36) and satisfaction (d = 1.43) improved from baseline to 1-month follow-up, with greater declines in depression (d = 0.44) for those with more severe symptoms. Increases in satisfaction were associated with decreases in depressive symptoms (d = 0.23), and decreases in depressive symptoms were associated with increases in satisfaction (d = 0.33). Individuals with depression and relationship distress may be well served by this intervention.
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Affiliation(s)
- Erica A Mitchell
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | | | | | - James V Cordova
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Kristina Coop Gordon
- College of Education, Health, and Human Sciences, University of Tennessee Knoxville, Knoxville, Tennessee, USA
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3
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Gil M, Kim SS, Kim D, Kim S. Online coaching blended couple-oriented intervention for preventing depression among Korean middle adulthood: A feasibility study. FAMILY PROCESS 2023; 62:1478-1505. [PMID: 37641515 DOI: 10.1111/famp.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/27/2023] [Accepted: 07/22/2023] [Indexed: 08/31/2023]
Abstract
Depression and marital satisfaction have a reciprocal cause-and-effect relationship. Thus, couple relationships should be considered to maximize the effectiveness of couple-oriented interventions for depression. Moreover, developing culturally tailored couple-oriented interventions is critical for improving cultural acceptability and enhancing the perceived effectiveness of the interventions. A new culturally tailored MindGuide Couple intervention was developed to prevent Korean middle adulthood depression and enhance couple relationships using intervention mapping. This feasibility study used a single-arm, pre- and post-test, and 2-month follow-up design to explore the reach, acceptability, and preliminary effectiveness of this preventive intervention. Reach was assessed by recruitment, retention, and completion rates; acceptability was measured based on helpfulness, suitability, and satisfaction; and preliminary effectiveness was measured by depression (CES-D), positive and negative affect (PANAS), satisfaction with life (SWLS), couple satisfaction (CSI), and healthy relationship between spouses (FRAS). Fifteen middle-aged couples participated in four psychoeducational and asynchronous online modules and four synchronous coaching sessions via videoconferencing for 5-7 weeks. Data were analyzed using descriptive statistics and repeated measures with analysis of variance. With a 94.1% completion rate, the participants demonstrated high satisfaction with the online coaching blended intervention and reported that it was helpful and easy to use. Both husbands and wives showed significant differences over time in depression, couple satisfaction, and healthy relationships between spouses. This feasibility study demonstrated the successful reach, acceptability, and potential effectiveness of this preventive intervention. Additionally, we suggest the importance of culturally tailored and online coaching blended couple-oriented intervention for preventing depression and promoting healthy couple relationships.
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Affiliation(s)
- Minji Gil
- College of Nursing, Ewha Womans University, Seoul, South Korea
- Department of Nursing, Gangneung-Wonju National University, Wonju, South Korea
| | - Suk-Sun Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Daeun Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Sunhai Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
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Whittaker KJ, Johnson SU, Solbakken OA, Tilden T. Treated together-changed together: The application of dyadic analyses to understand the reciprocal nature of alliances and couple satisfaction over time. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:1226-1241. [PMID: 35603996 PMCID: PMC9790276 DOI: 10.1111/jmft.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
In a Norwegian study of 73 couples attending a residential couple therapy program lasting between 6 and 12 weeks, weekly self-report data on therapy alliance and couple satisfaction were collected using routine outcome monitoring (ROM). The aim was to show how dyadic analyses could be applied to examine the predictive association between alliances and couple satisfaction. Results showed that improved alliance between dyad members and their couple therapist predicted their spouses' couple satisfaction. Furthermore, improved couple satisfaction predicted improvement in spouse's alliance. The clinical implication of these findings should heighten awareness to the importance of establishing and maintaining the alliance of male partners in couple therapy, something that predicts their spouses' couple satisfaction. These findings help nuance the already existing literature on the working alliance. Furthermore, we propose that dyadic analyses should be widely used in any psychotherapeutic research that aims to understand the reciprocal effects of dyads.
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Affiliation(s)
- Kristoffer J. Whittaker
- Research Institute, Modum Bad Psychiatric CenterVikersundNorway
- Psychological InstituteUniversity of OsloOsloNorway
| | - Sverre Urnes Johnson
- Research Institute, Modum Bad Psychiatric CenterVikersundNorway
- Psychological InstituteUniversity of OsloOsloNorway
| | | | - Terje Tilden
- Research Institute, Modum Bad Psychiatric CenterVikersundNorway
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Description and First Steps Toward the Empirical Validation of the Plan Formulation Method for Couples. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Farrell AK, Stanton SCE, Sbarra DA. Good Theories in Need of Better Data: Combining Clinical and Social Psychological Approaches to Study the Mechanisms Linking Relationships and Health. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:863-883. [PMID: 34878961 DOI: 10.1177/17456916211027563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study of intimate relationships and health is a fast-growing discipline with numerous well-developed theories, many of which outline specific interpersonal behaviors and psychological pathways that may give rise to good or poor health. In this article, we argue that the study of relationships and health can move toward interrogating these mechanisms with greater precision and detail, but doing so will require a shift in the nature of commonly used research methods in this area. Accordingly, we draw heavily on the science of behavior change and discuss six key methodologies that may galvanize the mechanistic study of relationships and health: dismantling studies, factorial studies, experimental therapeutics, experimental mediation research, multiple assessments, and recursive modeling. We provide empirical examples for each strategy and outline new ways in which a given approach may be used to study the mechanisms linking intimate relationships and health. We conclude by discussing the key challenges and limitations for using these research strategies as well as novel ideas about how to integrate this work into existing paradigms within the field.
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Pentel KZ, Baucom DH, Weber DM, Wojda AK, Carrino EA. Cognitive-behavioral couple therapy for same-sex female couples: A pilot study. FAMILY PROCESS 2021; 60:1083-1097. [PMID: 34325480 DOI: 10.1111/famp.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
Despite comparable levels of relationship satisfaction and intimacy, same-sex couples break up faster and more often than different-sex couples, highlighting a need for quality couple therapy. Research suggests that culturally tailored services are desired by same-sex couples and may be more effective and better received. Although efficacious couple therapies exist to treat relationship distress, they have been overwhelmingly studied with different-sex couples. Sexual minority (SM) affirming couple therapies have not been systematically developed or evaluated. The current study involved developing and pilot testing a couple therapy tailored for distressed same-sex female couples. This treatment integrates the SM stress model with the empirically supported cognitive-behavioral couple therapy framework and is the first culturally tailored couple therapy for same-sex couples to be empirically evaluated. Therapists delivered the treatment in an open-trial format to a pilot sample of 11 same-sex female couples experiencing relationship distress and SM stress. Treatment was delivered with high adherence to the treatment manual. Participants reported high treatment satisfaction. As hypothesized, participants experienced significant decreases in relationship distress and improvements in couple coping with SM stress from pre- to post-therapy. Limitations precluded clear conclusions regarding anticipated improvements in individual mental health. Participants experienced comparable or stronger improvements in relationship functioning compared to couples in a similar benchmark study. Given this is a small pilot study, results are interpreted with caution. Implications for culturally tailoring evidence-based couple therapy for marginalized groups are discussed.
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Affiliation(s)
- Kimberly Z Pentel
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danielle M Weber
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexandra K Wojda
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily A Carrino
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Cooper E, Adler-Baeder F, McGill J. Individual mental health and couple functioning following couple relationship education participation: Exploring prospective cross-lagged influences among changes. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:945-961. [PMID: 33594670 DOI: 10.1111/jmft.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
Limited research on couple relationship education (CRE) programs explores the relationships among potential outcomes over time. This study conducted tests of processes of change in CRE participants' mental health and couple functioning, based on previous evidence of concurrent benefit in these domains following CRE participation. Using a diverse sample of 926 men and women we first tested the stress generation model (Journal of Abnormal Psychology, 1991, 100(4), 555-561) assumptions that individual functioning influences relational functioning. We found support for immediate changes in mental health predicting changes in couple functioning 6 months later. However, a full cross-lagged prospective model comparatively testing the stress generation model and the marital discord model (Depression in marriage: A model for etiology and treatment. Guilford, 1990), which emphasizes relational functioning impacts on individual well-being over time, revealed the stronger directional link for both men and women was from immediate changes in couple functioning to later changes in individual mental health. Practical implications and future research directions are suggested.
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Abstract
Committed, long-term romantic relationships are ubiquitous among modern society. They are one of the most important contexts for the development, maintenance, and treatment of psychopathology. In this review, I first place psychopathology within the most commonly cited theoretical model of marital satisfaction and stability and then discuss how relationship satisfaction is conceptualized and assessed in this literature. In the second half of the review, I describe the theories regarding how romantic relationships may be connected to psychopathology. Relationship distress is easily incorporated into a diathesis-stress model as an important trigger for psychopathology. Next, I review cross-sectional research, longitudinal research, and treatment efficacy research linking relationship quality and psychopathology. I provide evidence for the robustness of these effects and areas where research must expand. I finish with a summary section that synthesizes what is known about the mechanisms linking relationship distress and psychopathology.
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Affiliation(s)
- Susan C South
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana 47907, USA;
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Tilden T, Ulvenes P, Zahl-Olsen R, Hoffart A, Johnson SU, Wampold BE, Håland ÅT. Predicting change through individual symptoms and relationship distress: A study of within- and between-person processes in couple therapy. Clin Psychol Psychother 2021; 28:1275-1284. [PMID: 33605519 DOI: 10.1002/cpp.2575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In couple therapy clients often suffer from a blend of individual psychiatric symptoms as well as severe relational distress. However, research is inconclusive on whether relational change predicts symptom change or vice versa. Because answers to this question could have important clinical implications on what to focus on in couple therapy at which time in treatment, more research is recommended. METHOD In this study, data collected before every therapy session were used to test whether changes in relational functioning predicted symptom functioning or vice versa. The study used a multilevel modelling approach, and the variables of interest were disaggregated into within- and between-person effects. RESULTS The results indicated that if an individual improved more than expected on relational functioning, this predicted more improvement than expected on individual symptoms. No significant reciprocal relationship was found between these variables. CONCLUSIONS The clinical implication is discussed, suggesting that an emphasis on relational improvement seems to be an important mechanism during couple therapy that may facilitate the change on individual symptoms in the long run.
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Affiliation(s)
- Terje Tilden
- Research Institute at Modum Bad Psychiatric Center, Vikersund, Norway
| | - Pål Ulvenes
- Research Institute at Modum Bad Psychiatric Center, Vikersund, Norway.,Psychological Institute, University of Oslo, Oslo, Norway
| | - Rune Zahl-Olsen
- Department for Child and Adolescent Mental Health, Sorlandet Hospital, Kristiansand, Norway
| | - Asle Hoffart
- Research Institute at Modum Bad Psychiatric Center, Vikersund, Norway.,Psychological Institute, University of Oslo, Oslo, Norway
| | - Sverre Urnes Johnson
- Research Institute at Modum Bad Psychiatric Center, Vikersund, Norway.,Psychological Institute, University of Oslo, Oslo, Norway
| | - Bruce E Wampold
- Research Institute at Modum Bad Psychiatric Center, Vikersund, Norway.,Department of Counseling Psychology, University of Wisconsin, Madison, Wisconsin, USA
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Whisman MA, Sbarra DA, Beach SRH. Intimate Relationships and Depression: Searching for Causation in the Sea of Association. Annu Rev Clin Psychol 2021; 17:233-258. [PMID: 33567901 DOI: 10.1146/annurev-clinpsy-081219-103323] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article provides a critical review of existing research on intimate (marriage or marriage-like) relationship distress and risk for depression. Using the meta-framework of research triangulation, we seek to synthesize research evidence across several different methodologies and study designs and to draw the most reliable conclusion regarding a potential causal association between relationship distress and depression. Focusing on existing correlational (i.e., observational), genetically informed, and intervention (i.e., experimental) research on the association between relationship distress and depression, we conclude that the existing body of research evidence supports the claim that relationship distress is a causal risk factor for depression. A secondary aim of the article is to highlight a variety of effective methods that, when viewed from the perspective of triangulation, enhance the pursuit of causal inference, including propensity score matching, target trial emulation, directed acyclic graph approach, and Mendelian randomization.
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Affiliation(s)
- Mark A Whisman
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado 80309-0345, USA;
| | - David A Sbarra
- Department of Psychology, University of Arizona, Tucson, Arizona 85721-0068, USA
| | - Steven R H Beach
- Center for Family Research and Department of Psychology, University of Georgia, Athens, Georgia 30602-3013, USA
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