Relationship education research: current status and future directions

"No, It's You:" Dyadic perceived need for change predicts relationship education outcomes

Relationship education (RE) efforts have been shown to help couples and individuals with a variety of family relationships. However, much still needs to be identified in terms of what factors are salient to outcomes. Drawing on therapeutic models of change, we have identified perceived need for change as one such potential factor. Using data from a couple RE course (n = 447 couples), we assessed how dyadic congruence and average ratings of each partner's need for change were associated with change in three RE outcomes: knowledge, communication, and commitment. In general, the more partners perceived that their partner needed to change, above and beyond what their partner thought, the less change occurred. Implications for RE programming and implementation are discussed, as well as the potential role of therapeutic models and techniques in RE.

Biomedical and behavioral outcomes of 2GETHER: A randomized controlled trial of a telehealth HIV prevention program for young male couples

OBJECTIVE

This study evaluated the efficacy of the 2GETHER relationship education and HIV prevention program for young male couples in reducing risk for HIV.

METHOD

We conducted a comparative effectiveness randomized controlled trial of 2GETHER, a five-session hybrid group- and couple-based intervention delivered via videoconference, relative to a single-session HIV testing and risk reduction counseling protocol delivered to couples. We randomized 200 young male couples (N = 400) to 2GETHER or control from 2018 to 2020. Primary biomedical (i.e., rectal Chlamydia and Gonorrhea infection) and behavioral outcomes (i.e., condomless anal sex [CAS]) were measured at 12-months postintervention. Secondary outcomes were other HIV prevention and risk behaviors, relationship quality, and substance use. Multilevel regression was used to model intervention outcomes to account for clustering within couples. Postintervention change over time was modeled as a latent linear growth curve at the within-persons level.

RESULTS

We observed significant intervention effects on primary biomedical and behavioral HIV risk outcomes. Participants in 2GETHER had significantly lower odds of rectal STIs at 12-months relative to control. We also observed significantly steeper declines in the number of CAS partners and acts from baseline to 12-month follow-up in 2GETHER relative to control. Few differences were observed for secondary relationship and HIV-related outcomes.

CONCLUSIONS

2GETHER is an efficacious intervention that has a significant impact on both biomedical and behavioral HIV prevention outcomes among male couples. Couple-based HIV prevention programs enhanced with evidence-based relationship education may effectively reduce the most proximal predictors of HIV infection. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The influence of relationship pattern labeling on intimacy, acceptance, and relationship satisfaction

Relationship health has a strong influence on physical and emotional health, and with reported rates of divorce at 40-50%, relationship health is a critical public health issue. Thus, it is important to identify mechanisms that encourage healthy relationship functioning. This study measures the impact of engaging in discussions of challenging relationship patterns, or Relationship Pattern Labeling (RPL). Such discussions are embedded in existing interventions, and yet there is no literature, to our knowledge, that examines the impact of these discussions independently. Our results indicate significant small increases in intimacy (p = 0.002), acceptance (p < 0.001), and relationship satisfaction (p = 0.003) when participants engaged in RPL. We present preliminary evidence that supports the current applications of RPL and indicates that it may be successfully extended into independent online interventions.

Impact of Prenatal Group Healthy Relationship Education on Postpartum Contraception

Objective

We aimed to evaluate the impact of an antenatal group healthy relationship education program on the postpartum use of long-acting reversible contraception (LARC).

Materials and Methods

This is a planned subgroup analysis of a larger randomized controlled trial. Pregnant and newly parenting women were randomized to either group healthy relationship education, "MotherWise," or no additional services. An evidence-based healthy relationship education program and individual case management sessions were provided. The program did not include any prenatal care or contraception counseling. This subgroup analysis included those participants with a nonanomalous gestation randomized at <40 weeks who received care and delivered at a single safety-net hospital and were discharged home with a live infant(s).

Results

From September 2, 2016 to December 21, 2018, 953 women were randomized in the larger trial; 507 met inclusion criteria for this study; 278 randomized to program and 229 controls. Participants were mostly young, parous, Hispanic, publicly insured women. Participants randomized to program were more likely to take a prescription medicine and be delivered through cesarean; there were not any other significant differences in baseline, antenatal, or perinatal outcomes. Those randomized to program were more likely to be discharged home with immediate postpartum LARC in place (odds ratio [OR] 1.87; confidence interval [CI] 1.17-3.00), and more likely to be using LARC at the postpartum visit (OR 2.19; CI 1.34-3.56).

Conclusion

Antenatal group healthy relationship education provided separately from prenatal care is associated with a twofold increase in the use of postpartum LARC.

Clinical Trial Registration

ClinicalTrials.gov NCT02792309; https://clinicaltrials.gov/ct2/show/NCT02792309?term=NCT02792309&draw=2&rank=1.

Romantic Relationship Education: A Literature Review with Recommendations for Turkiye

Intimate relationships are the focal aspiration for human beings. Romantic relationship education is described as a road map for helping people to find strategies and solutions that fit their context, values and relationship goals. By using evidence-based skills training, people can learn techniques to navigate typical relationship challenges and safely express emotions. Being in a mutually satisfying committed relationship has proven to be associated with many positive outcomes including life satisfaction, physical well-being, better coping with major illness, as well as longer life expectancy and career achievement. Relationship education programs are developed by psychologists in Western countries as a preventive intervention for couples, adolescents and emerging adults before relationships reach crisis stage. There is, however, a lack of empirical studies to examine the effectiveness of relationship education within the Turkish cultural context. The overarching aim of this study is to review the relationship education programs within Turkish and international literature. This study provides an overview of the relationship education, and its scope, and theoretical foundations and also effectiveness of relationship education programs for couples, adolescents and emerging adults. The study further provides cultural, theoretical and practical recommendations for future directions in Turkish relationship education programs.

Protocol for an attention-matched randomized controlled trial of 2GETHER: a relationship education and HIV prevention program for young male couples

BACKGROUND

Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial.

METHODS

We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up.

DISCUSSION

2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03186534 .

Couple Relationship Education: Before and During COVID-19

The restrictions imposed by the COVID-19 pandemic have required program planners to re-evaluate the provision of relationship education (RE). The current mixed-methods study focuses on the Healthy Relationships [State] initiative's transition from in-person to virtual online RE programing, measuring program impact and comparing the outcomes between the two delivery methods for individuals participating in Couple LINKS, a curriculum designed for adults in committed relationships. Comparisons between delivery methods revealed that in-person participants showed greater gains than virtual participants on key program measures; however, the outcomes were positive for all. Qualitative responses of virtual participants revealed what they liked most and liked least about the virtual format, citing their appreciation for the curriculum, the opportunity to develop new skills, facilitator quality, online accessibility, and couple time. Schedule conflicts and uneven course pacing, reference materials, technology, and sharing personal information were listed as things participants liked least about the virtual program. Implications for the future delivery of RE programs are discussed.

Examining quality time as a mediator of dyadic change in a randomized controlled trial of relationship education for low-income couples

Research identifying specific mechanisms of positive change for couples participating in relationship education is scant. Recent studies have identified the potential of communication skills as a likely mechanism, yet more information is needed about the contribution of process factors. Thus, we examined the influence that quality time spent together had on positive post-intervention outcomes based on couples' reports of dyadic coping and dyadic adjustment for 1,367 low-income couples randomly assigned to receive relationship education. Results indicated that treatment couples reported significant gains in quality time spent together, and that those gains fully mediated positive changes in dyadic coping and adjustment. Additionally, actor and partner effects existed such that men's and women's reports of improved quality time influenced their own and their partners dyadic coping and dyadic adjustment. We discuss study implications for practice and future research.

Predictors of mothers' participation in a mother-only coparenting intervention conducted in fatherhood programs

While fatherhood programs are increasingly implementing coparenting classes for mothers, very little is known about the circumstances that could increase or inhibit a mother's participation in joining such a class. The current study uses ecological systems theory to explore the microsystems, mesosystems, and macrosystems that relate to mothers' participation in a coparenting class. Pretest data from 277 fathers attending fatherhood programs are used to predict mothers' participation in a mother-only coparenting class. Fathers' perceived relationship quality, perceptions of the coparenting alliance, recent legal challenges, and residing in a rural/small-town community were significantly associated with whether the mother participated in the coparenting program. Fatherhood programs should address the issues that appear to deter mothers from participating in coparenting interventions, including high levels of couple conflict, recent father incarceration, and recent father trouble with the law.

Couples Therapy Delivered Through Videoconferencing: Effects on Relationship Outcomes, Mental Health and the Therapeutic Alliance

Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between 1 to 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing.

Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010-2019

This article systematically reviewed 34 rigorous evaluation studies of couple relationship education (CRE) programs from 2010 to 2019 that met the criteria for Level 1 well-established interventions. Significant advances include reaching more diverse and disadvantaged target populations with positive intervention effects on a wider range of outcomes beyond relationship quality, including physical and mental health, coparenting, and even child well-being, and evidence that high-risk couples often benefit the most. In addition, considerable progress has been made delivering effective online CRE, increasing services to individuals rather than to couples, and giving greater attention to youth and young adults to teach them principles and skills that may help them form healthy relationships. Ongoing challenges include expanding our understanding of program moderators and change mechanisms, attending to emerging everyday issues facing couples (e.g., healthy breaking ups, long-distance relationships) and gaining increased institutional support for CRE.

Individual mental health and couple functioning following couple relationship education participation: Exploring prospective cross-lagged influences among changes

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.

How Effective is Online Couple Relationship Education? A Systematic Meta-Content Review

Due to logistical and financial barriers that keep many distressed couples from seeking psychotherapy, online relationship education is a more accessible alternative. In the decade since a web-based program showed equivalent effectiveness to traditional marriage education (Duncan et al., 2009), several fully online programs have been developed and evaluated. We reviewed nine studies of four different programs that sampled 2,000 + couples. Specifically, we rated each study's experimental rigor and compared research designs, theoretical and empirical grounding, average post-intervention and follow-up effect sizes, and differential effectiveness. Across studies, measured outcomes included relational (improved satisfaction, quality, confidence, commitment, communication; reduced conflict and aggression) and individual functioning on various indices of mental and physical health, emotional expression, and quality of life. Finally, we discuss the strengths and limitations of the research evidence, describe the two most evidence-based programs (ePREP and OurRelationship) in some detail and make recommendations for future study of these promising kinds of interventions.

Online relationship education programs improve individual and relationship functioning: A meta-analytic review

Online access to relationship enhancing educational resources are needed now more than ever, and there is a growing number of available programs for couples to choose. But, what is the evidence that these programs improve individual and relationship well-being? We conducted a meta-analysis, using random-effects, examining individual and relationship outcomes of online relationship education programs. We identified 12 publications included in the analysis, and found that online relationship education programs produced significant effects in increasing relationship satisfaction, communication skills, relationship confidence, positive relationship qualities, and decreasing negative relationship qualities. At the individual-level, we found that online relationship programs reduced anxiety and depressive symptoms, increased health satisfaction, and overall quality of life. Additionally, we found no differences related to gender, whether or not couples were identified as "distressed," whether or not the programs were "enhanced," or length of the program.

Sexual Agreements Among Young Sexual and Gender Minorities Assigned Male at Birth: Associations with Relationship Quality and Break-Up

Previous studies have shown that sexual non-monogamy is not associated with lower relationship satisfaction among adult male same-sex couples and may therefore be a viable alternative to monogamy. However, sexual minority men with non-monogamous agreements have reported lower commitment and trust in their relationships than those with monogamous agreements-potentially raising their risk of break-up. In this study, we investigated whether sexual agreements (monogamous, non-monogamous, or no sexual agreement) were associated with relationship quality and rates of break-up over 1 year in a sample of 338 young sexual and gender minorities assigned male at birth (SGM-AMAB). Participants reported their sexual agreement and indices of relationship quality (satisfaction, trust, and commitment) at baseline, as well as their relationship status (intact or broken up) at 6- and 12-month follow-up. Results showed no significant differences by sexual agreement in concurrent trust, but participants with monogamous agreements reported higher satisfaction and commitment than those with non-monogamous agreements or no sexual agreement. Despite these significant differences in relationship quality, there were no significant differences in rates of break-up at 6- or 12-month follow-up across the sexual agreement types. However, having a monogamous agreement was indirectly associated with lower rates of break-up through relationship commitment. Although results were mixed, findings provide some preliminary support that young SGM-AMAB in relationships with monogamous agreements may have higher satisfaction and commitment at early relationship stages, and that monogamous agreements may be a protective factor against break-up over 1 year through the mechanism of relationship commitment.

Association between relationship characteristics and willingness to use PrEP among same-sex male couples: a cross-sectional actor-partner analysis in Guangzhou, China

The association between relationship characteristics and pre-exposure prophylaxis (PrEP) acceptability among same-sex male couples has been limitedly examined. Dyadic survey data of 139 concordant HIV-negative same-sex male couples in Guangzhou, China were collected. The willingness to use PrEP was measured assuming that the participant's partner was HIV-positive. The actor-partner interdependence model was used to examine how one's relationship characteristics affected the PrEP willingness of the subject and his partner. Most participants (79.5%) were willing to use PrEP. The two individuals of the couple were distinguished by sex role in relationship, namely one usually playing the insertive role and the other usually playing the receptive role in anal intercourse. The former was labeled as "top" and the latter labeled as "bottom". The PrEP willingness of the top partner increased when he would think his partner is having sex with other people if the partner requests condom use in relationship (AOR: 5.74, 95% CI: 1.10-29.87), and decreased when his partner would get violent upon condom use requests in relationship (AOR: 0.19, 95% CI: 0.04-0.88). The PrEP willingness of the bottom partner increased when he trusted his partner (AOR: 1.13, 95% CI: 1.02-1.25) and when he or his partner disclosed the relationship to parents (AOR: 10.57, 95% CI: 1.91-58.61). Considering the sex role and relationship characteristics in couple-based interventions are important to optimize PrEP uptake among HIV-discordant same-sex male couples.

Investigating the status of marital burnout and related factors in married women referred to health centers

Background

Marital burnout is an important issue in marriage and many factors play an important role in this phenomenon. The aim of this study was to determine the status of marital burnout and the factors affecting married women who were referred to health centers because of it.

Methods

In this study, 936 women were selected by multistage sampling and data collection was performed using questionnaires of demographic and couple burnout. Data analysis was performed using SPSS software version 24.

Results

The mean (± SD) of marital burnout, in this study, was 55.46 (± 18.03) (out of 147 score). There was a significant relationship between the level of women's education with total marital burnout, and the subscales of somatic and emotional burnout (P < 0.05). A significant relationship was also observed between mandatory marriage and total marital burnout, as well as subscales of somatic, emotional, and psychological burnout (P < 0.05). A significant relationship was detected and observed between women's participation in training courses of communication skills and total marital burnout, inclusive of the subscales regarding psychological burnout (P < 0.05). The results of linear regression showed a significant relationship between mandatory in marriage, marital satisfaction, marriage duration, and husband's level of education with women's marital burnout. The variables were finally able to predict 12% of marital burnout variance. It should be noted that marital satisfaction had a higher effect on predicting marital burnout (P < 0.001).

Conclusions

Marital satisfaction was one of the effective factors in predicting marital burnout, so it can be concluded that it is necessary to pay more attention to this issue. Educational programs and examining the factors that enhance marital satisfaction are needed to prevent and reduce marital burnout in married couples.

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.

Romantic relationships and sexual minority health: A review and description of the Dyadic Health Model

A large body of literature has documented the health promotive effects of healthy committed relationships on the health and wellbeing of heterosexual people in different-sex relationships, including observational and longitudinal studies, couple-based intervention development and evaluation efforts, and articulation of theoretical frameworks. A much smaller but growing field of research has observed that same-sex relationships have similar effects on health outcomes but that these couples face unique stressors that may impact relationship functioning and health. Further, extant theoretical frameworks do not sufficiently address the multiple pathways by which psychosocial vulnerabilities and stressors impact same-sex relationship functioning, engagement in health-related risk behaviors, and the mental and physical health of sexual minorities in relationships. The purpose of this manuscript is to: a) review the existing literature on relationship functioning and health among sexual minorities, including both observational and intervention studies; and b) present an integrated model of relationship functioning and health for same-sex couples that can be used as a basis for further studies on sexual minority dyads, as well as the development of novel couple-based interventions to optimize the health promoting effects of relationships.

The Relationship Between Social Support and Family Relationships Among Low-Income Couples Attending Relationship Education

Results are mixed for relationship education (RE) interventions with low-income couples. For couples who experienced positive changes, it is not clear what aspects of program models contributed to change. Many low-income couples attend government-funded RE with limited access to social and community resources. Program models often provide related resources complimentary to RE skill-building. We examined the relationship between income, social support, and family functioning for low-income, ethnically diverse couples (N = 856) who attended RE, as well as the mediating effects of social support on family functioning outcomes. Analyses included three separate dyadic models that examined associations among constructs at baseline and immediately following the RE intervention. Results demonstrated relationships between participants' reported social support and family functioning such that (a) social support was associated with baseline family functioning for both men and women; (b) men's baseline social support was influenced by women's baseline family functioning; and (c) men's and women's social support change score had a positive influence on their own family functioning change score. However, social support was not a significant mediator of change in family functioning. Implications for RE practice and research are also discussed.

'At the End of the Day, It's Love': An Exploration of Relationships in Neurodiverse Couples

Most autistic people report challenges in initiating and developing intimate, long-term relationships. We used a phenomenological approach to interview thirteen people who were in a neurodiverse intimate relationship (where one partner had a diagnosis of autism) in order to explore the challenges and facilitators both neurotypical and autistic partners experienced. Analysis revealed that ND relationships progressed along similar pathways as non-ND relationships. Facilitators included the strength-based roles that each partner took on and the genuine support and care for each other. Challenges were reported in communication, difficulties reading and interpreting emotions, and idiosyncratic characteristics of the autistic partner. Strategies that both partners used to cope with these challenges and their perspectives of relationship-support services are also presented.

Can Interventions that Strengthen Couples' Relationships Confer Additional Benefits for their Health? A Randomized Controlled Trial with African American Couples

This study examined the effects of the Protecting Strong African American Families (ProSAAF) prevention program on adults' self-reported health outcomes 25 months after enrollment. ProSAAF is a couple-focused prevention program specifically designed to meet the needs of African-American families residing in the rural South. African-American couples (N = 346) with an early adolescent child participated in a randomized controlled trial of the program. Dyadic data analyses indicated significant direct effects on changes in couple functioning post-intervention as well as significant indirect effects of ProSAAF on changes in health through post-intervention improvements in couple functioning. These benefits were documented for men's and women's general health, depressive symptoms, and problematic sleep. There were no significant direct effects of ProSAAF participation on changes in health. Findings provide tempered optimism regarding the potential benefits of couple-focused programming for adults' physical, mental, and behavioral health.

Relationship Education and HIV Prevention for Young Male Couples Administered Online via Videoconference: Protocol for a National Randomized Controlled Trial of 2GETHER

Background

Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER.

Objective

The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions.

Methods

This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up.

Results

As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing.

Conclusions

2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas.

Trial Registration

ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541

International Registered Report Identifier (IRRID)

DERR1-10.2196/15883

Evaluación de un programa de tratamiento para los malos tratos en el noviazgo

En la literatura especializada no se reporta el diseño ni la evaluación de alternativas de intervención para adolescentes y adultos jóvenes involucrados en actos de violencia en el noviazgo, una problemática que alcanza una alta prevalencia en la actualidad. Por tanto, el presente estudio tuvo como objetivo implementar y evaluar la efectividad de un programa para parejas jóvenes no casadas que han vivenciado malos tratos, mediante un diseño cuasi-experimental con prueba-posprueba y grupos intactos ¾experimental y control¾. En total, participaron 12 parejas heterosexuales de adolescentes y jóvenes entre los 17 y 26 años, vinculadas mediante una convocatoria realizada por diferentes medios en su ciudad de residencia, seis asignadas al grupo experimental y seis al grupo control. El programa se desarrolló en 10 sesiones, más una de segui- miento, e incluyó psicoeducación sobre la violencia en el noviazgo, creencias y expectativas sobre la relación de pareja, habilidades de comunicación, empatía, manejo de la ira y manejo de los celos. Los resultados evidenciaron disminuciones estadísticamente significativas a nivel de postratamiento en el grupo experimental ¾en comparación con el grupo control¾ en actitudes a favor de la violencia íntima, comunicación sumisa y frecuencia de los malos tratos, así como un incremento en la comunicación asertiva, cambios que se mantuvieron al mes de finalizada la intervención. Estos resultados respaldan la efectividad del programa.

Love in Action: An Integrative Approach to Last Chance Couple Therapy

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce-who often describe this therapy as their "last chance." In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high-conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three "primary colors" of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language-based and action-based practices, suggesting that meaning is held and expressed as much through interaction or "relational motion" as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action-based interventions in early stages of therapy, by engaging couples in "experiments in possibility." Typical action approaches are described. An extended vignette follows.

When the "U" is not Inverted: Trajectories of Expressed Emotional Arousal Predict Relationship Satisfaction

Maladaptive emotional reactivity and dysfunctional communication during couple conflict are both destructive to couple functioning, and observational research has elucidated how conflict escalates. However, much of the evidence is based on measures that combine content (i.e., what was said) and the emotion with which it was said, which are then examined using sequential analyses. Despite the general presumptions about underlying emotional reactivity and escalation in negative emotions as part of relationship distress and deterioration, little empirical data are available that directly examine these continuous shifts in emotions. The current study examined concurrent and longitudinal associations between relationship satisfaction and trajectories of change in vocally expressed emotional arousal during couple conflict in 62 couples who participated in a relationship education program. Contrary to expectations and patterns found in distressed couples, trajectories followed a U-shape rather than an inverted U-shape curve, with steeper and more persistent decreases in emotional arousal predicting more stable relationship satisfaction over time. In addition, there were within-couple effects. These results suggest that early signs for relationship deterioration may be less in the form of overt escalation as would be seen in distressed couples. Instead, couples who subsequently deteriorate more are less effective in calming emotional arousal. They also are less able to remain at lower emotional arousal. It is possible that the more pronounced escalation toward the end of the conversation in more at-risk couples is a precursor of the greater escalation patterns seen in distressed couples; this should be examined empirically. Limitations and implications are discussed.

Do Male Couples Agree on Their Sexual Agreements? An Analysis of Dyadic Data

Male couples often formulate sexual agreements, but little is known about the extent to which partners concur about their exact terms. Disagreements, particularly with respect to sex outside the relationship, may induce stress and potentially increase the risk of HIV and other sexually transmitted infections. Our study sought to describe concordance between male partners on several aspects of their sexual agreements, overall, as well as stratified by dyadic HIV serostatus and relationship duration. Between July 2014 and May 2016, we collected bidirectional data from 160 male couples residing in Atlanta, Boston, and Chicago. Overall, we observed weak concordance for whether or not couples had a mutual agreement about sex with outside partners. Even among 110 couples in which both partners reported having an agreement, there was weak-to-moderate concordance for general rules that might apply to having sex outside the relationship (e.g., forming emotional relationships is not allowed, outside sexual activities must be disclosed), and for specific sexual behaviors allowed or disallowed (e.g., topping without a condom, bottoming without a condom). Concordance for the type of sexual agreement was higher within HIV seroconcordant negative partnerships compared to HIV serodiscordant partnerships, and lower within relationships ≥ 5 years and 1 to < 5 years compared to those < 1 year. Dyadic interventions for male couples (e.g., couples HIV testing and counseling, relationship education programs) can offer unique opportunities for skills building around negotiating sexual agreements and might especially benefit HIV serodiscordant partnerships, and those in the formative stages of their relationships.

An Implementation Study of Relationship Checkups as Home Visitations for Low-Income At-Risk Couples

Couples with the greatest need for relationship health maintenance and intervention are often least able to afford and access it; therefore, accessible, affordable, effective, and brief interventions are needed to improve relationship health for those who need it most. Consequently, this paper examined whether a brief relationship intervention could be effectively implemented with a low-income, underserved population. All enrolled participants (N = 1,312) received the Relationship Checkup, which consists of an assessment and a feedback session delivered in their homes or at a local clinic at their request. Measures assessed relationship satisfaction, communication, psychological and physical aggression, and intimacy at baseline and 1-month follow-up, and program and relationship satisfaction at 6-month follow-up. All participants reported significant improvements on all outcomes with small effect sizes. However, moderation analyses suggested that distressed couples reported significantly larger effects across the board. Overall, participants reported that they were highly satisfied with the intervention both immediately after its delivery and 6 months later. Findings provide preliminary support for the effectiveness of this brief checkup and point to the utility of offering these kinds of low-cost brief interventions in flexible formats for those who might have the most difficulty accessing them.

Intervenções Preventivas com Casais: O que Podemos Aprender com a Experiência Internacional?

Resumo A dissolução da unidade conjugal é um desafio familiar e para os diversos sistemas sociais a esta relacionados. O objetivo deste artigo é revisar a literatura sobre programas preventivos com casais, visando a identificar os formatos de sucesso, as lacunas existentes no que é oferecido no Brasil e o que podemos aprender com a experiência internacional. Os dados são apresentados e discutidos privilegiando os estudos que se mostraram teórica e empiricamente relevantes para o desenvolvimento de um programa adaptado à realidade brasileira. Os estudos encontrados apontam para a eficácia das intervenções preventivas na promoção de habilidades relacionadas à resiliência conjugal. Entretanto, os mecanismos de mudança implicados nesse processo e sua repercussão na qualidade conjugal ainda não foram esclarecidos.

The Effects of a Couples-Based Health Behavior Intervention During Pregnancy on Latino Couples' Dyadic Satisfaction Postpartum

Many couples tend to report steadily decreasing relationship quality following the birth of a child. However, little is known about the postpartum period for Latino couples, a rapidly growing ethnic group who are notably underserved by mental and physical health caregivers in the United States. Thus, this study investigated whether a brief couples' intervention focused on helping couples support each other while increasing healthy behaviors might improve dyadic functioning postpartum. This study presents secondary analyses of data regarding couple functioning from a larger randomized controlled trial with 348 Latino couples to promote smoking cessation. Portions of the intervention taught the couple communication and problem-solving skills to increase healthy behavior. Couples participated in four face-to-face assessments across 1 year starting at the end of the first trimester. Latent growth curve analyses revealed that the treatment group reported an increase in relationship satisfaction and constructive communication after the intervention, which diminished by 1-year follow-up, returning couples to their baseline levels of satisfaction. Results suggest that incorporating a brief couple intervention as part of a larger health intervention for Latinos may prevent postpartum decreases in relationship satisfaction.

Improving Young Male Couples' Sexual and Relationship Health in the 2GETHER Program: Intervention Techniques, Environments of Care, and Societal Considerations

Young male couples are at high risk for acquiring human immunodeficiency virus (HIV). However, few HIV prevention programs meet the needs of young male couples that express an interest in how to maintain healthy relationships. As such, we developed 2GETHER, a couple-based program that integrates HIV risk reduction and sexual health information into a relationship education program specific to young male couples. 2GETHER was guided by cognitive-behavioral theories of HIV risk reduction and relationship functioning and was informed by a social-ecological perspective to address factors within and outside the couple that can impact sexual and relationship health. As a micro-level intervention, 2GETHER intervenes directly with couples via psychoeducation and cognitive-behavioral strategies to change couples' communication patterns, sexual health behaviors, and relationship satisfaction. Successful implementation of 2GETHER requires mezzo-level interventions that create an affirming environment of care for sexual-minority individuals and facilitators who are culturally competent in working with young male couples. Although macro-level interventions to change societal acceptance of and policies germane to sexual-minority couples are beyond the scope of 2GETHER, we discuss how clinicians can advocate for systemic changes to improve sexual-minority couples' health, and how 2GETHER addresses the impact of such macro-level factors on the couple's relationship. Our experience developing and testing 2GETHER indicates that HIV prevention programs for young male couples should reflect the unique contexts shaping sexual-minority individuals' relationships and lives, and that programs should intervene within and across multiple levels when possible to improve health for sexual-minority men.

Sexuality Within Female Same-Gender Couples: Definitions of Sex, Sexual Frequency Norms, and Factors Associated with Sexual Satisfaction

Despite a growing number of female same-gender (FSG) relationships, couples-based research and interventions have focused primarily on mixed-gender couples. Consequently, research has applied a heteronormative lens to understanding some relationship factors, including sexuality. The current study sought to provide descriptive data regarding frequency and conceptualizations of sex across partners in FSG relationships, as well as to analyze how relationship factors are associated with sexual satisfaction in this population. Participants (N = 206) were 103 adult FSG couples who had been together for at least 2 months. Individuals provided self-report data on how they conceptualized sex, and actor-partner models were utilized to assess relationship factors associated with sexual satisfaction. Findings indicated that women in FSG relationships hold broad definitions of sex, with the majority of behaviors conceptualized as sex, including acts that involved partnered genital touching. In dyadic actor-partner models, sexual satisfaction was predicted by several factors including sexual frequency, emotional intimacy, and sexual intimacy. Unexpectedly, higher desired sexual frequency was associated with lower sexual satisfaction; however, this finding only emerged after controlling for actual sexual frequency, suggesting that discrepancies between desired and actual sex frequency may be important for FSG couples. Implications for clinical practice with FSG couples are explored, including a strength-based focus on broad conceptualizations of sex within this population and targeting relationship factors associated with sexual satisfaction.

Clinical Guidelines for Working With Stepfamilies: What Family, Couple, Individual, and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence-informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world-wide. As a result many clinicians rely on their training in first-time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first-time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex-spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three-level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family-of-Origin. The article describes some "easy wrong turns" for well-meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.

Stress spillover, African Americans' couple and health outcomes, and the stress-buffering effect of family-centered prevention

This study investigated (a) the stress spillover pathways linking contextual stressors, changes in couple relationship functioning and depressive symptoms, and changes in individuals' physical health, and (b) the stress-buffering effect of participation in an efficacious, family centered prevention program designed to protect couples from the deleterious effects of stressors. The sample consisted of 346 rural African American couples (63% married) who participated in a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program. Participants were assessed at three time points across 17 months. Results examining stress spillover within the control group indicated that elevated current, but not prior, financial hardship was associated with decreased effective communication, relationship satisfaction, and relationship confidence as well as increased depressive symptoms; current levels of racial discrimination also predicted greater depressive symptoms. Relationship confidence and relationship satisfaction, but not communication or depressive symptoms, in turn predicted declines in self-reported physical health. Results examining stress-buffering effects suggested that participation in ProSAAF protected individuals' relationship confidence from declines associated with elevated financial hardship. In addition, the indirect effect linking financial hardship to declines in physical health through relationship confidence that emerged among participants in the control group was no longer evident for ProSAAF couples. Results highlight the effect of contextual stressors on African Americans' couple and individual well-being and the potential for the ProSAAF program to provide a constructed resilience resource, protecting couple's confidence in their relationship from the negative effects of financial hardship and, consequently, promoting physical health. (PsycINFO Database Record

Enhancing Relationship Skills and Couple Functioning with Mobile Technology: An Evaluation of the Love Every Day Mobile Intervention

A research-informed mobile application (app) was created to encourage and activate couples to demonstrate healthy relationship behaviors in an effort to promote relationship quality, stability, and resilience. The app, Love Every Day, is grounded in the literature on couple quality, habit formation, and family resilience, and it uses tenets of effective behavioral intervention technologies. Forty-three couples (N = 86 participants) engaged with the app across a 21-day period and completed online evaluations, which consisted of a pretest, posttest, and three weekly questionnaires. Findings suggest that the couples' app promoted high levels of engagement, such that most participants viewed the app multiple times a day and also submitted answers to daily prompts 19.8 of the 21 days (94% of the intervention). Pretest and posttest assessments suggest that participants enhanced their relationship skills and behaviors, including knowledge of their partner's general well-being, care for one's partner, partner communication, and self-efficacy to manage conflict. Participants also reported higher levels of relationship quality after engaging with the app for 21 days, including less relationship distress, greater partner cohesion, better relationship satisfaction, and more relationship confidence. Implications for self-directed modes of relationship education and promoting family resilience are discussed.

Is Communication a Mechanism of Relationship Education Effects among Rural African Americans?

Enhancing communication as a means of promoting relationship quality has been increasingly questioned, particularly for couples at elevated sociodemographic risk. In response, the current study investigated communication change as a mechanism accounting for changes in relationship satisfaction and confidence among 344 rural, predominantly low-income African American couples with an early adolescent child who participated in a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program. Approximately 9 months after baseline assessment, intent-to-treat analyses indicated ProSAAF couples demonstrated improved communication, satisfaction, and confidence compared with couples in the control condition. Improvements in communication mediated ProSAAF effects on relationship satisfaction and confidence; conversely, neither satisfaction nor confidence mediated intervention effects on changes in communication. These results underscore the short-term efficacy of a communication-focused, culturally sensitive prevention program and suggest that communication is a possible mechanism of change in relationship quality among low-income African American couples.

Associations Between Participant Ratings of PREP for Strong Bonds and Marital Outcomes 1 Year Postintervention

After completing a relationship education program, collecting participant evaluations of the program is common practice. These are generally used as an index of "consumer satisfaction" with the program, with implications for feasibility and quality. Rarely have these ratings been used as predictors of changes in marital quality, although such feedback may be the only data providers collect or have immediate access to when considering the success of their efforts. To better understand the utility of such ratings to predict outcomes, we evaluated links between participant ratings and changes in self-reported marital satisfaction and communication scores one year later for a sample of 191 Army couples who had participated in a relationship education program delivered by Army chaplains (PREP for Strong Bonds). Overall ratings of general satisfaction with the program and the leader did not predict changes in marital outcomes one year later, whereas higher ratings of how much was learned, program helpfulness, increased similarity in outlook regarding Army life, and helpfulness of communication skills training predicted greater change in communication skills one year later. Higher ratings of items reflecting intent to invest more time in the relationship, and increased confidence in constructive communication and working as a team with the spouse predicted greater increases in both marital satisfaction and communication skills one year later. The constructs of intention and confidence (akin to perceived behavioral control) suggest that the Theory of Planned Behavior may be particularly useful when considering which Army couples will show ongoing benefit after relationship education.

Integrating HIV Prevention and Relationship Education for Young Same-Sex Male Couples: A Pilot Trial of the 2GETHER Intervention

Young men who have sex with men are at high risk for HIV, and most new HIV infections occur in serious relationships. This pilot study assessed the feasibility, acceptability and preliminary efficacy of the 2GETHER couples-based HIV prevention and relationship education intervention for young same-sex male couples. We enrolled 57 young male couples (N = 114) into a four-session hybrid group and individual intervention. We assessed acceptability via post-session surveys and exit interviews, and we examined preliminary efficacy at a two week posttest. The vast majority of participants (93%) reported exclusively positive impressions of 2GETHER, and all components received high mean ratings. We observed decreases in HIV risk behavior, increases in information, motivation and behavioral skills related to HIV prevention, and improvement in relationship investment between pretest and posttest. Integrating relationship education and sexual health programming may be an effective way to reduce HIV transmissions in young male couples.

Relationship Education for Military Couples: Recommendations for Best Practice

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.

The Effectiveness of Couple and Individual Relationship Education: Distress as a Moderator

Current literature yields mixed results about the effectiveness of relationship education (RE) with low-income participants and those who experience a high level of individual or relational distress. Scholars have called for research that examines whether initial levels of distress act as a moderator of RE outcomes. To test whether initial levels of relationship and/or individual distress moderate the effectiveness of RE, this study used two samples, one of couples who received couple-oriented relationship education with their partner (n = 192 couples) and one of individuals in a relationship who received individual-oriented RE by themselves (n = 60 individuals). We delivered RE in a community-based setting serving primarily low-income participants. For those attending with a partner, there was a significant interaction between gender, initial distress, and time. Findings indicate that women who were relationally distressed before RE reported the largest pre-postgains. Those who attended an individual-oriented RE program reported significant decreases in individual distress from pre to post, but no significant relationship gains. Findings also suggest that initial levels of distress did not moderate the effectiveness of individual-oriented RE.