Does Web-Based Relationship Education Improve Sexual Intimacy? Initial Examination, Replication, and Exploration of Moderation in a Low-Income Sample.

Sexual intimacy, characterized as the experience between individuals of sharing general affection and sexual activity with one another within the Personal Assessment of Intimacy in Relationships inventory, is positively related to relationship satisfaction and stability. However, many studies of couple therapy have shown that it only results in small-sized (and often non-significant) improvements in sexual intimacy. Furthermore, there are numerous financial, logistical, and psychological barriers to couple therapy. Thus, the current study sought to examine whether two brief online relationship education programs (OurRelationship and ePREP) could overcome these barriers and yield similar-sized effects to more intensive couple therapy. In two independently collected samples of low-income couples (NSample 1 = 742 Couples; M AgeSample 1 = 33.19; NSample 2 = 671 Couples; M AgeSample 2 = 33.48), the current study found that: OurRelationship (d = 0.24-0.28) and ePREP (d = 0.26-0.34) produced small-sized changes in sexual intimacy relative to a waitlist control condition in both samples, the magnitude of the effect size replicated in a second sample and, with rare exception, these changes were generally not moderated by key variables of interest. Given that web-based relationship education is significantly shorter, less expensive, and more accessible than in-person couple interventions, web-based relationship education could be considered a viable candidate for couples experiencing concerns with sexual intimacy.

Profiles of Low-Income Help-Seeking Couples and Implications for Intervention Gains: A Couple-Centered Approach.

Using a couple-centered approach, the current study seeks to understand (a) the specific ways in which help-seeking couples vary in how their relationship satisfaction changes over time, (b) whether there are important differences in relationship characteristics at the beginning of the interventions, and (c) whether couples with distinct relationship characteristics benefit equally from effective online relationship programs. Mixed-gender low-income couples (Ncouple = 659) seeking help for their relationship were randomly assigned to one of two online relationship programs (n = 432) or the wait-list control group (n = 227). Latent profile analyses were conducted to identify (a) trajectory profiles with both partners' relationship satisfaction assessed at baseline, during, and postprogram, and at 2- and 4-month follow-ups; and (b) baseline couple profiles with indicators of baseline communication, commitment, emotional support, and sexual satisfaction reported by both partners. Four unique satisfaction trajectories were identified: women-small-men-medium improvement (39%), men-only decline (25%), large improvement (19%), and women-only improvement (17%). Five unique baseline couple profiles were identified: conflictual passionate (30%), companionate (22%), men-committed languishing (22%), satisfied (16%), and languishing (10%). Compared to control couples, intervention couples' odds of following the large improvement trajectory increased and their odds of following the men-only decline trajectory decreased; the odds of following the other two intermediate trajectories did not differ by intervention status. Moreover, couples with more distressed baseline profiles were more likely to follow trajectories characterized by greater satisfaction gains regardless of their intervention status. However, program effects did not differ based on baseline couple profiles, suggesting that a universal approach may be sufficient for delivering online relationship programs to improve relationship satisfaction in this population.

Trajectories of Perceived Gratitude and Change Following Relationship Interventions: A Randomized Controlled Trial With Lower-Income, Help-Seeking Couples.

The current study was designed to advance basic and applied research on perceived gratitude from one's partner in established couple relationships. From a three-arm randomized controlled trial involving 615 lower-income, help-seeking couples (N = 1,224 individuals), study analyses examined (a) the trajectory of perceived gratitude from one's partner among couples assigned to the wait-list condition (i.e., absent of any intervention), and (b) changes in perceived gratitude for individuals assigned to either the OurRelationship (OR) or ePREP relationship intervention condition. With respect to the first aim, levels of perceived gratitude among wait-listed couples demonstrated no significant mean increase over the 6-month period; this rate of change was significantly different from rates of change observed in other relationship constructs (e.g., satisfaction, communication, support) during the wait-list period. Being married, female, and having more children were all associated with lower initial levels of perceived gratitude. For the second aim, individuals assigned to either the OR or ePREP treatment condition demonstrated significant improvements in levels of perceived partner gratitude compared to wait-listed couples. The magnitude of program effect sizes for gratitude (d = 0.33), however, was 3%-48% smaller compared to the magnitude of program effects of other relationship constructs (0.34 < d < 0.64). Results indicated that perceived gratitude is a distinct component of couple relationships, generally lower in more established relationships, and can be improved by participating in OR or ePREP relationship interventions. Implications for research and practice related to gratitude in couple relationships are discussed.

A randomized controlled trial of the online OurRelationship program with varying levels of coach support.

Online programs that reduce relationship distress fill a critical need; however, their scalability is limited by their reliance on coach calls. To determine the effectiveness of the online OurRelationship program with varying levels of coach support, we conducted a comparative effectiveness trial with 740 low-income couples in the United States. Couples were randomly assigned to full-coach (ncouples = 226; program as originally designed), automated-coach (ncouples = 145; as a stand-alone program with tailored automated emails only), contingent-coach (ncouples = 145; as an adaptive program where tailored automated emails are followed by more coaching if couples did not meet progress milestones), or a waitlist control condition (ncouples = 224). All analyses were conducted within a Bayesian framework. Completion rates were comparable across conditions (full-coach: 65 %, automated-coach: 59 %, contingent-coach: 54 %). All intervention couples reported reliable pre-post gains in relationship satisfaction compared to waitlist control couples (dfull = 0.46, dcontingent = 0.47, and dautomated = 0.40) with no reliable differences across intervention conditions. Over four-month follow-up, couples in full- and contingent-coach conditions maintained gains in relationship satisfaction and couples in the automated-coach condition continued to improve. Given the comparable completion rates and minimal differences in effect sizes across intervention conditions, all three coaching models appear viable; therefore, the choice of model can vary depending on available resources as well as couple or stakeholder preferences. This study was preregistered (ClinicalTrials.govNCT03568565).

Effects of online relationship programs for low-income couples during the perinatal period.

Low-income couples experience increased stress and declines in relationship quality during the perinatal period. They also encounter many barriers to accessing relationship services. Using a subsample of low-income perinatal couples (n = 180) from two randomized controlled trials, the current study examined the impact of online relationship interventions, OurRelationship (OR) and ePREP, in a Bayesian framework. From pre to post, relative to waitlist control couples, couples in OR and ePREP experienced improvements in relationship quality (Mean d = 0.51) and psychological distress (Mean d = 0.28); OR couples, relative to waitlist control couples, also experienced improvements in perceived stress (Mean d = 0.33). These improvements were maintained through four-month follow-up and did not differ across gender. These findings suggest brief online relationship interventions may be an important resource for low-income perinatal couples.

Web-Based Relationship Education and Pornography-Related Behaviors: A Single-Group Design During the COVID-19 Pandemic.

Research surrounding pornography and its impact on individual and relationship functioning is a frequent and ongoing debate in the current literature. However, recent meta-analyses and aggregated studies suggest that relationship distress is associated with higher levels of general pornography use. This may be a reason why a significant number of men and women view pornography and seek help for their use. In the present study, we explored whether participation in the OurRelationship program, a web-based relationship education program that has been empirically shown to reduce relationship distress but is not tailored to reduce general pornography use, was associated with reliable changes in pornography-related behaviors. In a sample of low-income and diverse couples (N = 314 couples; 628 individuals), we observed high completion rates (64.3%) as well as reliable, small-sized decreases in the frequency and duration of pornography use for the average couple (d = 0.12-0.13). Furthermore, post hoc analyses found that individuals who began the program viewing pornography daily reported reliability-larger decreases in pornography-related behaviors (d = 0.32-0.90) than those who viewed pornography less frequently. However, we did not see reliable changes in couples' arguments about pornography use or perceptions of problematic use. The findings were generally not moderated by gender or lifestyle changes due to the COVID-19 pandemic. Clinicians struggling to reduce their client's general pornography use may consider including a focus on improving general romantic relationship functioning.

Partner outcomes from an uncontrolled trial of Couple HOPES: A guided online couple intervention for posttraumatic stress disorder and relationship enhancement.

Posttraumatic stress disorder (PTSD) is associated with significant individual and relationship impairment for people with PTSD and their romantic partners. Conjoint treatments, such as cognitive behavioral conjoint therapy for PTSD (CBCT), are designed to address individual and relationship factors, yet significant barriers impede accessing in-person therapy. Couple HOPES (i.e., Helping Overcome PTSD and Enhance Satisfaction) is a coach-guided, online couple intervention for PTSD based on CBCT that was designed to address these barriers. Previous investigations have found preliminary efficacy of Couple HOPES for improving PTSD symptoms, relationship functioning, and some individual functioning domains for the partner with probable PTSD. However, no study to date has tested individual outcomes for romantic partners, which is needed to fully evaluate the intervention's promise. The current study tested these partner outcomes in a combined, uncontrolled sample of 27 couples. Intent-to-intervene analyses found significant improvements at postintervention in four of eight tested outcomes, including ineffective arguing, g = 0.74; anger, g = 0.32; perceived health, g = 0.67; and quality of life, g = 0.56. Depressive symptoms, generalized anxiety, alcohol misuse, and work functioning did not significantly change, gs = 0.17-0.42. Among participants who completed a 1-month follow-up assessment, generalized anxiety, g = 0.43, and perceived health, g = 0.73, significantly improved over follow-up, whereas anger, g = -0.48, lost gains previously made. Results were largely consistent in the completer sample. These findings show the potential of Couple HOPES to have broad benefits not only for individuals with probable PTSD but also for their romantic partners.

Dyadic digital health interventions: Their rationale and implementation.

While most psychosocial and behavioral digital health interventions have been designed to be consumed by an individual, intervening at the level of a dyad - two interdependent individuals - can more comprehensively address the needs of both individuals and their relationship. The clinical utility of the dyadic digital health intervention approach, as well as the practical implementation of this design, will be demonstrated via three examples: eSCCIP, FAMS, and OurRelationship.

Introduction to special section: Federally funded, community-based healthy marriage and responsible fatherhood program impact studies.

The focus of this special section is impact studies that were conducted as part of the Administration for Children and Families' Healthy Marriage and Responsible Fatherhood initiative. This initiative has led to more than 2 million people receiving relationship education and fatherhood programs across the United States over the last two decades. Community organizations develop these programs, select their curricula and content, and run these programs in their local communities. Many programs funded in the 2015-2020 cohort of grantees included randomized controlled trials of program effectiveness; some of these studies are presented in this issue, with the goal of marrying the field of program evaluation and family science.

Does coparenting improve during the OurRelationship program? Explorations within a low-income sample during the COVID-19 pandemic.

Low-income couples are at an increased risk for relationship instability and divorce, which can have residual impacts on coparenting between the two partners. Growing evidence suggests that brief online relationship education programs can be an effective tool for alleviating relationship distress among low-income couples. However, findings remain mixed when it comes to whether benefits from relationship-focused programs not explicitly addressing coparenting spillover to coparenting among those with children. This preregistered study sought to investigate whether couples participating in an evidence-based online relationship-focused intervention, the OurRelationship program, experienced improvements in coparenting during the coronavirus disease 2019 (COVID-19) pandemic. To expand on the existing literature, coparenting outcomes assessed included partners' gatekeeping behaviors in addition to coparenting satisfaction, given their important implications for partner involvement in parenting. We also examined the extent to which changes in coparenting were moderated by pre-post gains in relationship satisfaction, child gender, division of childcare, and pandemic disruptions. In a sample of 136 low-income couples (N = 272 individuals) and a one-group/pre-post design, we found medium-sized gains in relationship satisfaction (Cohen's d = .76) and small-sized improvements in all coparenting aspects assessed (|d|s = .29-.39). Couples with greater gains in relationship satisfaction experienced greater improvements in coparenting; further, coparenting changes were robust to other moderators. Taken together, findings suggested that brief online relationship education programs, such as the OurRelationship program, may be a promising option to improve coparenting among relationally distressed low-income couples with children during a global health crisis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An uncontrolled trial of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement.

Novel interventions that overcome limited access to empirically supported psychotherapies for posttraumatic stress disorder (PTSD) are sorely needed. Couple helping overcome PTSD and enhance relationships (HOPES), a guided, online couple intervention drawing from cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson, 2012), was designed to decrease PTSD symptoms and improve relationship satisfaction. The present study is the first uncontrolled trial of 17 couples in which one partner was a military member, veteran, or first responder and had probable PTSD (PTSD + partner) based on self-report assessment. Intent-to-intervene analyses revealed significant improvements from pre- to postintervention in PTSD + partners' self-reported PTSD symptoms (g = .72), as well as their intimate partner's relationship satisfaction (g = .34) and behavioral accommodation of PTSD symptoms (g = .84). There were also significant improvements in PTSD + partners' depression (g = .43) and perceived relationship arguments (g = .62). There were similar results found in the completer sample. There were no adverse events and high satisfaction with the intervention in those who completed the evaluation. These findings provide additional initial data on the safety, feasibility, and efficacy of Couple HOPES. The similarities of intent-to-intervene and completer results, as well as the need for randomized controlled trial designs to test Couple HOPES, are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Online relationship education for help-seeking low-income couples: A Bayesian replication and extension of the OurRelationship and ePREP programs.

Low-income couples are at increased risk for relationship instability and divorce. In response, online relationship education programs such as ePREP and OurRelationship have been developed to more easily reach this population. A previous trial indicated that these programs promote relationship functioning (Doss et al., 2020) and individual well-being (Roddy et al., 2020a). However, given that these effects were notably larger than previous studies of in-person relationship education and approached effect sizes observed in couple therapy, it is possible that the magnitude of these effects was somewhat spurious; therefore, these findings need replication. The current manuscript seeks to replicate these programs' previous effects on relationship functioning and determine whether these effects are stable. Using a sample of 671 low-income couples seeking relationship help (N = 1337 individuals) and Bayesian estimation, the current study replicated previous findings that the OurRelationship and ePREP programs offered with four coaching calls produced reliable improvements in relationship functioning relative to a 6-month waitlist control group. There were no statistically reliable differences between the two active interventions. Bayesian analyses indicated that the effects of the two online programs were larger than the average effects of in-person relationship education for low-income couples reported in previous studies, roughly equivalent to efficacy studies of in-person relationship education reported in previous studies, smaller than those that resulted from the OurRelationship program delivered to distressed couples without an income requirement and smaller than couple therapy.

Las parejas de bajos recursos tienen mayor riesgo de inestabilidad en las relaciones y de divorcio. En respuesta a esto, se han desarrollado programas de educación sobre las relaciones, como ePREP y OurRelationship, con el fin de llegar más fácilmente a esta población. Un ensayo previo indicó que estos programas promueven el funcionamiento de las relaciones (Doss et al., 2020) y el bienestar individual (Roddy et al., 2020a). Sin embargo, teniendo en cuenta que estos efectos fueron notablemente mayores que los de estudios previos de la educación presencial sobre las relaciones y que abordaron tamaños del efecto observados en la terapia de pareja, es posible que la magnitud de estos efectos fuera de alguna manera falsa, por lo tanto, estos resultados necesitan repetirse. En el presente manuscrito se busca reproducir los efectos previos de estos programas en el funcionamiento de la relación y determinar si estos efectos son estables. Utilizando una muestra de 671 parejas de bajos recursos que buscaban ayuda para las relaciones (N = 1337 personas) y el cálculo bayesiano, el presente estudio reprodujo los resultados anteriores que ofrecieron los programas OurRelationship y ePREP con cuatro llamados de capacitación, generando mejoras fiables en el funcionamiento de la relación respecto de un grupo de referencia en lista de espera de seis meses. No hubo diferencias estadísticamente fiables entre las dos intervenciones activas. Los análisis bayesianos indicaron que los efectos de los dos programas virtuales fueron mayores que los efectos promedio de la educación presencial sobre las relaciones para parejas de bajos recursos informados en estudios previos, aproximadamente equivalentes a los de los estudios de eficacia de la educación presencial sobre las relaciones informados en estudios previos, menores que los obtenidos del programa OurRelationship impartido a parejas con distrés sin requisitos de ingresos, y menores que los de la terapia de pareja.

A review of the research during 2010-2019 on evidence-based treatments for couple relationship distress.

The current article presents a review of the published research from 2010 to 2019 on the treatment of couple relationship distress; 37 studies met all criteria for inclusion. Behavioral Couple Therapy, Cognitive Behavioral Couple Therapy, Emotionally Focused Therapy, and Integrative Behavioral Couple Therapy meet criteria as "well-established" approaches, Insight-Oriented Couple Therapy is a "possibly efficacious" approach, and several other others are "experimental" treatments for treating couple relationship distress (Southam-Gerow & Prinstein, 2014). Furthermore, several less-intensive interventions-the Marriage Check-up, OurRelationship, and Hold Me Tight programs-have generated substantial support for their ability to improve relationships and are classified as "well-established" or "probably efficacious" interventions. We recommend that future research focus on expanding the reach of evidence-based interventions across a range of settings and populations, deepening our understanding of the mechanisms of change and underlying factors in the change process across approaches, and improving treatment success through treatment matching and progress monitoring.

Regulating digital therapeutics for mental health: Opportunities, challenges, and the essential role of psychologists.

With so many promising digital therapeutics for anxiety and obsessive-compulsive (OC) spectrum problems, there is an urgent need to consider how evolving regulatory oversight of digital therapeutics is poised to shift how these tools are developed, evaluated, reimbursed, and delivered. In this commentary, we discuss both opportunities and potential pitfalls associated with emerging government regulations of digital therapeutics for mental health, and we consider how applying the traditional 'prescription-based' medical approval paradigm to digital therapeutics for mental health could ultimately undermine and limit the broad accessibility of these software-based innovations that have been explicitly designed to expand the accessibility of care. For example, the vast majority of behavioural and mental health providers do not have 'prescription privileges' (a term originally rooted in pharmacologic practices), and as a result, under current regulations in the U.S. would not be authorized to make FDA-cleared digital therapeutics available to their patients. This is particularly concerning given that most digital therapeutics for mental health are directly rooted in psychological and behavioural science, yet psychologists would not be authorized to incorporate these innovations into their practice. We consider how synchronizing regulatory standards across countries may prove useful, and we conclude by arguing that multidisciplinary teams making regulatory decisions concerning digital therapeutics for mental health must include representation from the discipline and practice of psychology. PRACTITIONER POINTS: Emerging government regulations of digital therapeutics for mental health present both opportunities and potential pitfalls Applying the traditional 'prescription-based' medical approval paradigm to digital therapeutics for mental health could ultimately undermine the broad accessibility of these software-based innovations. Synchronizing regulatory standards across countries may prove useful. Multidisciplinary teams making regulatory decisions concerning digital therapeutics for mental health must include representation from the field of psychology.

Harnessing technology to provide online couple interventions.

The logistical, financial, and attitudinal barriers to in-person treatments for relationship distress become even more formidable during periods of social isolation and physical separation. Digital couple interventions are a way to overcome these barriers to work with distressed couples in a remote and asynchronous fashion. We present the OurRelationship program as an example of such approach and detail its significant effects on relationship functioning, mental health, health behaviors, coparenting, and child adjustment across several randomized controlled trials. Notably, the program is more effective (and more likely to be completed) when it is provided with a coach and with the romantic partner-illustrating the importance of social connection even when treatments cannot be provided in person.

Dealing with loss in the face of disasters and crises: Integrating interpersonal theories of couple adaptation and functioning.

The COVID-19 pandemic has highlighted the significant and varied losses that couples can experience during times of global and regional disasters and crises. What factors determine how couples navigate their close relationships during times of loss? In this paper, we elaborate and extend on one of the most influential frameworks in relationship science-the Vulnerability Stress Adaptation Model (VSAM, Karney and Bradbury, 1995)-to enhance the model's power to explain relationships during loss-themed disasters/crises. We do so by elaborating on attachment theory and integrating interdependence theory (emphasizing partner similarities and differences). Our elaboration and extension to the VSAM provides a comprehensive framework to guide future research and inform practice and policy in supporting relationships during and beyond loss-themed disasters/crises.

Happy, healthy, and wedded? How the transition to marriage affects mental and physical health.

Decades of research have documented the apparent health benefits of marriage, but the dynamics of how health may change across the transition to marriage are not fully understood. In two studies, we compared being unmarried or married on several indices of mental and physical health. In Study 1, we used a national sample of 1,078 individuals in different-sex relationships who completed surveys by mail. Compared with those who were cohabiting or dating, married individuals generally reported better mental and physical health than those in less committed relationships, and most differences remained when controlling for putative selection factors. Study 2 used longitudinal data from the participants in the Study 1 sample who later married (N = 168) to study changes within individuals over the transition to marriage on the same indicators. Six waves of mailed surveys spanning 20 months were employed. Findings of Study 2 indicated that although some indicators of mental and physical health were improving up until the point of marriage, these indicators then stabilized or began to decline, with women experiencing these declines more than men. Findings are more consistent with selection effects (i.e., better-adjusted individuals are more likely to get married) than social causation effects (i.e., marriage causes improvements in mental and physical health) and suggest that if marriage does have a causal effect on well-being in the short term, it may actually manifest in the lead-up to the wedding. Implications of these findings are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Moderating role of socioecological factors on web-based relationship interventions for lower income couples.

Low-income couples tend to face more external stressors and report less stable romantic relationships compared to higher income couples. A recent nationwide randomized controlled trial of the web-based OurRelationship and ePREP programs was conducted with a sample of 742 lower income couples within 200% of the federal poverty line to help improve relationship distress (Doss et al., 2020). Using a socioecological framework, the current study examined whether the presence of intrapersonal-level, couple-level, and community-level factors moderated those couples' gains in relationship satisfaction during the intervention period as well as maintenance of those gains over 4-month follow-up relative to waitlist-control. Using multilevel modeling, results revealed that both interventions were effective in serving lower income couples relative to couples in the waitlist control group with minimal evidence of moderation by individual-level, couple-level, or neighborhood factors. Thus, the interventions are effective in reducing relationship distress across many socioecological factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Optimizing Coaching During Web-Based Relationship Education for Low-Income Couples: Protocol for Precision Medicine Research.

BACKGROUND: In-person relationship education classes funded by the federal government tend to experience relatively high attrition rates and have only a limited effect on relationships. In contrast, low-income couples tend to report meaningful gains from web-based relationship education when provided with individualized coach contact. However, little is known about the method and intensity of practitioner contact that a couple requires to complete the web-based program and receive the intended benefit. OBJECTIVE: The aim of this study is to use within-group models to create an algorithm to assign future couples to different programs and levels of coach contact, identify the most powerful predictors of treatment adherence and gains in relationship satisfaction within 3 different levels of coaching, and examine the most powerful predictors of treatment adherence and gains in relationship satisfaction among the 3 levels of coach contact. METHODS: To accomplish these goals, this project intends to use data from a web-based Sequential Multiple Assignment Randomized Trial of the OurRelationship and web-based Prevention and Relationship Enhancement programs, in which the method and type of coach contact were randomly varied across 1248 couples (2496 individuals), with the hope of advancing theory in this area and generating accurate predictions. This study was funded by the US Department of Health and Human Services, Administration for Children and Families (grant number 90PD0309). RESULTS: Data collection from the Sequential Multiple Assignment Randomized Trial of the OurRelationship and web-based Prevention and Relationship Enhancement Program was completed in October of 2020. CONCLUSIONS: Some of the direct benefits of this study include benefits to social services program administrators, tailoring of more effective relationship education, and effective delivery of evidence- and web-based relationship health interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33047.

Initial outcomes of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement.

Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) is a guided, online couple intervention adapted from Cognitive-Behavioral Conjoint Therapy for posttraumatic stress disorder (PTSD). It was created to overcome a range of barriers to accessing evidence-based treatments for PTSD and the intimate relationship problems associated with it. This manuscript describes initial outcomes of the intervention in a series of 10 couples. Participants were military, veteran and first responders with probable PTSD and their intimate partners. Couples completed the program and measurements of PTSD, relationship satisfaction, and secondary outcomes at pre-, mid-, and post-intervention. Mean satisfaction for the program was high and it was completed by seven of ten couples. Participants with PTSD evidenced significant and large pre- to post-intervention effect size improvements in PTSD symptoms (g = 0.80) and perceived health (g = 1.13). They also exhibited non-significant but medium effect size pre- to post-intervention improvements in quality of life (g = 0.62), and depression (g = 0.53), and small effect size pre- to post-intervention improvements in argumentativeness (g = 0.43), anger (g = 0.31), and anxiety (g = 0.31). Partners reported significant and moderate pre- to post-intervention effect size improvements in relationship satisfaction (g = 0.68), and medium but not significant effect size improvements in accommodation of PTSD (g = 0.56). Results provide initial support for the feasibility, acceptability, and efficacy of Couple HOPES for improving PTSD and relationship satisfaction. However, more testing in larger samples, including with randomized controlled designs, is needed.