Prevention of marital dysfunction: behavioral approaches and beyond.

Marital dysfunction is a significant problem in the U.S., with far-ranging effects on the mental health, physical health, and economic well-being of people who experience it. In addition, marital discord and divorce appear to have adverse effects on children. This review describes the historical roots of current prevention programs and critically reviews marriage preparation programs that have been examined in the peer-reviewed literature. The results of 13 studies suggest that behaviorally oriented, skills-based marriage preparation programs can lead to behavioral changes that may help prevent the emergence of marital dysfunction. Whereas there has been modest improvement in the methodology of the program evaluations, suggestions for continued improvements are made. Ways to enhance the effectiveness of marriage preparation programs using the principles of prevention are described.

Family interactions of schizophrenic and schizoaffective patients: determinants of relatives' negativity.

Videotaped family problem-solving interactions of 57 schizophrenic or schizoaffective patients and their relatives were examined for predictors of negativity of their communication behavior. Ratings of patients' behaviors and independent assessments of patients' symptomatology were used to predict the negativity of relatives in the videotaped interaction. The results indicated that severity of symptomatology was not related to relatives' negativity. Patients' social skill, as independently assessed by a role-play test, also was not associated with relatives' negativity. The regression results suggest that with both members of a patient-relative dyad, the quality of communication in a discussion is related to the other participant's level of negativity.

Intimate relationships and depression: is there a causal connection?

The causal pathways that link depression and dissatisfaction in intimate relationships were estimated in 115 patients during the first 12 weeks of treatment with cognitive-behavioral therapy for depression. Depression severity, as measured by the Beck Depression Inventory, was negatively correlated with relationship satisfaction at intake and at 12 weeks. However, structural equation modeling was not consistent with the hypothesis that depression severity has a causal effect on relationship satisfaction levels and suggested that relationship satisfaction may have only a weak reciprocal effect on depression severity. As predicted, married patients were substantially less depressed 12 weeks after the beginning of treatment, when controlling for initial depression severity. Contrary to expectations, marital status predicted improvement even when relationship satisfaction was controlled. Unexpectedly, dysthymia at intake was associated with low relationship satisfaction after 12 weeks, when initial relationship satisfaction was controlled, suggesting that chronic, low-level depression may have a stronger association with interpersonal problems than other forms of depression, such as major depressive episodes. The theoretical and clinical implications of the findings are discussed.

A multisite investigation of the reliability of the Scale for the Assessment of Negative Symptoms.

OBJECTIVE: The Scale for the Assessment of Negative Symptoms is a widely used instrument for measuring negative symptoms in schizophrenia, but few studies have examined its reliability. This study examined the interrater, internal, and test-retest reliabilities of the scale and its factor structure in the context of a multisite study. METHOD: Two hundred seven patients with schizophrenia who were participating in the Treatment Strategies in Schizophrenia study were assessed with the Scale for the Assessment of Negative Symptoms following a symptom exacerbation and again 3-6 months later. All assessments were performed by trained psychiatrists who were treating the patients. RESULTS: Interrater reliabilities ranged from low to high for the items on the Scale for the Assessment of Negative Symptoms but were statistically significant in most cases. Most correlations between individual items and subscale total scores were moderate to high, as were coefficient alphas for each subscale, indicating adequate internal consistency. Test-retest correlations were of moderate magnitude. Few differences in reliability statistics between sites were found, although differences in mean scale ratings between sites were present. A factor analysis indicated three factors corresponding to the Affective Flattening or Blunting subscale, the Avolition-Apathy and Anhedonia-Asociality subscales, and the Alogia and Inattention subscales. CONCLUSIONS: The results suggest that the Scale for the Assessment of Negative Symptoms has good reliability and is a useful instrument for the measurement of negative symptoms in multisite clinical studies. The internal reliability of the Alogia, Avolition-Apathy, and Inattention subscales could be improved by replacing some items and including additional items.

Expressed emotion, social skill, and response to negative affect in schizophrenia.

The social skills and social perception of schizophrenia patients in response to negative affect was examined as a function of family expressed emotion (EE). Patients participated in a role-play test, a social perception test, and a problem-solving discussion with a family member and were assessed on several measures of symptomatology. EE of family members was evaluated with the Camberwell Family Interview. On the role-play test, patients with less critical relatives became more assertive in response to increased negative affect from a confederate portraying either a family member or friend, but patients with highly critical relatives did not. Patients with highly critical relatives were also less assertive when confronted with negative affect from a confederate portraying a family member rather than a friend. The behaviors of both relatives and patients during a family problem-solving interaction were related to the EE dimensions of criticism, emotional overinvolvement, and warmth. Patient gender was also related to family problem solving but was independent of EE. Patient ratings of affect on a videotaped social perception task were not related to family EE, and there were few differences in psychopathology between patients with high and low EE relatives. The results support the validity of the EE construct as an index of relatives' affective behavior and suggest that patients' social skills, such as assertiveness, may mediate negative affective exchanges in their families.

An assessment of the educational needs of chronic psychiatric patients and their relatives.

Both psychiatric patients and their relatives benefit from learning about mental illness and how to cope with it, but the specific interests of these consumers remain unclear. To determine specific educational needs and to compare the needs of different consumers, a questionnaire survey was conducted with a sample of patients with schizophrenia and affective disorder and their relatives. Both patients and relatives reported strong interest in learning more about psychiatric illness and strategies for coping with common problems, but patients with schizophrenia were less interested than patients with affective disorder and both sets of relatives. Discriminant analyses revealed that needs differed as a function of patient diagnosis, patient/relative status, and relatives' membership of a self-help and advocacy organisation. Consumers of mental health services are capable of specifying their own educational needs, and educational programmes should be tailored to meet these.

Role of femininity and masculinity in distressed couples' communication.

The relationship between sex role identity and marital communication of maritally distressed couples was examined. Interactional behavior of 60 maritally distressed couples was coded with the Marital Interaction Coding System and examined in relation to the level of femininity and masculinity of the spouses. Base-rate analyses indicated that femininity was positively related to greater rates of negative behavior among husbands and wives. As predicted, sequential analyses supported that wives' femininity was associated with greater negative reciprocity of the wives. Men's femininity was associated with husbands' tendency to terminate fewer negative sequences of behavior in comparison with their wives. High masculinity of the wives was associated with shorter sequences of negative behavior. Implications of the findings and future directions for research are discussed.

Supplementing behavioral marital therapy with cognitive restructuring and emotional expressiveness training: an outcome investigation.

The current study investigated whether the effectiveness of behavioral marital therapy (BMT) would be increased by the addition of cognitive restructuring (CR) and/or emotional expressiveness training (EET) for maritally distressed couples. Sixty such couples were randomly assigned to 1 of 3 therapists and 1 of 5 treatment conditions (BMT Alone, CR + BMT, BMT + EET, CR + BMT + EET, or waiting list) for 12 weeks of conjoint marital therapy. Within each treatment condition, couples typically improved on the variables focused on in treatment. However, comparisons among active treatment conditions showed few significant differences among treatments; the treatments were equally effective in increasing marital adjustment. Thus, the addition of CR and EET did not appear to increase the overall effectiveness of treatment. Possible reasons for the current findings are provided, and suggestions for future marital outcome investigations are outlined.

Creating images of the future: a simulation game for dietetics students.

A learning activity was developed for senior dietetics students to prepare them to respond to a changing future. It combined two methods commonly used to study the future--scenarios and simulation games. The simulation game asked the players to make career choices in accordance with specified scenarios in the areas of politics, economics, health care, foodservice systems, education, and technology. Scenarios could change throughout the game, either by chance or the choice of the players. Major factors affecting individual life-styles, such as acquiring a partner or children, were included. Each player made career choices at 5-year intervals, as he or she moved through life from the present age to age 65. At each age interval, the players discussed the options created by the scenarios in relation to the availability of career choices. Student and instructor response to the activity has been favorable.