Couple therapy for military veterans: overall effectiveness and predictors of response.

Despite the numerous challenges facing U.S. veterans and their relationships, there have been no examinations of the effectiveness of couple therapy for relationship distress provided to veterans. In the present study, 177 couples presenting for couple therapy at two Veteran Administration Medical Centers completed assessments of relationship satisfaction prior to therapy and weekly during therapy. Results revealed that the average couple showed significant gains in relationship satisfaction during treatment (d=0.44 for men; d=0.47 for women); gains were larger for couples beginning therapy in the distressed range (d=0.61 for men; d=0.58 for women) than for couples in the nondistressed range (d=0.19 for men; d=0.22 for women). Rates of premature termination were high, with 19% of couples completing fewer than three sessions and 62% rated as not completing a "full course" of therapy. Benchmarking analyses demonstrated that the average gains were larger than would be expected from natural remission and similar to previous effectiveness trials; however, average gains were smaller than those observed in couple therapy efficacy trials. Relationship, psychological, and demographic characteristics were generally unrelated to the amount of change in therapy after controlling for initial satisfaction. However, African American couples showed significantly larger gains than Caucasian, non-Hispanic couples. Thus, though yielding smaller effects than those shown in efficacy trials, the impact of couple therapy for veterans' relationship problems appears to generalize across various demographic, psychological, and relationship characteristics.

Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients.

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence.

Brief relationship therapy for alcoholism: a randomized clinical trial examining clinical efficacy and cost-effectiveness.

The purpose of this study was to examine the clinical efficacy and cost effectiveness of brief relationship therapy (BRT), a shortened version of standard behavioral couples therapy (S-BCT), with alcoholic male patients (N = 100) and their nonsubstance-abusing female partners. Participants were randomly assigned to 1 of 4 treatment conditions: (a) BRT, (b) S-BCT, (c) individual-based treatment (IBT), or (d) psychoeducational attention control treatment (PACT). Equivalency testing revealed that, compared with those assigned to S-BCT, participants who were randomly assigned to BRT had equivalent posttreatment and 12-month follow-up heavy drinking outcomes. Moreover, at 12-month follow-up, heavy drinking and dyadic adjustment outcomes for patients who received BRT were superior to those of patients who received IBT or PACT. BRT was significantly more cost effective than the S-BCT, IBT, or PACT.

The occurrence of male-to-female intimate partner violence on days of men's drinking: the moderating effects of antisocial personality disorder.

In this study, the moderating effects of antisocial personality disorder (ASPD) on the day-to-day relationship between male partner alcohol consumption and male-to-female intimate partner violence (IPV) for men entering a domestic violence treatment program (n=170) or an alcoholism treatment program (n=169) were examined. For both samples, alcohol consumption was associated with an increased likelihood of nonsevere IPV among men without a diagnosis of ASPD but not among men with ASPD (who tended to engage in nonsevere IPV whether they did or did not drink). Drinking was more strongly associated with a likelihood of severe IPV among men with ASPD compared with those without ASPD who also drank. These results provide partial support for a multiple threshold model of intoxication and aggression.

Behavioral couples therapy for substance abuse: rationale, methods, and findings.

Behavioral couples therapy (BCT), a treatment approach for married or cohabiting drug abusers and their partners, attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it. In multiple studies with diverse populations, patients who engage in BCT have consistently reported greater reductions in substance use than have patients who receive only individual counseling. Couples receiving BCT also have reported higher levels of relationship satisfaction and more improvements in other areas of relationship and family functioning, including intimate partner violence and children's psychosocial adjustment. This review describes the use of BCT in the treatment of substance abuse, discusses the intervention's theoretical rationale, and summarizes the supporting literature.

An examination of indirect risk of exposure to HIV among wives of substance-abusing men.

The purpose of the present investigation was to explore risk and preventive behaviors for potential HIV exposure among 362 married drug-abusing men entering outpatient treatment and their wives. During the year before entering treatment, 144 husbands (40%) reported they had engaged in sexual or drug use behaviors that placed them at high risk for HIV exposure. Nearly all of the wives of these husbands (n=138, 96%) reported they had sexual intercourse with their spouses during this same time period. Among these sexually active couples, 108 of the wives (78%) reported that condoms were not regularly used when they had intercourse with their spouses, thus placing them at high risk for indirect exposure to HIV. Seventy-seven (71%) of these 108 wives reported they were not aware their husbands had engaged in high risk behaviors and thus were unknowingly placed at high risk for indirect exposure to HIV. Among those couples with husbands who had engaged in a high risk behavior, longer marriages, a diagnosis of antisocial personality disorder for husbands, and wives' lack of knowledge of husbands' high risk behaviors were uniquely associated with an increased likelihood of wives being placed at high risk for indirect exposure to HIV.

The relationship between the amount of face-to-face contact and partners' reports of domestic violence frequency.

This investigation examines the relationship between partners' amount of face-to-face contact and partners' frequency of domestic violence. Men entering a domestic violence treatment program (N = 134) and their intimate partners were asked to complete the Conflict Tactics Scale (CTS) at the beginning of treatment and 12 months after treatment completion concerning partner violence during the previous year. Partners were also asked to identify days during the year before and the year after treatment during which they did not have face-to-face contact. Results indicated that at both baseline and 12-month posttreatment follow-up, the number of days of face-to-face contact was significantly related to verbal aggression and physical violence. However, after controlling for physical violence, the relationship between the number of days of face-to-face contact and verbal aggression was not significant; the relationship between the number of days of face-to-face contact and physical violence remained significant, even after controlling for verbal aggression.

Behavioral couples therapy for drug-abusing patients: effects on partner violence.

Using data from a previous investigation, the purpose of the present study was to examine the effect of Behavioral Couples Therapy (BCT) on the prevalence of partner violence among married or cohabiting substance-abusing men (N = 80). Participants were randomly assigned to receive either BCT or individual-based treatment (IBT). The proportion of couples who engaged in male-to-female physical aggression was not different during the year before treatment for dyads in BCT (n = 17, 43%) and IBT (n = 19, 48%). However, a smaller proportion of couples in the BCT condition reported male-to-female physical aggression during the year after treatment (n = 7, 18%) than those in the IBT condition (n = 17, 43%). Dyadic adjustment, frequency of heavy drinking, and frequency of drug use during the year after treatment mediated the relationship between type of treatment and the prevalence of male-to-female physical aggression.

Behavioral couples therapy for female substance-abusing patients: effects on substance use and relationship adjustment.

Married or cohabiting female drug-abusing patients (N = 75) were randomly assigned to either a behavioral couples therapy condition (BCT; n = 37), which consisted of group, individual, and behavioral couples therapy sessions, or to an equally intensive individual-based treatment condition (IBT; n = 38), which consisted of group and individual counseling. During most of the 1-year follow-up, compared with participants who received IBT, those who received BCT reported (a) fewer days of substance use, (b) longer periods of continuous abstinence, (c) lower levels of alcohol, drug, and family problems, and (d) higher relationship satisfaction. However, differences in relationship satisfaction and number of days of substance use dissipated over the course of the posttreatment follow-up period and were not significantly different by the end of 1 year.

Depression in spouses of chronic pain patients: the role of patient pain and anger, and marital satisfaction.

Although several studies have shown that spouses of chronic pain patients may experience clinically significant depressive symptoms few studies have comprehensively examined the role of both patient and spouse-related factors in the development and maintenance of this emotional distress. Twenty-nine married male chronic benign low back pain patients and their spouses were recruited in order to examine the role of patient, spouse, and marital factors in spouse depressive symptomatology. The results indicated that 28% percent of the spouses in the sample reported significantly depressed mood. A 2-stage regression analysis was employed that revealed 3 significant predictors of spouse's depressed mood, namely patient's average pain; patient's reported levels of anger and hostility, and the spouse's level of marital satisfaction. These findings are discussed in terms of their implications for clinical interventions for pain patients and their families.