Prediction of response to treatment in a randomized clinical trial of couple therapy: a 2-year follow-up (original) (raw)
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Prediction of response to treatment in a randomized clinical trial of marital therapy
Journal of Consulting and Clinical Psychology, 2005
Many studies have examined pretreatment predictors of immediate posttreatment outcome, but few studies have examined prediction of long-term treatment response to couple therapies. Four groups of predictors (demographic, intrapersonal, communication, and other interpersonal) and 2 moderators (pretreatment severity and type of therapy) were explored as predictors of clinically significant change measured 2 years after treatment termination. Results demonstrated that power processes and expressed emotional arousal were the strongest predictors of 2-year response to treatment. Moderation analyses showed that these variables predicted differential treatment response to traditional versus integrative behavioral couple therapy and that more variables predicted 2-year response for couples who were less distressed when beginning treatment. Findings are discussed with regard to existing work on prediction of treatment response, and directions for further study are offered.
Journal of Consulting and Clinical Psychology, 2006
Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT;. Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy.
Objective: Building on earlier work examining predictors of short-and moderate-term treatment response, demographic, intrapersonal, communication, and interpersonal variables were examined as predictors of clinically significant outcomes five years after couples completed one of two behaviorally based couple therapies. Method: One hundred and thirty-four couples were randomly assigned to Integrative Behavioral Couple Therapy (IBCT; or Traditional Behavioral Couple Therapy (TBCT; Jacobson & Margolin, 1979) and followed for 5 years after treatment. Outcomes include clinically significant change categories of relationship satisfaction and marital status at 5-year follow-up. Optimal subsets of predictors were selected using an automated, bootstrapped selection procedure based on Bayesian Information Criterion. Results: Higher levels of commitment and being married for a longer period of time were associated with decreased likelihood of divorce/separation (Odds Ratio [OR] = 1.39, p = .004; OR = 0.91, p = .015). Being married for a longer period of time was also associated with increased likelihood of positive, clinically significant change (OR = 1.12, p = .029). Finally, higher levels of wife desired closeness were associated with increased odds of positive, clinically significant change and decreased odds of divorce for moderately distressed, IBCT couples (OR = 1.16, p = 0.002; OR = 0.85, p = 0.007, respectively) whereas the opposite was true for moderately distressed, TBCT couples (OR = 0.77, p < 0.001; OR = 1.17, p = 0.002, respectively). Conclusions: Commitment-related variables are associated with clinically significant outcomes at 5-year follow-up as well as at termination and moderate-term follow-up.
Behaviour Research and Therapy, 2015
To examine changes in dyadic communication, as well as links between communication and long-term relationship outcomes, 134 distressed couples randomly assigned to either Traditional Behavioral Couple Therapy (TBCT; or Integrative Behavioral Couple Therapy (IBCT; Jacobson & Christensen, 1998) were observed in video-recorded interactions. Observers rated discussions of relationship problems at 3 time points (pre-therapy, post-therapy, 2-year follow-up) and relationship outcomes (i.e., treatment response and relationship stability) were measured at a 5-year follow-up. Consistent with previous examinations of individual partner communication (K.J.W. Baucom et al., 2011; Sevier et al., 2008), TBCT produced greater improvements from pre-therapy to post-therapy (d = .27 -.43) and superior communication at post-therapy (d = .30 -.37). However, IBCT produced greater improvements from post-therapy to 2-year follow-up (d = .32 -.39). Both levels of, and changes in, dyadic communication were associated with relationship outcomes, even when controlling for individual communication. Our findings lend additional support for theoretical and practical differences between these two therapies and the utility of assessment at the level of the couple.
Research on couples and couple therapy: What do we know? Where are we going?
Journal of Consulting and Clinical Psychology
This article discusses the outcome and process research on couple therapy and integrates the articles special section "Couples and Couple Therapy" into the discussion. All tested couple treatments show statistically significant effects relative to control groups, but there are no reliable differences between different theoretical models. Moreover, all tested approaches leave substantial numbers of couples unimproved or at least still somewhat distressed. A discussion of the strengths and weaknesses of various designs concludes that within-model comparisons have been more productive in producing knowledge than between-model comparisons. Recommendations for future research include developing a technology that would make possible matching studies focusing on Aptitude × Treatment interactions. Also, there needs to be greater emphasis on basic research and prevention.
Improving Relationships: Mechanisms of Change in Couple Therapy
Journal of Consulting and Clinical Psychology, 2005
In a sample of 134 married couples randomly assigned to traditional or integrative behavioral couple therapy (TBCT vs. IBCT), a multivariate hierarchical growth curve analysis using latent variable regression revealed that measures of communication, behavior frequency, and emotional acceptance acted as mechanisms of change. TBCT led to greater changes in frequency of targeted behavior early in therapy, whereas IBCT led to greater changes in acceptance of targeted behavior both early and late in therapy. In addition, change in behavioral frequency was strongly related to improvements in satisfaction early in therapy; however, in the 2nd half of therapy, emotional acceptance was more strongly related to changes in satisfaction. Research and clinical implications are discussed.
Behavior Therapy, 2008
To investigate changes in couple communication and potential mechanisms of change during treatment, 134 distressed couples, who were randomly assigned to either traditional or integrative behavioral couple therapy (TBCT; IBCT), were observed in relationship and personal problem discussions prior to and near the end of treatment. Analyses were conducted using the Hierarchical Linear Modeling program. Over the time in therapy, during relationship problem discussions, positivity and problem solving increased while negativity decreased. Compared to IBCT, TBCT couples had the largest gains in positivity and reductions in negativity. During personal problem discussions, negativity decreased, while withdrawal increased and positivity decreased. TBCT couples had larger declines in negativity. In both discussion types, increases in marital satisfaction were associated with increases in positivity and problem solving. Declines in marital satisfaction were associated with increased negativity during relationship problem interactions and increased withdrawal during personal problem interactions. However, no treatment differences in these associations were found. Differences in rule-governed and contingency-shaped behavior change strategies between the two therapies and implications of findings are discussed.
Behavioral marital therapy: An evaluation of treatment effects across high and low risk settings
Behavior Therapy, 1990
The present study examined the generalization of treatment effects of a cognitivebehavioral treatment program for marital distress. Following a baseline phase, each of four couples received two phases of marital therapy within a multiple baseline across subjects design. The first phase of treatment was behavioral marital therapy (BMT) focusing on communication and problem solving skills. The second phase was cognitivebehavioral marital therapy (CBMT) which focused on conflict management skills in high risk interactive settings at home. Couples' communication was assessed in a training setting in the clinic and each of two generalization probe settings at home (a low risk and a high risk) setting. The BMT phase produced a clear reduction in communication negativity in the training setting which generalized to both the low and the high risk setting. The CMBT phase produced little additional changes in communication, however, it was associated with changes on a measure of positive and negative partnerreferent thoughts.
Family Process, 2019
Even though couple therapy is efficacious, there is no improvement in up to 50% of the couples. Also effect sizes found in effectiveness studies in real-world settings are considerably lower than those found in efficacy studies. There is a need to understand more about couple therapy effectiveness in practice settings and the factors responsible for different outcomes. A German nationwide study on the effectiveness of couple counseling including 554 couples applied the same methodology as two earlier studies in the same field. A remarkable consistency was found over the three independent studies in the burden with individual and relationship distress as well as in the rates of improvement. This supports the insight that the improvements reached through couple therapy in practice settings are only about half of the effect sizes reached in efficacy trials. Additionally this study investigated 64 factors, which were found to be influential for relationship quality and stability in earlier studies, for their impact on outcome. Factors present at initiation and termination of therapy were found, which correlate significantly with outcome and with separation of the couple in the follow-up. These factors could be included in prediction models for improvement and separation of the couple. The implications for the practice of couple therapy and for future research are discussed.