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This study evaluated the efficacy of a self-paced, Internet-based marriage and relationship skills education program ("Power of Two Online"). The program integrated an online intervention with print supplemental resources. New and expectant parents (n = 79) were randomly assigned to the 2-month intervention or placebo-control group. Assessments were conducted at baseline, 1-month, and 2-month follow-up intervals. Latent growth curve modeling was used to examine differences between conditions for marital satisfaction and conflict management. Participants who received the intervention reported trajectories of improved marital satisfaction and improved marital conflict management over time relative to controls. Implications for widespread dissemination of marriage and relationship education as a primary prevention tool are discussed.
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BRIEF REPORT
A Randomized Clinical Trial of Online–Biblio Relationship Education for
Expectant Couples
Christina J. Kalinka
University of Colorado, Denver
Frank D. Fincham
The Florida State University
Abigail H. Hirsch
TherapyHelp, Inc., Denver, Colorado
This study evaluated the efficacy of a self-paced, Internet-based marriage and relationship skills education
program (“Power of Two Online”). The program integrated an online intervention with print supplemental
resources. New and expectant parents (n79) were randomly assigned to the 2-month intervention or
placebo-control group. Assessments were conducted at baseline, 1-month, and 2-month follow-up intervals.
Latent growth curve modeling was used to examine differences between conditions for marital satisfaction and
conflict management. Participants who received the intervention reported trajectories of improved marital
satisfaction and improved marital conflict management over time relative to controls. Implications for
widespread dissemination of marriage and relationship education as a primary prevention tool are discussed.
Keywords: computer-based interventions, prevention, relationship education, marriage satisfaction
Supplemental materials: http://dx.doi.org/10.1037/a0026398.supp
Marriage and relationship education (MRE) has been widely
adopted as a tool to help couples create happy, healthy rela-
tionships and to decrease divorce rates. Recent meta-analyses
show that MRE increases marital satisfaction and communica-
tion skills while also reducing aggression between partners and
lowering divorce rates (Hawkins, Blanchard, Baldwin, & Faw-
cett, 2008; Blanchard, Hawkins, Baldwin, & Fawcett, 2009). As
the benefit of MRE services becomes clear, calls for ways to
provide a more diverse demographic of couples with empiri-
cally based services in a broader spectrum of settings have
grown (Braithwaite & Fincham, 2011). In light of the need for
new delivery mechanisms and with the explosion of Internet use
and capabilities online resources emerge as a logical vehicle for
MRE delivery. Existing trials of online MRE appear promising,
though they have used only the most basic of technological
advances (e.g., Braithwaite & Fincham, 2011; Duncan, Steed, &
Needham, 2009).
MRE is also especially promising as a vehicle for primary
prevention during high-risk periods. Given the well-documented
stresses and declines in marital satisfaction associated with the
transition to parenthood and birth of a child, we have chosen to
target this intervention to the pre- and postpartum period (e.g.,
Doss, Rhoades, Stanley, & Markman, 2009). Meta-analysis sug-
gests that in-person MRE during this period is able to create
positive impact on marital communication (Pinquart & Teubert,
2010).
In order to increase the reach of empirically validated relationship
education, research done outside the laboratory is critical (Markman
et al., 2004). Effectiveness trials, like this study, which examine
treatment outcomes under the more practical conditions of everyday
implementation, are essential for understanding how a program works
in real-world conditions. Because we wanted to evaluate the potential
of online MRE to function as a broad-based primary prevention
mechanism, we recruited a community-based sample of new and
expectant parents who utilized the intervention from the privacy and
comfort of their own homes and chose when and how much they used
the program. Although such an approach could limit the magnitude of
the program’s effect, the information gleaned from testing the impact
of the program in the real conditions that any Internet-based MRE
would have to function is critical.
In summary, we believe a self-paced, skills-based, Internet-
delivered MRE program for new and expectant parents will create
a scalable and accessible vehicle for leveraging MRE’s primary-
prevention potential, enabling participants to counter the potential
slide into declining marital satisfaction over the pre- and postpreg-
nancy period.
Christina J. Kalinka, Department of Clinical Psychology, University of
Colorado Denver; Frank D. Fincham, Family Institute, The Florida State
University; Abigail H. Hirsch, TherapyHelp, Inc., Denver, Colorado.
This research was funded by the United States Department of Health and
Human Services, Administration for Children and Families, Grant 90-FE-
0123.
Abigail H. Hirsch is an owner of the Power of Two Online program.
Correspondence concerning this article should be addressed to Christina
J. Kalinka, Department of Clinical Psychology, University of Colorado
Denver, Campus Box 173, 1200 Larimer Street, Room 5005D, Denver, CO
80217-3364. E-mail: christina.kalinka@ucdenver.edu
Journal of Family Psychology © 2012 American Psychological Association
2012, Vol. 26, No. 1, 159–164 0893-3200/12/$12.00 DOI: 10.1037/a0026398
159
Method
Participants and Procedure
We recruited a community sample of heterosexual individuals in
committed relationships at metropolitan obstetrics/gynecology of-
fices and via Internet advertising. Participants were required to be
trying to conceive, currently pregnant, or parenting an infant under
age one. They also needed to have no major mental health con-
cerns, be proficient in English, and be interested in receiving an
online relationship skills intervention in accordance with our ap-
proved Western Institutional Review Board protocol. All assess-
ment, including informed consent, was conducted entirely online.
Participants were randomly assigned to the intervention condi-
tion or a placebo-control condition using a computer-generated,
randomization list (see Figure 1 for subject flow). At baseline
measurement (pretreatment), there were no significant between
group differences on demographic or independent variables (i.e.,
age, gender, education, race/ethnicity, relationship status, time in
relationship, living arrangement, number of children, pregnancy
phase), or dependent variables (i.e., relationship satisfaction, con-
flict resolution, depression) when comparing subjects assigned to
the intervention condition with those assigned in the placebo-
control condition.
In addition, there were no significant differences at baseline
measurement on demographic independent variables or dependent
variables when comparing subjects that completed the study to
those who were lost during follow-up, both within their respective
condition (i.e., comparing the specific condition’s completers to
the specific condition’s drop outs) and across all conditions (i.e.,
comparing everyone who completed the study to all those who
dropped out of the study). We also computed change from baseline
to 1 month and found no substantial differences between those
who dropped out with those who completed the study.
The intervention condition received access to an interactive
MRE intervention teaching broad relationship skills (“Power of
Two Online”) and associated resource materials after completing
the baseline online assessment. Power of Two Online consisted of
12 different modules grouped into five areas: Overview, Commu-
nication, Emotion Regulation, Decision Making, and Positivity
and Intimacy. See Table 1 for more details on the types of skills
taught in each unit. Each module had 8 to 12 specific activities that
could be completed in any order, such as interactive flash games,
videos, real-world challenges, and assignments related to sections
from the Power of Two print and DVD resources also sent to each
participant (Heitler, 1997; Heitler & Hirsch, 2003, 2006). More
details on the intervention are provided in the online supplemental
materials. During the first active intervention month, participants
received biweekly reminders to use the online materials via their
choice of text-message or e-mail. After this, they receive biweekly
generic messages expressing appreciation for participation or shar-
ing generic relationship statistics.
The control group was asked to complete the same online
assessments as the intervention condition. Participants in the con-
trol condition were told that they would be participating in a study
of relationship education and would receive regular communica-
tion from our team with information about marriage as well as
when they would be asked to take assessments. During this period,
they received the same kinds of generic messages that the inter-
vention group received during their second month. After the study
was completed, control group participants were offered the online
intervention.
Participants were generally in their late twenties (N79; mean
[M]
age
28 years, standard deviation [SD]
age
5.75 years) and
female (85.7%). The ethnic breakdown of participants was as
follows: 84.3% White (non-Hispanic), 7.1% Hispanic, 5.7% bira-
cial, and 2.9% Black. Participants were relatively diverse in terms
of educational background—approximately half held a bachelor’s
degree or higher (51.5%), 47.1% completed high school, and 1.4%
reported that they did not have a high school education. Partici-
pants mostly were having their first or second child (42.9% and
40.0%, respectively), and were married (72.9%). On average,
subjects had been with their partner/spouse for 5.41 years (SD
3.39 years). Of the 27.1% of participants who reported that they
were not currently married, 78.9% said they were currently cohab-
Randomized (n = 118)
Assessed for eligibility (n = 151)
ENROLLMENT Excluded for not meeting inclusion criteria (n = 33)
Other condition not used in this study (n = 39)
Placebo Control (n = 34)
Number o f Completed Asse ssments:
Baseline - Time 1: 31
One month - Time 2: 28
Two month - Time 3: 27
Reasons for dropout: Did not respond to
our multiple attempts to contact
Number o f Completed Asse ssments:
Baseline - Time 1: 39
One month - Time 2: 29
Two month - Time 3: 21
Reasons for dropout: Did not respond to
our multiple attempts to contact
Power of Two Online Intervention (n= 45)
Figure 1. Sampling and flow of participants through the randomized
clinical trial. Please note that the other condition not used in this study was
a 1-month waitlist control group without follow-up data, therefore not
appropriate for the latent growth curve model used in our analyses.
Table 1
Power of Two Online Intervention Skills
Topic area Power of two skills covered
Overview 1. Why marriage skills?
2. Does marriage matter?
3. Introduction to skill areas
Communication 4. Talking
5. Listening
6. Dialogue
Emotion regulation 7. Understanding anger
8. Managing anger
Decision making 9. Decision making patterns
10. Win–win decision making
Positivity and intimacy 11. Being a supportive spouse
12. Building intimacy
13. Maintaining safety
Note. For more details about the skills covered in the Power of Two
online MRE Intervention, see http://www.PowerofTwo
Marriage.com
160 KALINKA, FINCHAM, AND HIRSCH
iting with their significant other. Although including participants
from across the pregnancy/young baby demographic might lessen
the program’s overall effect, in the spirit of an effectiveness trial,
we opted for broad inclusion criteria. Only one member of a couple
was allowed to complete study surveys, although subjects were
encouraged to share materials with their spouse/partner.
Measures
Participants completed the Ineffective Arguing Inventory
(IAI: Kurdek, 1994), which is a measure of conflict resolution;
the Couples Satisfaction Index (CSI: Funk & Rogge, 2007),
which is a measure of relationship satisfaction; and the Center
for Epidemiologic Studies Depression scale (CESD; Radloff,
1977), which is a measure of depressive symptom severity.
Coefficient alphas for these measures in the present sample
were .95 for the IAI, .95 for the CSI, and .86 for the CESD.
Means and standard deviations at baseline, 1 month and 2
month follow-ups are presented in Table 2.
Results
Latent growth curve (LGC) analysis was used to examine the
data. Please note all references related to statistical methodology
are provided in the Appendix. LGC represents repeated measures
of a given concept as a function of time. Each time point mea-
surement is an indicator of two latent growth factors, initial status
and change of slope, on which individuals may vary. Because
initial status is similar to the intercept in a regression equation, the
unstandardized loadings of all indicators (the three time points for
each subscale) on initial status were fixed to one. To specify a
linear trend, the loading of T1 on slope was fixed to 0, T2 was
fixed at 1, and T3 was fixed at 2; this is analogous to centering in
hierarchical linear modeling.
Because postpartum depression impacts 10 –15% of the post-
partum population, is likely to correlate with marital satisfaction/
functioning and would likely vary over the course of our interven-
tion, we chose to include depression scores as a time varying
covariate (Robertson, Grace, Wallington, & Stewart, 2004).
Condition was included in the model as a fixed covariate, and
the variances from the latent variables (intercept and slope) were
allowed to covary; thus, providing information about the relation-
ship between initial levels of the dependent variable and the rate of
change across time. Specifying the model as described provides
information about the impact of the intervention on change or
“growth” over time. By using maximum likelihood estimation,
missing data could be handled so that a growth curve could be fit
for all respondents even if they did not have complete data.
Ineffective Arguing
When ineffective arguing was entered into the model, a negative
variance contributed to a nonpositive definite matrix (a Heywood
case). Per standard practice, the offending variance was set to zero
and the model was rerun. The corrected model provided a good fit
to the data that was not significantly different from the uncorrected
model,
2
(9) 10.79, p.29, comparative fit index (CFI) .99,
Tucker Lewis Index (TLI) .87; root mean square error approx-
imation (RMSEA) 0.054. In this model, condition predicted
slope such that those who received the intervention showed more
effective arguing over time relative to the control group, (␤⫽
.40, p.005, Hedges’ g.42). Slope and intercept were
significantly inversely associated (r⫽⫺.39, p.05) with one
another, suggesting that higher initial levels of ineffective arguing
were associated with a lower rate of change in ineffective arguing
over time. See Figure 2 for path diagram.
Relationship Satisfaction
When scores for the CSI were entered into the model, a negative
variance was generated, thus the offending estimate was set to 0
and the model was rerun. The corrected model provided an excel-
lent fit to the data that was not significantly different from the
uncorrected model,
2
(9) 4.84, p.84, CFI 1.00, TLI
1.07; RMSEA 0.00. In this model, condition only predicted
slope such that those who received the intervention had greater
satisfaction over time relative to the control group (␤⫽.420, p
.005, Hedges’ g.24).
Slope and intercept were not significantly associated, suggesting
that initial levels of relationship satisfaction were not associated
with the rate of change in satisfaction over time. See Figure 3 for
path diagram.
Discussion
This effectiveness study investigated the impact of a self-paced,
skills-based, Internet-delivered MRE program administered to new
and expectant parents. The Power of Two Online appears to be
Table 2
Couples Satisfaction Index and Ineffective Arguing Inventory Means and Standard Deviations
Baseline 1-month F/U 2-month F/U
NM(SD)NM(SD)NM(SD)
Intervention
CSI 39 4.83 (1.10) 29 4.91 (1.21) 21 5.10 (1.21)
IAI 39 2.54 (.77) 29 2.41 (.85) 21 2.27 (.81)
Placebo control
CSI 31 5.14 (.90) 28 4.88 (.99) 27 4.85 (.89)
IAI 31 2.49 (.73) 28 2.63 (.72) 27 2.58 (.72)
Note. CSI Couples Satisfaction Index; IAI Ineffective Arguing Inventory. F/U follow-up. Higher CSI
scores higher relationship satisfaction. Higher IAI scores higher level of ineffective arguing skills.
161
SELF-PACED ONLINE RELATIONSHIP EDUCATION
viable as a primary prevention tool for preventing relationship
decline during the period around the birth of a child. Specifically,
we found that individuals in the intervention condition showed
more productive management of conflict situations and experi-
enced less of a decline in relationship satisfaction relative to
controls.
These findings are particularly striking when looked at in com-
parison with other studies presented in the meta-analysis of in-
person MRE for expectant parents. Though our observed effect
sizes both fall in the small range (Hedges g of .2 to .49), they are
also comparable to far more intensive and expensive workshop-
based interventions. For example, Pinquart and Teubert (2010)
found average effect sizes of around .3 for impact on couple
adjustment and communications for interventions with six or more
in person sessions. This work finds effect sizes of a similar
magnitude for this self-paced, online– bibliotherapy intervention.
Limitations and Future Directions
Our study has several limitations. First, it focused on partici-
pants at a unique life-stage transition. Although having more
resources in the empirically validated toolbox for expectant par-
ents is most certainly an asset, research extending this online MRE
intervention to a wider cross-section of couples would be benefi-
cial in determining its overall scope of effectiveness.
Second, it would have been ideal to have a long-term follow-up.
Future work investigating long-term impact and best practices for
increasing duration of gains from an online MRE resource would
also be advantageous.
A third limitation in this work concerns questions raised by the
mixed Internet and print materials provided to participants. Be-
cause data are not available on the degree to which participants
used the print versus the Internet materials, we were not able to
determine the relative impact of the two aspects of the interven-
tion. In addition, the literature on the efficacy of bibliotherapy for
MRE is also strikingly lacking—to the best of our knowledge, the
current literature includes no studies that directly address this
question. At the same time, there is some evidence from a related
domain, parenting skills, that self-paced bibliotherapy does appear
effective (Sanders, Markie-Dadds, Tully, & Bor, 2000), suggesting
that this aspect of our combined Internet– bibliotherapy interven-
tion may have been a potent contributor to the overall demon-
strated effect.
Two lines of future work would be merited here. First, would be
to tease out the relative impact of the print versus Internet mate-
rials— especially, as more of the print content is made available in
a digital format. Findings by Greg et al. (1999) about limitations of
self-directed bibliotherapy for treating panic attacks as compared
to bibliotherapy combined with periodic check-ins with a clinician
suggest a second direction for future work—that the programs
overall efficacy might be enhanced if a light-touch personalized
check-in could be added to the program.
Fourth, the relatively high attrition levels, especially in the
intervention condition are less than ideal. It is certainly possible
that attrition in the intervention condition was driven by people not
finding the intervention helpful, whereas similar people did not
drop out from the control condition. This would result in the
appearance of more impact than was actually created and the
findings of this initial report should be read with some caution in
light of this possibility. While such loss is likely normal for any
real-world application, future work should look both to identify
ways to reduce attrition and equally important must be designed to
test if attrition is truly at random or has systematic bias.
Because this was an effectiveness study, we did not have the
level of experimental control of a laboratory-based intervention.
Unfortunately, we know nothing about what materials participants
focused on most and how regularly they used the materials, mak-
ing it impossible to distinguish which components of the interven-
tion were the most helpful (e.g., online course components, video,
supplemental print resources). Future work should address more
specifically best practices for Internet-based MRE. How much
material and at what time periods? How important is repeated
exposure over time? What types of materials create the most robust
changes? The possible digital MRE delivery formats are numerous
and rapidly expanding, so it is crucial that we increase our sophis-
Group
Intercept Slope
IAI (time 1) IAI (time 2) IAI (time 3)
-.40 .03
-.39
Figure 2. Ineffective Arguing Inventory (IAI).
Group
Intercept Slope
CSI (time 1) CSI (time 2) CSI (time 3)
-.25
.42 -.15
Figure 3. Couples Satisfaction Index (CSI) model diagram.
162 KALINKA, FINCHAM, AND HIRSCH
tication about the strengths and limitations of each type of media
on its own and in conjunction with other media types.
Likewise, data gathered in the study also does not include
information about dosage rates for each participant. While our
qualitative impressions based on e-mails with participants prior to
sending them compensation checks left our team with the belief
that dosage rates varied considerably, we are unable to report on
connections between dosage and impact. It is possible that a
just-in-time approach like this can create considerable impact by
providing even just a very brief dose of learning on a highly
relevant topic. At the same time, it may be that the program’s
impact comes from the sustained, consistent presence that is pos-
sible with an online– biblio approach. Sorting out questions about
optimal dosage would most certainly be an essential component
for future work.
Implications and Conclusions
Our findings support the premise that it is possible to use the
Internet and supplemental print materials to deliver effective MRE.
Specifically, this work indicates that the characteristics of tradi-
tional MRE, such as live teachers and group settings, can be offset
through the use of engaging and interactive digital and print
self-study materials. This study provides a hopeful chord in the
search for a way to make primary prevention MRE available to all
interested individuals and couples. The scalability and cost-
effectiveness of such an approach are most exciting—a course like
Power of Two Online can be delivered for cents per user and is not
constrained by geography. Likewise, the potential to move MRE
into the online world so central in most young couples’ lives is also
encouraging. Indeed, as society becomes increasingly tied to our
digital existence, the future of MRE may depend on our ability to
successfully transition these tools into the digital sphere.
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Received February 2, 2011
Revision received October 12, 2011
Accepted October 20, 2011
164 KALINKA, FINCHAM, AND HIRSCH
... Although these online programs are more cost-effective than in-person interventions (Georgia Salivar, Rothman, Roddy, & Doss, 2018), and help overcome many of the barriers to in-person programs, they still have limitations. One limitation is that both of these programs assume that both members of a couple are willing to participate in the program which may be an unrealistic expectation (Kalinka, Fincham, & Hirsch, 2012;Nowlan, Roddy, & Doss, 2017;Rhoades & Stanley, 2011). Indeed, requiring both members of the dyad to participate in a relationship intervention program has been identified as "the single greatest barrier to widespread dissemination of the programs" (p. ...
... A study of ePREP with individual undergraduate students (their partners did not participate) showed reductions in depressive symptoms, negative affect, anxiety symptoms, frequency of psychological and physical aggression, as well as an increase in trust (Braithwaite & Fincham, 2007) but contrary to the authors' original hypotheses, there was no measurable gain in global relationship satisfaction (Braithwaite & Fincham, 2007). Relatedly, a study of Power of Two Online, an individuallyoriented skills-based intervention directed towards expectant parents, found that those assigned to the treatment condition showed improvements in effective arguing and relationship satisfaction over time (Kalinka et al., 2012). Additionally, a meta-analysis investigating individually delivered relationship education programs for emerging adults found medium (d ¼ 0.36) effect sizes for improving relationship skills and relationship attitudes compared to control groups (Simpson, Leonhardt, & Hawkins, 2018). ...
... A number of the brief interventions that have been reviewed thus far have utilized technology for dissemination; however, all these trials were conducted on desktop and laptop computers (Braithwaite & Fincham, 2007;Braithwaite & Fincham, 2009;Braithwaite & Fincham, 2011;Doss et al., 2016;Kalinka et al., 2012;Nowlan et al., 2017). Moving towards intervention delivery on a smartphone is important because negligible differences in smartphone ownership have been found between race, education level, age, or biological sex (Pew Research Institute, 2018). ...
Article
Although online and app-based relationship interventions have been developed to promote relationship well-being, they require a computer, tablet, or smartphone and a high-speed data connection. Instead, text messaging may be a more cost-effective form of delivery. In the current study, 461 participants from three universities, who were mostly female (73%) and white (68%), were randomly assigned to a control group or to a text message treatment condition where they received one text a day for 28 days. Results indicated that text messaging was rated by participants as a favorable method of treatment delivery. However, romantically-involved college students in the treatment condition did not report significantly greater gains in individual or relationship functioning than couples in the control group. Further, although students in the text intervention did not become violent during the study, they reported fewer decreases in violence than the control group.
... In a study done by Kalinka, Fincham, Frank, and Hirsch (2012), participants in an online, self-directed relationship education program experienced less decline of relationship satisfaction, and more productive management of conflict situations, relative to controls. Similarly, participants in another self-directed PREP-based intervention program were found to have a significantly greater increase in content knowledge between assessments than those in the control group of the study (Loews et al., 2012). ...
... Similarly, Duncan et al. (2010) declared that with the increasing evidence of the effectiveness of MRE, it is extremely important for us to better understand and investigate what characteristics of individuals lead to participation or a lack of participation in marriage preparation and relationship programs. Kalinka et al. (2012) suggest that as benefits of MRE become more apparent, so does the need to provide MRE that is empirically supported to various diverse populations. In addition, it is also alarming that research on MRE programs, despite its growth, has focused so little on the demographics or characteristics of the participants and often looks only at effects of an intervention (DeMaria, 2005). ...
Article
Little is known about the role that personality may play in participation and outcomes of marriage and relationship education (MRE) programs in varying formats and no research has been conducted to assess what role personality and emotional readiness factors may play in the outcomes of self-directed MRE. Data collected through online Relationship Evaluation Questionnaire (RELATE) was used to analyze how personality and emotional readiness factors affect perceived change and helpfulness in self-directed MRE interventions for 746 individuals who participated in such interventions. Extroversion was significant across factors predicting perceived positive change among men and women. Implications of this research for self-directed MRE interventions are discussed.
... Another online relationship program found that participants in their program reported higher levels of relationship satisfaction and sexual satisfaction (Rosier & Tyler, 2017). One randomized controlled trial examining an online couples program targeting expectant couples found that couples who were in the intervention group improved their relationship satisfaction and their ability to manage conflict (Kalinka et al., 2012). These studies, and others, suggest that online relationship education programs positively impact both individual and relationship well-being. ...
Article
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.
... Finally, several web-based romantic relationship enhancement programs exist, some of which teach communication skills, and these often do target couples in distress. However, studies of these programs have only shown benefits for relationship outcomes and have rarely measured changes in interpersonal behaviors (e.g., [63,64]; see [65] for an exception). ...
Article
Background: Millions of people worldwide are underserved by the mental health care system. Indeed, most mental health problems go untreated, often because of resource constraints (eg, limited provider availability and cost) or lack of interest or faith in professional help. Furthermore, subclinical symptoms and chronic stress in the absence of a mental illness diagnosis often go unaddressed, despite their substantial health impact. Innovative and scalable treatment delivery methods are needed to supplement traditional therapies to fill these gaps in the mental health care system. Objective: This study aims to investigate whether a self-guided web-based course can teach pairs of nonprofessional peers to deliver psychological support to each other. Methods: In this experimental study, a community sample of 30 dyads (60 participants, mostly friends), many of whom presented with mild to moderate psychological distress, were recruited to complete a web-based counseling skills course. Dyads were randomized to either immediate or delayed access to training. Before and after training, dyads were recorded taking turns discussing stressors. Participants' skills in the helper role were assessed before and after taking the course: the first author and a team of trained research assistants coded recordings for the presence of specific counseling behaviors. When in the client role, participants rated the session on helpfulness in resolving their stressors and supportiveness of their peers. We hypothesized that participants would increase the use of skills taught by the course and decrease the use of skills discouraged by the course, would increase their overall adherence to the guidelines taught in the course, and would perceive posttraining counseling sessions as more helpful and their peers as more supportive. Results: The course had large effects on most helper-role speech behaviors: helpers decreased total speaking time, used more restatements, made fewer efforts to influence the speaker, and decreased self-focused and off-topic utterances (ds=0.8-1.6). When rating the portion of the session in which they served as clients, participants indicated that they made more progress in addressing their stressors during posttraining counseling sessions compared with pretraining sessions (d=1.1), but they did not report substantive changes in feelings of closeness and supportiveness of their peers (d=0.3). Conclusions: The results provide proof of concept that nonprofessionals can learn basic counseling skills from a scalable web-based course. The course serves as a promising model for the development of web-based counseling skills training, which could provide accessible mental health support to some of those underserved by traditional psychotherapy.
... Derivado deste, o Within Our Reach tem como foco casais e apresentou resultados positivos tanto no pós-intervenção quanto no seguimento de 30 meses, em um estudo recente (Rhoades, 2015).O Relationship Evaluation (RELATE) e o Couple CARE (Halford et al., 2003), são programas em formato autoguiado, com o foco na comunicação entre os membros do casal. O Power of Two é uma versão inteiramente online de educação conjugal (Kalinka, Fincham, & Hirsch, 2012). O Family Foundations (Feinberg & Kan, 2008), o Working Together Program (Owen & Rhoades, 2012 ) e uma versão adaptada do Couple CARE para pais (Petch, Halford, Creedy, & Gamble, 2012a) têm também sido aplicados a casais parentais buscando desenvolver estilos parentais mais saudáveis e, consequentemente, alcançar melhores desfechos para os filhos. ...
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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.
... To our knowledge, aside from this study's pilot version, [40] this is the first IBCT study for PG involving more than one person in treatment. Other studies have investigated couple therapies on-line, e.g. the Our Relationship program, [41][42][43] on-line help for couples with sexual dysfunction, [44] expectant couples [45] and for children with mental health problems and their care-givers. [46] Several studies have investigated internet-based interventions involving only the gambler. ...
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Background and aims: There is evidence that cognitive behavioral therapy (CBT) is effective for treating problem gambling (PG). Some research points to the possible benefits of involving concerned significant others (CSOs) in treatment. This study compared the efficacy of behavioral couples therapy (BCT) and CBT for both the gambler and the CSO. Design: Two parallel-group randomized controlled study comparing two different Internet-based treatments for PG. Follow-up measures were conducted at treatment finish, and at 3-, 6- and 12-month post treatment. Setting: Stockholm, Sweden. Participants: A total of 136 problem gamblers and 136 CSOs were included in the study: 68 gamblers and 68 CSOs for each treatment condition. The gamblers were on average 35.6 years old and 18.4% were female. CSOs were on average 45.3 years old and 75.7% were women. Interventions: A treatment based on BCT was compared with a CBT intervention. Both treatments were Internet-based with 10 therapist-guided self-help modules accompanied by weekly telephone and e-mail support from a therapist. CSOs were given treatment in the BCT condition, but not in the CBT condition. Measurements: The primary outcome measures were Time-Line Follow-Back for Gambling (TLFB-G), and the NORC Diagnostic Screen for Gambling Problems (NODS) for problem gamblers, corresponding to DSM-IV criteria for Pathological Gambling. Secondary outcomes measures were Patient Health Questionnaire-9 (PHQ-9), The Generalized Anxiety Disorder 7-item scale (GAD-7), The Relation Assessment Scale Generic (RAS-G), The Alcohol Use Disorders Identification Test (AUDIT), The Inventory of Consequences of Gambling for the Gambler and CSO (ICS), and adherence to treatment for both the problem gambler and the CSO. Findings: The outcomes of both gambler groups improved, and differences between the groups were not statistically significant: TLFB-G: multiplicative effect = 1.13, 95% [0.30;4.31]; NODS: multiplicative effect = 0.80, 95% [0.24;2.36]. BCT gamblers began treatment to a higher proportion than CBT gamblers: p = .002. Conclusions: Differences in the efficacy of Internet-based behavioral couples therapy and cognitive behavioral therapy for treatment of problem gambling were not significant, but more gamblers commenced treatment in the behavioral couples therapy group.
... However, this may not prevent deterioration in marital quality over time (Cobb & Sullivan, 2015). Couples who used an online program teaching relationship skills had higher satisfaction levels over time (Kalinka, Fincham, & Hirsch, 2012). Other educational interventions found beneficial included using pamphlets and short messages on mobile phones (SMS) regarding pre-menstrual syndrome, which in turn increased men's knowledge and practices regarding pre-menstrual syndrome to improve marital satisfaction in both men and women (Morowatisharifabad, Karimiankakolaki, Bokaie, Fallahzadeh, & Gerayllo, 2014). ...
Article
Background: Infertility, or the inability to conceive or carry a pregnancy to live birth, affects one in sixteen married women. Stress that arises from infertility treatment may affect marital interaction, specifically, satisfaction. An emerging approach in infertility diagnosis and treatment called NaProTECHNOLOGY (NPT) may benefit marital interactions; however, no studies have explored marital satisfaction in this specific population. Objectives: To examine demographic variables and marital satisfaction scores in couples with infertility who are using NPT. Methods: A quantitative, descriptive, cross-sectional study was completed utilizing demographic surveys and the Index of Marital Satisfaction (IMS). Results: The sample consisted of 36 couples with mean ages of 34.67 years for men and 33.31 years for women; most were White, held at least a bachelor’s degree, employed, had an annual income of $75,000 or greater, and Catholic. Mean IMS scores were 12.08 for men and 11.75 for women, indicating marital satisfaction. Paired t-tests demonstrated no statistical significant difference between genders (p = 0.772), but did show a positive Pearson correlation of 0.672. A scatter plot demonstrated a positive relationship with a linear regression (r²) of 0.451. There were no statistically significant relationships between IMS scores and demographic variables. Conclusions: The majority of couples reported marital satisfaction. It is difficult to determine if this is related to the demographics of the respondents or related to NPT. Implications for Nursing: Nurse practitioners should be aware of the potential effect infertility and treatment can have on marital satisfaction. Future studies are necessary to further explore and expand this topic.
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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.
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Flexible-delivery marriage education (ME) has many advantages over traditional alternatives in reaching couples during the time of COVID-19 lockdown or other national emergencies. In an effort to add to the research of flexible-delivery ME, this exploratory study evaluated an online class adapted from an empirically-validated, marriage curriculum (Four Gifts of Love Class, [FGL]) under home lockdown conditions lasting over 2 months caused by COVID-19 government restrictions. Using a concurrent multiple-baseline single-case experimental design, three distressed couples residing in the Philippines completed seven online lessons over 7 weeks while experiencing home lockdown. Visual analysis of the data suggested that all three couples responded positively to the intervention. The Tau-U and SMDall analyses for each couple ranged from a small to large effect size on measures of marital adjustment (weighted average Tau-U = .50, p < .05; BC-SMD = 0.34) and romantic love (weighted average Tau-U = .52, p < .01; BC-SMD = 0.31), with increases reaching clinical and statistical significance for one couple out of the three. In addition, there was no attrition. The promising results from this preliminary study suggested that the online adaptation of FGL as a flexible-delivery ME could mitigate marital decline, especially during times of calamity when traditional-delivery ME is unavailable and marital decline is predicted. Further study of this program and other online ME programs are recommended to expand the limited research in this area of flexible-delivery ME.
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This brief describes the types and prevalence of outcomes measured in evaluations of HMRE programs over the last decade at the individual, couple, family, and community levels. The brief ends with a discussion about the potential implications of these findings, as well as various considerations for evaluators and practitioners when selecting outcomes for HMRE evaluations.
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In this article we discuss, illustrate, and compare the relative efficacy of three recommended approaches for handling negative error variance estimates (i.e., Heywood cases): (a) setting the offending estimate to zero, (b) adopting a model parameterization that ensures positive error variance estimates, and (c) using models with equality constraints that ensure nonnegative (but possibly zero) error variance estimates. The three approaches are evaluated in two distinct situations: Heywood cases caused by lack of fit and misspecification error, and Heywood cases induced from sampling fluctuations. The results indicate that in the case of sampling fluctuations the simple approach of setting the offending estimate to zero works reasonably well. In the case of lack of fit and misspecification error, the theoretical difficulties that give rise to negative error variance estimates have no ready-made methodological solutions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Preliminary psychometric data are presented for two inventories that assess conflict in couples. The Ineffective Arguing Inventory (IAI) is a self-report measure that assesses a dysfunctional style of couple conflict resolution. The Conflict Resolution Style Inventory (CRSI) has complementary self-report and partner-report versions that assess four personal conflict resolution styles for each member of the couple. Subjects were both partners of 75 gay, 51 lesbian, 108 married nonparent, and 99 married parent couples. Findings for each inventory are presented regarding the factor structure of items, the internal consistency of composite scores, the 1-year stability of composite scores, the relation between couple members' composite scores, and the link between composite scores and relationship satisfaction, change in satisfaction, and relationship dissolution. Generally, results warrant further examination of the IAI and CRSI as measures of conflict for couples.
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The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
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There is growing evidence that self-directed marriage relationship interventions can produce measured benefits. In this study we experimentally evaluate the potential of web-based marriage education, as a self-directed approach, to generate measurable positive outcomes in marriage relationships, compared with traditional marriage education and to a control group. Both website and traditional marriage education interventions produced positive changes to exceed those in the control group. There was no difference in the magnitude of change produced by the traditional versus the website intervention. Implications of the findings for marriage and relationship education are discussed.
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We present an evaluation of the extent to which an empirically based couples' intervention program was successfully disseminated in the community. Clergy and lay leaders from 27 religious organizations who were trained to deliver the Prevention and Relationship Enhancement Program (PREP) were contacted approximately yearly for 5 years following training to determine whether they still used PREP and which aspects were used. Results indicated that 82% continued to use at least parts of the program, especially parts dealing with communication and conflict management. Results also showed that clergy and lay leaders extended the use of the curriculum from premarital couples to married couples. We discuss implications for future efforts toward disseminating empirically based programs into community settings.
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The present meta-analysis integrates results of 21 controlled couple-focused interventions with expectant and new parents. The interventions had, on average, small effects on couple communication (d = .28 standard deviation units) and psychological well-being (d = .21), as well as very small effects on couple adjustment (d = .09). Stronger effects emerged if the intervention included more than five sessions, included an antenatal and postnatal component, and was led by professionals rather than semiprofessionals.
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