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A Randomized Clinical Trial of a Computer Based Preventive Intervention: Replication and Extension of ePREP
Abstract
This randomized clinical trial replicated the efficacy of the ePREP preventive intervention for mental health and relationship relevant outcomes in a sample of 77 college students. It extended previous research by demonstrating efficacy at a 10-month follow up. Participants in the ePREP condition experienced improved mental health and relationship relevant outcomes relative to those who received a placebo intervention. The impact of the ePREP intervention on these outcomes was durable to relationship dissolution with and without repartnering. The flexibility of this intervention empowers it to overcome key obstacles in the dissemination of relationship education.
... Traditionally delivered in-person, RE has become increasingly available in online formats as a way to make programs more accessible (Georgia & Doss, 2013;Turner et al., 2019). Research comparing the outcomes between in-person and online RE programs is somewhat limited (Braithwaite & Fincham, 2009Roddy et al., 2018), and very few studies have compared the outcomes of these delivery methods in the midst of a crisis that forced the reorganization of program delivery (Higginbotham, Turner, & Bradford, 2021). ...
... Online RE for couples has been found to have mainly positive impacts (Braithwaite & Fincham, 2007, 2009, 2014Georgia & Doss, 2013;Georgia Salivar et al., 2018;Nadan et al., 2020;Roddy et al., 2017;Roddy et al., 2018;Simpson & Reid, 2014). Still, it is important to note variations in approaches, which range from self-guided, asynchronous programs (Braithwaite & Fincham, 2007, 2009, 2014, a blend of synchronous and asynchronous delivery (Doss et al., 2019;Georgia Salivar et al., 2018;Roddy et al., 2017), or purely synchronous delivery, as evaluated in this current study. ...
... Online RE for couples has been found to have mainly positive impacts (Braithwaite & Fincham, 2007, 2009, 2014Georgia & Doss, 2013;Georgia Salivar et al., 2018;Nadan et al., 2020;Roddy et al., 2017;Roddy et al., 2018;Simpson & Reid, 2014). Still, it is important to note variations in approaches, which range from self-guided, asynchronous programs (Braithwaite & Fincham, 2007, 2009, 2014, a blend of synchronous and asynchronous delivery (Doss et al., 2019;Georgia Salivar et al., 2018;Roddy et al., 2017), or purely synchronous delivery, as evaluated in this current study. ...
The restrictions imposed by the COVID-19 pandemic have required program planners to re-evaluate the provision of relationship education (RE). The current mixed-methods study focuses on the Healthy Relationships [State] initiative's transition from in-person to virtual online RE programing, measuring program impact and comparing the outcomes between the two delivery methods for individuals participating in Couple LINKS, a curriculum designed for adults in committed relationships. Comparisons between delivery methods revealed that in-person participants showed greater gains than virtual participants on key program measures; however, the outcomes were positive for all. Qualitative responses of virtual participants revealed what they liked most and liked least about the virtual format, citing their appreciation for the curriculum, the opportunity to develop new skills, facilitator quality, online accessibility, and couple time. Schedule conflicts and uneven course pacing, reference materials, technology, and sharing personal information were listed as things participants liked least about the virtual program. Implications for the future delivery of RE programs are discussed.
... ePREP is a skills-based program that teaches couples about risk factors for relationship problems including communication danger signs, conflict management techniques, communication and problem-solving skills, and ways to build commitment and friendship. ePREP has been shown to positively impact several key domains of relationship functioning (Braithwaite and Fincham 2007;Braithwaite and Fincham 2009;Braithwaite and Fincham 2014). In addition to improving the relationship domain, there is evidence that ePREP impacts individual functioning. ...
... In addition to improving the relationship domain, there is evidence that ePREP impacts individual functioning. Specifically, the ePREP program reduced both depression and anxiety symptoms compared to controls at the end of the program (Braithwaite and Fincham 2007) and at 10-month follow-up (Braithwaite and Fincham 2009). ...
... Results replicate and extend previous work on web-based relationship programs' impact on individual mental health. Previous trials of the OR program (Doss et al. 2016;Doss et al. 2019) and ePREP (Braithwaite and Fincham 2007;Braithwaite and Fincham 2009) demonstrated their ability to reduce symptoms of anxiety and depression, findings which were replicated in the present study (the measure of psychological distress is a mixture of depressive and anxious symptoms). This project extends previous work by demonstrating positive benefits to problematic alcohol use, anger, and perceived stress. ...
Relationship distress is a pervasive problem in the USA that disproportionally impacts couples with low-income levels. The goal of the present study was to evaluate the effectiveness of two online relationship interventions, OurRelationship and ePREP, both of which were supported by a paraprofessional coach, in improving mental health and physical health behaviors with low-income couples. Couples (N = 742) were randomized to either intervention or a 6-month waitlist control group and assessed pre-, mid-, and post-intervention as well at 4 and 6 months after randomization. Results from multilevel models indicated that during treatment, compared to couples in the waitlist group, couples in the intervention groups reported significantly greater improvements in mental health that were small to moderate in magnitude (psychological distress, anger, problematic alcohol use, and perceived stress) as well as improvements in physical health/health behaviors (perceived health, insomnia, and exercise) that were small in magnitude. Furthermore, the differences between intervention and waitlist groups were maintained over follow-up. Treatment gains in both mental health and physical health behaviors were generally stronger for those who began treatment with greater difficulties in those areas. Implications of these findings with regard to intervention and policy are discussed.
... The search yielded 17 studies. The symptomology measured within trials were depression [28,[42][43][44][45][46][47][48][49][50][51][52], anxiety [28,[42][43][44][45][46][47][48]50], stress [46,[53][54][55], psychological distress [50,54,56], social anxiety [52], and examination anxiety [57]. Some interventions focused on general psychological well-being: improving relationship functioning [43,44], decreasing elevated levels of perfectionism [28,42], increasing students' use of mindfulness [54], improving international students' social support, acculturation, and hardiness [56], and increasing use of lucid dreaming to help alleviate depression [51]. ...
... The search yielded 17 studies. The symptomology measured within trials were depression [28,[42][43][44][45][46][47][48][49][50][51][52], anxiety [28,[42][43][44][45][46][47][48]50], stress [46,[53][54][55], psychological distress [50,54,56], social anxiety [52], and examination anxiety [57]. Some interventions focused on general psychological well-being: improving relationship functioning [43,44], decreasing elevated levels of perfectionism [28,42], increasing students' use of mindfulness [54], improving international students' social support, acculturation, and hardiness [56], and increasing use of lucid dreaming to help alleviate depression [51]. ...
... The symptomology measured within trials were depression [28,[42][43][44][45][46][47][48][49][50][51][52], anxiety [28,[42][43][44][45][46][47][48]50], stress [46,[53][54][55], psychological distress [50,54,56], social anxiety [52], and examination anxiety [57]. Some interventions focused on general psychological well-being: improving relationship functioning [43,44], decreasing elevated levels of perfectionism [28,42], increasing students' use of mindfulness [54], improving international students' social support, acculturation, and hardiness [56], and increasing use of lucid dreaming to help alleviate depression [51]. Of the studies, seven trials were of three interventions conducted on separate samples; therefore, there are 14 distinct interventions for review. ...
Mental health literacy encompasses an individual’s knowledge and attitudes which influence recognition, treatment and management of a mental health problem. Depression is a common mental health problem experienced by university students, but they often do not seek professional help for their mental health, and prefer more informal sources of help. Online interventions to improve students’ mental health literacy could be a useful and engaging mental health promotion strategy in this population, in order to help improve their recognition and appraisal of depression, their ability to respond to it appropriately (either through seeking professional help or applying self-help), and improve their ability to support others experiencing depression. This thesis describes four studies conducted to inform the development of an online mental health literacy intervention tailored for Nottingham-based university students. These studies describe: 1) a systematic review and meta-analysis of website-based interventions for common mental health problems in university students; 2) a survey-based study investigating the profile of depressive, anxiety and hypomanic/manic symptomology in local students; 3) an interview-based study with students about their mental health and well-being since entering university, and their perspectives about help-seeking and self-management; and 4) an exploratory study investigating students’ mental health first aid skills for a hypothetical friend experiencing depression. This, coupled with literature review of student mental health, mental health help-seeking, and mental health literacy, resulted in the development of the pilot online intervention (“Managing Your Mood Online”), which underwent usability testing with a sample of representative end users. This study found the pilot intervention to be acceptable and usable, but with many potential areas for improvement. This thesis concludes with several considerations for future development of the online intervention.
... These varying early relationship experiences are associated with poorer current functioning (e.g., mental health) and prospective functioning (e.g., relational and well-being outcomes; Collins et al., 2009;Overbeek et al., 2007). Therefore, early adulthood (conceptualized here as individuals between 18 and 30 years of age, similar to Fincham et al., 2011;Hemez, 2018) is a fitting time for relationship education (RE; Rhoades & Stanley, 2009) aimed at equipping individuals and couples with principles and skills to prevent or minimize factors that jeopardize the healthy development of their current and future romantic relationships (Braithwaite & Fincham, 2009). ...
... Participant motivation (i.e., interest) is dependent on the degree to which participants view the covered content areas as relevant to their lives (Hawkins et al., 2004). Previous work has adapted adult RE curricula to early adults (Braithwaite & Fincham, 2009); however, as the pathways to relationships during early adulthood continue to vary, further tailoring of RE content areas based on early adults' specific vulnerabilities and external stressors is important for effectiveness with diverse populations. ...
Objective
The purpose of this study was to explore how vulnerabilities, stressors, and adaptive processes influenced early adults' (N = 1,073) future relational desires and topic preferences in relationship education (RE).
Background
There is great diversity in pathways to relationship formation. Early adults are exposed to risk factors from their past and present relationship experiences that can influence their current and future relational functioning. Thus, there is an increasing need to provide individually relevant relationship education services to ultimately help early adults navigate these diverse relationship processes and transitions. To ensure relevant and successful programing, relationship educators need to consider early adults' future relational preferences and variations in early adults' interest in specific areas of RE content.
Methods
Combining data from a nationally representative sample (N = 436) and a snowball sample (N = 637), we collected information on various risk factors for relationship distress early adults had observed or experienced, demographic information, and current relationship status to identify not only future relational desires but also interest in RE topics.
Results
Results indicated that early adults are concurrently experiencing many risks that influence their future relational desires and interests in specific RE topics.
Conclusion
We demonstrate how each risk factor independently influences an early adult's future relational desires and interest in RE topics, while also highlighting the cumulative effect of risk factors on these outcomes.
Implications
Implications highlight tailoring functions within RE to increase interest and engagement and more precisely address specific participant stressors and vulnerabilities.
... 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). ...
... This study provides evidence that simple prompts designed to increase investment in the relationship might not provide enough dose to improve relationship functioning. Although this sample was in a unique phase of relationship development and ceiling effects could explain part of why we failed to observe a positive impact, other interventions have observed positive effects among emerging adults in dating relationships (e.g., Braithwaite & Fincham, 2007;Braithwaite & Fincham, 2009), suggesting that something more than reminders to invest in the relationship are needed to produce a measurable effect in this population. ...
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 this way, self-directed CRE may successfully mitigate couples' perceived obstacles to attendance (e.g., high monetary cost and time commitment, low privacy), thereby extending the potential reach of CRE (Braithwaite & Fincham, 2007;Wilson & Halford, 2008). On the downside, approaches that are purely self-directed might have some disadvantages, for instance, lack of individualized and personal support and decreasing motivation and engagement of participants, leading to a relatively high level of attrition (e.g., Braithwaite & Fincham, 2009. These are the reasons why self-directed relationship education is often combined with face-to-face components (i.e., blended programs) to strengthen their impact. ...
... This may be the reason why self-directed approaches are increasingly proposed in the context of CRE (Bodenmann et al., 2014;Braithwaite & Fincham, 2014;Halford et al., 2004). By the same token, a drawback of only self-directed programs may be the lack of individualized and personal support couples receive, as opposed to in person delivery (e.g., Braithwaite & Fincham, 2009. Therefore, blended programs strive to combine the advantages of self-directed and face-to-face elements to maximize the efficacy of CRE. ...
The aim of this randomized controlled trial was to examine the efficacy of an evidence-based relationship distress prevention program, the Couples Coping Enhancement Training (CCET), in dual well-earning couples and to investigate whether effects vary by (a) hours of professional contact and (b) mode of delivery (face-to-face vs. self-learning DVD). N = 159 couples were randomly assigned to one of four intervention conditions: (1) standard CCET (15 hours face-to-face), (2) compact CCET (12 hours face-to-face), (3) short CCET (self-learning DVD + 8 hours face-to-face), or (4) wait-list control group. Relationship satisfaction and dyadic coping skills were assessed by means of questionnaires completed prior to and two weeks after completion of the treatment, at 3-month follow-up, and at 6-month follow-up. Baseline latent change models for two factors showed that the CCET enhanced relationship satisfaction and dyadic coping skills in couples relative to the wait-list control group, albeit effects were small. The standard format of the CCET was not more effective than the compact or the short format indicating that reduced amount of professional contact did not decrease the treatment’s efficacy and that the self-learning DVD successfully replaced the psycho-educational part of the program. Since dual earner couples usually face multiple stressors, it is a promising finding that they can strengthen their relationship with a relatively short time investment.
... For instance, the e-Prep program, which was initially developed to strengthen romantic relationships, was proved to reduce depressive symptoms in young adults (171). ...
The COVID-19 pandemic impacted on the mental state of young adults, adolescents and children and was highly researched through the scientific community. Restrictive measures enhanced the psychological consequences of COVID-19 in their lives, altering their emotional state. Thus, the purpose of this systematic review is to describe the impact of COVID-19 in children, adolescents and young adults, giving special focus in Mood Disorders, depressive symptoms and suicide or suicide attempts, during the pandemic. A research in following databases was conducted up to December 28, 2020: Pubmed, Google Scholar, EMBASE, SCOPUS, ERIC, ProQuest and PsycInfo. During the COVID-19 pandemic, children presented mild to moderate depressive symptoms, while adolescents moderate to severe depressive symptoms. Concerning young adults, they also presented mild to moderate depressive symptoms, while in some studies severe to extremely severe depressive symptoms were reported. Suicidal ideation was described in all groups, with different extent in each one. Only one suicide by a teenage girl was reported, during that time. Identifying risk factors for developing depressive symptoms and subsequently leading to Depressive Disorders could be beneficial not only for individuals, but also for their families, peers and health professionals. Preventive programs, in accordance with assessment and treatment, could provide more safety and confidence in youths, promoting their well-being.
... Developing a theory-based online educational game for promoting relational skills in stepcouples Some non-traditional efforts have piloted ways to help stepcouples prevent marital and family difficulties (e.g., online intervention; telehealth; Braithwaite and Fincham, 2009;Gelatt et al., 2010). Web-based self-administered interventions with a behavior-modeling training (BMT) approach (i.e., visual demonstrations of behaviors) appear to increase self-efficacy and motivation (Cairncross and Mannion, 2001). ...
Background: Stepfamilies are a prevalent family form. However, less stable than nuclear, first marriage families due to the presence of risk factors such as the absence of social norms and the presence of stepchildren. Stepfamilies have unique educational needs regarding stepparenting and co-parenting issues. The development and documentation of psychoeducational intervention strategies can facilitate dissemination of ongoing studies and promote transparency. This article describes the background, design and protocol of a randomized controlled trial (RCT) evaluating the eficacy and feasibility of a web-based Psychoeducational Simulation Game (GSteps). Behavior-modeling video training (BMT) is used to demonstrate and promote relational skills, stepparenting and co-parenting effective strategies for adults in stepfamilies. A mental health professional will be available within the GSteps platform for clarification or emotional support.
Methods/design: A RCT design is presented to evaluate the outcomes of a self-administered, interactive and web-based psychoeducational Game targeting dyadic marital adjustment and interpersonal skills as the primary outcomes and remarriage beliefs, family function and stepparenting and co-parenting attitudes as the secondary outcomes. Other outcome measures include satisfaction with GSteps, participants' knowledge learned after the intervention and a purposive sampling method will be used to access feasibility. The minimum required sample size is 112 participants (56 per condition) randomly allocated either to an experimental group (EG), receiving GSteps intervention, or to a wait-list control group (CG). A survey is conducted electronically. Assessments take place at baseline (T 0), after the intervention (T 1) and 1-month follow-up (T 2).
Discussion: This protocol presents a RCT aimed at evaluating the efficacy of a web-based psychoeducational intervention (GSteps) designed for improving marital, stepparenting and co-parenting skills in adults who live in stepfamilies. The use of the protocol and results of intervention studies may guide the use and refinement of web-based psychoeducational intervention for stepfamilies. Additionally, GSteps may become a tool for health professionals to enhance stepfamily functioning, stepparenting skills, and marital adjustment of remarried adults.
... Busby and colleagues (2015) found much higher rates of couple agreement to complete brief online CRE (one session) than more extended online CRE (six sessions). Braithwaite and Fincham (2009) have found significant relationship effects with just a brief computer-based program. Also, the Singapore Family Ministry is offering (and doing an evaluation of) a 2-hour version of the 8-hour PREP program (Nazar, Personal Communication, July 2019). ...
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.
... Consequently, to mitigate relational distress with interventions that may be both more accessible and less threatening to people, practitioners have developed relationship education programs for individuals and couples (Williamson et al., 2019). There are now numerous services available (e.g., online resources and structured programs) that may help individuals strengthen their relationships (e.g., Braithwaite & Fincham, 2009). ...
Although therapy, relationship education, and online relationship resources may help alleviate relational distress, many adolescents and adults eschew help. Deciding to seek help for relationship concerns involves mental processes that reflect behavioral intentions and information-seeking behaviors. The present paper examines the prevalence of adolescents' (N = 183) intentions and behaviors to seek relationship help, and investigates determinants of such decisions. Results indicate that only readiness to change was consistently associated with help-seeking decisions. In contrast, other factors varied, with relationship status associated only with future intentions, and family difficulties associated only with behaviors to seek relational assistance. Programs may benefit from considering methods of disseminating information and encouraging adolescents to reflect upon reasons for considering making changes.
... The commission is implementing an extensive marketing campaign to make couples aware of the discount option and how to take advantage of it. The commission also contracted with the ePREP online relationship education program providers to offer free vouchers to Utah engaged couples to participate in this online, evidence-based program (Braithwaite & Fincham, 2009. This will open up services to those who cannot find a local, face-to-face provider, or who prefer a more private approach to premarital education. ...
... However, ePREP was no more effective in reducing aggression compared with CBASP. A second RCT revealed significant improvements in mental health and relationship outcomes and greater reductions in physical IPV from pre-intervention to a 10-month follow-up for ePREP participants compared with controls, but no difference in physical and psychological abuse during follow-up (Braithwaite & Fincham, 2009). ...
Intimate partner violence (IPV), which includes emotional, physical, and sexual violence in casual/dating and committed relationships, occurs at disproportionately high rates among college students. Prevention in college-age years is developmentally crucial, as college is associated with IPV risk. Relationship skills training has shown preliminary efficacy in decreasing IPV among college students. This article presents data from a controlled trial of Skills for Healthy Adult Relationships ( SHARe), a weekly eight-session (12-hr) group program for college students, which aims to prevent interpersonal conflict and IPV through enhancing positive communication, reducing negative communication, promoting positive relationship attitudes, and strengthening ability to self-regulate in interpersonal contexts. Sixty-two college students (54.8% female) were allocated to the SHARe group or a wait-list control by randomizing to condition and then reassigning some individuals to control based on schedule availability to attend groups. Participants completed self-report measures of positive and negative communication, interpersonal confidence, and perpetration of physical, emotional, psychological, injurious, and sexual violence at baseline, post-group, and at a 3-month follow-up. At baseline, participants reported low levels of recent severe IPV perpetration, but controls reported higher levels of emotional abuse. Analyses controlled for baseline IPV. SHARe participants reported significantly higher confidence in their ability to manage conflicts at post-intervention and significantly lower psychological aggression at the follow-up compared with wait-listed controls. At the 3-month follow-up, self-reported perpetration of psychological abuse was 1.5 times higher for wait-list controls versus SHARe participants. The findings indicate that SHARe can help college students improve their interpersonal skills and develop healthy, non-abusive relationships.
... They found that both approaches produced positive changes compared to the control group and that there was no difference in the amount of change between the intervention approaches. Several studies have examined the effectiveness of a computer-based preventive intervention (ePREP) on IPV (Braithwaite and Fincham 2007;Braithwaite and Fincham 2009;Braithwaite and Fincham 2011;Braithwaite and Fincham 2014). In each case, the authors determined that an online intervention could be an effective means of reducing the incidence or severity of IPV. ...
Although associations between religiosity and marital quality have been demonstrated in previous research, mechanisms still remain unclear. Three 3-step hierarchical multiple regression analyses were conducted to determine whether 10 individual, dyadic or family religious activities or uses of 7 forms of Christian media predicted positive relationship quality, negative interaction and intimate partner violence in a sample of North American Protestants. Joint spousal and family religious activities predicted higher levels of relationship quality. Individual activities, such as reading the Bible, and parent-child activities, such as praying with children and discussing Christians values with children, predicted lower levels of relationship quality. Listening to Christian talk radio and viewing Christian websites or blogs predicted lower levels of relationship quality. The authors inferred that individuals in low-quality relationships use activities such as reading the Bible, listening to Christian talk radio, and viewing Christian websites and blogs to seek information to improve relationships or promote healthy adaptation. Similarly, the authors speculated that praying with children and discussing spiritual values with them were seen as interventionary measures to protect children when parents were in low-quality relationships.
... Emerging adults' sexual partner choices have implications for the outcomes of their sexual interactions; however, limited resources exist for emerging adults navigating hookup culture (Garcia, Reiber, Massey, & Merriwether, 2012;Heldman & Wade, 2010). Existing relationship education programs targeted to emerging adults often focus on building skills within romantic relationships (e.g., Braithwaite & Fincham, 2009), with limited information about decision making in CSREs. Understanding the outcomes of different CSRE types informs the expansion of these programs to address diverse relationship types. ...
Casual sexual relationships and experiences (CSREs) are common among emerging adults, and their diversity may contribute to variability in their associations with mental health and future romantic relationship development. The present research used multiple regression analyses to examine how CSRE type (casual dating, friends with benefits [FWB], or booty call/one-night stand) is associated with short-term outcomes of these experiences, including positive and negative evaluations, plans to start a romantic relationship with a CSRE partner, and general plans for future CSREs. College students and non-college-attending emerging adults (N = 192, 80% female, mean age = 22.09 years) reported on recent sexual encounters through daily diaries collected around an alcohol consumption holiday. Individuals with casual dating partners evaluated their experiences more positively and/or less negatively than individuals with booty calls/one-night stands; these associations were moderated by gender and sexual behavior type. Individuals with casual dating partners were more oriented toward pursuing a romantic relationship with their partners than individuals with FWB or booty calls/one-night stands. However, no association was found between CSRE type and plans for future CSREs in general. Results highlight the diversity of CSREs and suggest that casual dating may be more rewarding than FWB and booty calls/one-night stands, particularly for women.
... Psychoeducational interventions (Braithwaite and Fincham 2009;Aboalshamat et al. 2015) The results of psychoeducational interventions are summarised in Table 1. Results are pooled in meta-analysis in Fig. 2 which presents the comparison of psychoeducational to alternative education on the outcomes of anxiety, depression and stress. ...
Effects of interventions for improving mental health of health professional students has not been established. This review analysed interventions to support mental health of health professional students and their effects. The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC and EMBASE were searched until 15th April 2016. Inclusion criteria were randomised controlled trials of undergraduate and post graduate health professional students, group interventions to support mental health compared to alternative education, usual curriculum or no intervention; and post-intervention measurements for intervention and control participants of mindfulness, anxiety, depression, stress/distress or burnout. Studies were limited to English and short term effects. Studies were appraised using the PEDro scale. Data were synthesised using meta-analysis. Four comparisons were identified: psychoeducation or cognitive-behavioural interventions compared to alternative education, and mindfulness or relaxation compared to control conditions. Cognitive-behavioural interventions reduced anxiety (−0.26; −0.5 to −0.02), depression (−0.29; −0.52 to −0.05) and stress (0.37; −0.61 to −0.13). Mindfulness strategies reduced stress (−0.60; −0.97 to −0.22) but not anxiety (95% CI −0.21 to 0.18), depression (95% CI −0.36 to 0.03) or burnout (95% CI −0.36 to 0.10). Relaxation strategies reduced anxiety (SMD −0.80; 95% CI −1.03 to −0.58), depression (−0.49; −0.88 to −0.11) and stress (−0.34; −0.67 to −0.01). Method quality was generally poor. Evidence suggests that cognitive-behavioural, relaxation and mindfulness interventions may support health professional student mental health. Further high quality research is warranted.
... More recent studies, however, speak to this issue. Braithwaite and Fincham have in a series of randomized controlled trials shown that a computer-based prevention and relationship enhancement program (ePREP) could reliably decrease IPV among college students and married couples (Braithwaite & Fincham, 2009, 2011. The program was derived from the Prevention and Relationship Enhancement program (Markman, Renick, Floyd, & Stanley, 1993) and focused on building adaptive conflict-management and relationship skills. ...
Objective:
The aim of this randomized controlled trial was to investigate the effect of an Internet-delivered cognitive behaviour therapy (iCBT), which incorporated emotion-regulation and conflict-resolution techniques, on intimate partner violence (IPV). Another aim was to test the theoretical underpinnings of the treatment model using mediation analysis.
Method:
Sixty-five participants with aggression problems in intimate adult relationships were recruited from the community and were randomly assigned to iCBT or to a monitored waitlist control. Participants were assessed with standardized self-report measures of IPV or aggression (Multidimensional Measure of Emotional Abuse, Revised Conflict Tactics Scale, and Aggression Questionnaire), relationship quality (Dyadic Adjustment Scale), anxiety or depression symptomatology (Patient Health Questionnaire; Generalized Anxiety Disorder Screener), at pretreatment, posttreatment (8 weeks), and 1-year follow-up. Process variables (subscales of Dysfunctional and Emotional Regulation Scale and Anger Rumination Scale) were assessed weekly over the active treatment phase.
Results:
Robust linear regression analysis of all randomized participants showed significant treatment effects on emotional abuse relative to control at postassessment. Mediation analysis using growth curve modeling revealed that the treatment effect was partially mediated by changes in emotion-regulation ability. Controlled effects on secondary outcomes were also observed. Analyses of uncontrolled effects indicted that gains on IPV were maintained at 1-year follow-up.
Conclusions:
iCBT focusing on enhancing conflict-resolution skills and emotion-regulation ability has the potential to reduce IPV among self-recruited individuals with mild forms of abusive behaviour in intimate relationships. Emotion-regulation ability is potentially a key therapeutic process of change.
Key practitioner message:
Internet-delivered clinician-guided cognitive behaviour therapy is a viable treatment option for reducing intimate partner violence among self-recruited individuals with mild forms of abusive behaviour. For persons who display patterns of frequent and severe violence, other treatments are most likely needed. Emotion-regulation training is potentially a key therapeutic component that ought to be incorporated in interventions targeting IPV.
... The ePREP program, based on principles of the empirically supported in-person Prevention and Relationship Enhancement Program (PREP; Markman, Stanley, & Blumberg, 2001), is a seven-hour program consisting of 1 hour of online content plus six hour-long homework assignments completed on a weekly basis. When completed by one member of the dyad, ePREP reduced rates of reported intimate partner violence (Braithwaite & Fincham, 2009) and decreased anxiety and psychological and physical aggression when compared to the waitlist control group (Braithwaite & Fincham, 2007). When completed by both members of the dyad, ePREP resulted in improved communication, reductions in self-and partner-reported assault, and a trend toward decreases in psychological aggression (Braithwaite & Fincham, 2011). ...
The negative impacts of relationship distress on the couple, the family, and the individual are well-known. However, couples are often unable to access effective treatments to combat these effects-including many couples who might be at highest risk for relationship distress. Online self-help interventions decrease the barriers to treatment and provide couples with high quality, research-based programs they can do on their own. Using a combined multiple baseline and randomized design, the present study investigated the effectiveness of the Brief OurRelationship.com (Brief-OR) program with and without staff support in improving relationship distress and individual functioning. Results indicated the program produced significant gains in several areas of relationship functioning; however, these gains were smaller in magnitude than those observed in Full-OR. Furthermore, effects of Brief-OR were not sustained over follow-up. Comparisons between couples randomized to Brief-OR with and without contact with a staff coach indicated that coach contact significantly reduced program noncompletion and improved program effects. Limitations and future directions are discussed.
... Using booster sessions or refreshers would be necessary to increase the impact of the intervention and sustain its positive effects over time (Knaak et al., 2014). Internet programs to reduce personal stigma seem to be as effective as interventions delivered face to face (Griffiths, Carron-Arthur, Parsons, & Reid, 2014), and new technologies have been used in a university setting to deliver interventions that promote mental health in an efficient way (Braithwaite & Fincham, 2009;Griffiths, Farrer, & Christensen, 2010). New technologies could be used as a low-cost way to deliver additional contact interventions that boost the effect of a face-to-face intervention. ...
The aim of this study was to evaluate the impact of a social contact and education intervention to improve attitudes to mental illness in first-year social work students. This was a 3-month cluster randomized controlled trial with two parallel arms: intervention (87) and control group (79). The intervention was a workshop led by an OBERTAMENT activist (a person with a mental illness trained in communication skills and empowerment by a social worker). We assessed intended future behavior toward people with mental illness, personal and perceived stigma, and mental health–related attitudes (self-reported questionnaire). The intervention improved social work students’ attitudes (d ≈ 0.50, p < .05) and reduced personal stigma toward people with mental illness (d = 0.35, p = .04) as well as improving their future intended behavior 2 weeks after the intervention (d = 0.51, p = .01). The intervention impact on authoritarian attitudes toward people with schizophrenia was maintained after 3 months (d = 0.94, p = .01). Long-term impact needs to be improved.
Intimate relationships are the focal aspiration for human beings. Romantic relationship education is described as a road map for helping people to find strategies and solutions that fit their context, values and relationship goals. By using evidence-based skills training, people can learn techniques to navigate typical relationship challenges and safely express emotions. Being in a mutually satisfying committed relationship has proven to be associated with many positive outcomes including life satisfaction, physical well-being, better coping with major illness, as well as longer life expectancy and career achievement. Relationship education programs are developed by psychologists in Western countries as a preventive intervention for couples, adolescents and emerging adults before relationships reach crisis stage. There is, however, a lack of empirical studies to examine the effectiveness of relationship education within the Turkish cultural context. The overarching aim of this study is to review the relationship education programs within Turkish and international literature. This study provides an overview of the relationship education, and its scope, and theoretical foundations and also effectiveness of relationship education programs for couples, adolescents and emerging adults. The study further provides cultural, theoretical and practical recommendations for future directions in Turkish relationship education programs.
Background:
A growing body of research shows the promise and efficacy of technology-based or digital interventions in improving the health and well-being of survivors of intimate partner violence (IPV). In addition, mental health comorbidities such as anxiety, post-traumatic stress disorder (PTSD), and depression occur three to five times more frequently in survivors of IPV than non-survivors, making these comorbidities prominent targets of technology-based interventions. Still, research on the long-term effectiveness of these interventions in reducing IPV victimization and adverse mental health effects is emergent. The significant increase in the number of trials studying technology-based therapies on IPV-related outcomes has allowed us to quantify the effectiveness of such interventions for mental health and victimization outcomes in survivors. This meta-analysis and systematic review provide critical insight from several randomized controlled trials (RCTs) on the overall short and long-term impact of technology-based interventions on the health and well-being of female IPV survivors.
Objectives:
To synthesize current evidence on the effects of technology-based or digital interventions on mental health outcomes (depression, anxiety, and PTSD) and victimization outcomes (physical, psychological, and sexual abuse) among IPV survivors.
Search methods:
We examined multiple traditional and grey databases for studies published from 2007 to 2021. Traditional databases (such as PubMed Central, Web of Science, CINAHL Plus, and PsychINFO) and grey databases were searched between April 2019 and February 2021. In addition, we searched clinical trial registries, government repositories, and reference lists. Authors were contacted where additional data was needed. We identified 3210 studies in traditional databases and 1257 from grey literature. Over 2198 studies were determined to be duplicates and eliminated, leaving 64 studies after screening titles and abstracts. Finally, 17 RCTs were retained for meta-analysis. A pre-registered protocol was developed and published before conducting this meta-analysis.
Selection criteria:
We included RCTs targeting depression, anxiety, PTSD outcomes, and victimization outcomes (physical, sexual, and psychological violence) among IPV survivors using a technology-based intervention. Eligible RCTs featured a well-defined control group. There were no study restrictions based on participant gender, study setting, or follow-up duration. Included studies additionally supplied outcome data for calculating effect sizes for our desired outcome. Studies were available in full text and published between 2007 and 2021 in English.
Data collection and analysis:
We extracted relevant data and coded eligible studies. Using Cochrane's RevMan software, summary effect sizes (Outcome by Time) were assessed using an independent fixed-effects model. Standardized mean difference (SMD) effect sizes (or Cohen's d) were evaluated using a Type I error rate and an alpha of 0.05. The overall intervention effects were analyzed using the Z-statistic with a p-value of 0.05. Cochran's Q test and Higgins' I 2 statistics were utilized to evaluate and confirm the heterogeneity of each cumulative effect size. The Cochrane risk of bias assessment for randomized trials (RoB 2) was used to assess the quality of the studies. Campbell Systematic Reviews registered and published this study's protocol in January 2021. No exploratory moderator analysis was conducted; however, we report our findings with and without outlier studies in each meta-analysis.
Main results:
Pooled results from 17 RCTs yielded 18 individual effect size comparisons among 4590 survivors (all females). Survivors included college students, married couples, substance-using women in community prisons, pregnant women, and non-English speakers, and sample sizes ranged from 15 to 672. Survivors' ages ranged from 19 to 41.5 years. Twelve RCTs were conducted in the United States and one in Canada, New Zealand, China (People's Republic of), Kenya, and Australia. The results of this meta-analysis found that technology-based interventions significantly reduced depression among female IPV survivors at 0-3 months only (SMD = -0.08, 95% confidence interval [CI] = -0.17 to -0.00), anxiety among IPV survivors at 0-3 months (SMD = -0.27, 95% CI = -0.42 to -0.13, p = 0.00, I 2 = 25%), and physical violence victimization among IPV survivors at 0-6 months (SMD = -0.22, 95% CI = -0.38 to -0.05). We found significant reductions in psychological violence victimization at 0-6 months (SMD = -0.34, 95% CI = -0.47 to -0.20) and at >6 months (SMD = -0.29, 95% CI = -0.39 to -0.18); however, at both time points, there were outlier studies. At no time point did digital interventions significantly reduce PTSD (SMD = -0.04, 95% CI = -0.14 to 0.06, p = .46, I 2 = 0%), or sexual violence victimization (SMD = -0.02, 95% CI = -0.14 to 0.11, I 2 = 21%) among female IPV survivors for all. With outlier studies removed from our analysis, all summary effect sizes were small, and this small number of comparisons prevented moderator analyses.
Authors' conclusions:
The results of this meta-analysis are promising. Our findings highlight the effectiveness of IPV-mitigating digital intervention as an add-on (not a replacement) to traditional modalities using a coordinated response strategy. Our findings contribute to the current understanding of "what works" to promote survivors' mental health, safety, and well-being. Future research could advance the science by identifying active intervention ingredients, mapping out intervention principles/mechanisms of action, best modes of delivery, adequate dosage levels using the treatment intensity matching process, and guidelines to increase feasibility and acceptability.
Background: Intuitive eating (IE) principles present an evidence-based strategy for improving one's relationship with food while reducing the incidence of weight cycling and health risks associated with chronic dieting and weight regain. Offering online programming provides improved access to education while reducing barriers to programme enrollment but is also associated with high rates of attrition. Aim: To examine the process of programme implementation and identify barriers and facilitators of engagement for an online IE programme for employees at a large Midwestern university. Methods: The web-based programme Finding Peace with Food: An Intuitive Eating Approach consisted of an online community with discussion prompts, 10 weekly modules containing videos, activities, and counsellor interviews and was developed using recognized health behaviour theory and evidence-based practices. Participants were university employees (n = 20). Qualitative data were assessed using a phenomenological approach to discern the themes of barriers and facilitators of programme participation. Participation rates were assessed using descriptive statistics. Results: All participants were Caucasian, 85% were female, and their ages ranged from 26–64. The module-based structure was well received. The primary barriers to participation were time constraints, overwhelming amount of information, and aversion to Flipgrid platform use. The quality and usefulness of the programme information were identified as facilitators of participation. Conclusion: Program participation was influenced by the time frame available to complete the programme modules and participants’ ease of use of platform applications.
Social Emotional Learning is a core competency in the coming future as mankind has created and invented a gadget, device or an app for almost most of technical and knowledge-based needs. Especially during the pandemic, the need for SEL programs becomes a necessity. The important process then remains to create individuals with sensitivity to navigate in such endowed systems, without feeling too powerful or at the polar end without feeling disconnected. It is undeniable society at large will be living with this sense of having the world at their fingertips! It is exactly because of this reason that it is necessary to be socially emotionally adjusted to co-exist with many such equally gifted or talented people around oneself. At the same time the children are exposed to the fast-paced world and ever demanding need to excel and perform better academically. The Brain Training Enhancement Program (“BTE”) is a scientifically designed well researched program using Neurofeedback to improve the brain ability of students in competitive exams. The A pre- and post-test quasi-experimental design was used to test the impact of a 10-week, online-based social and emotional learning (SEL) intervention, Brain Training Enhancement Program (“BTE”), on the academic performance and social and emotional competence of 12th grade students (N =82) in two classrooms in one school. Academic performance was assessed by report card grades done in the immediate past and immediately post intervention. Social and emotional competence was assessed with Psychometric Analysis and QEEG Measurements. Students in classrooms integrating BTE program had higher year-end grades and higher scores of social and emotional competences (e.g., Engagement, Self-Regulation, and Focus) compared to students in the comparison group. This study provides preliminary empirical evidence that SEL programs like BTE improve important student outcomes.
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
Romantic relationships are a central component of life and are linked to well‐being, making adaptive functioning critical. Yet, there are few theory‐driven, systematic efforts to prepare young people to function skillfully. This study reports the results of a randomized controlled trial of a two‐session relationship education program based on Davila and colleagues' construct of romantic competence. Participants were 154 (68 relationship education, 86 waitlist) emerging adult college students. They completed questionnaires initially, posttest, and at follow up. Compared to the waitlist, relationship education participants reported increases in workshop‐relevant knowledge, perspective taking, and adaptive decision making, all targets of the program. Qualitative data from relationship education participants at follow up indicated behavioral changes reflective of workshop material. This provides preliminary support of the program's efficacy.
Objective
Although relationship distress is strongly associated with mental health problems, poorer social functioning and lower quality of life, only a minority of distressed couples engage in effective couples therapy. Common barriers are the financial burden, fear of being stigmatized, long waitlists and logistical concerns, such as the difficulty in scheduling appointments. Therefore, more accessible help for relationship distress is needed, such as internet-based interventions.
Method
This study evaluates the efficacy of the German web-based PaarBalance program, an 18-sessions online program for couples and individuals in an intimate relationship. Participants with relationship distress recruited via the internet had access to the unguided self-help program for twelve weeks. A total of 117 individuals (N = 60 participated as couples, N = 57 participated without a partner) were randomly assigned to begin the intervention immediately or to a 12-week waitlist control group. The primary outcome was relationship satisfaction. Secondary outcomes included symptoms of depression and anxiety.
Results
The intervention group showed significant improvement in relationship satisfaction (Cohen's d =.77) compared with the waitlist control group. Small to medium effect sizes in favor of the intervention group, but no statistically significant differences were found regarding depression (d = .43) and anxiety (d = .45).
Conclusion
PaarBalance seems to be an effective self-guided intervention to improve relationship satisfaction in people with relationship problems.
A large body of literature has documented the health promotive effects of healthy committed relationships on the health and wellbeing of heterosexual people in different-sex relationships, including observational and longitudinal studies, couple-based intervention development and evaluation efforts, and articulation of theoretical frameworks. A much smaller but growing field of research has observed that same-sex relationships have similar effects on health outcomes but that these couples face unique stressors that may impact relationship functioning and health. Further, extant theoretical frameworks do not sufficiently address the multiple pathways by which psychosocial vulnerabilities and stressors impact same-sex relationship functioning, engagement in health-related risk behaviors, and the mental and physical health of sexual minorities in relationships. The purpose of this manuscript is to: a) review the existing literature on relationship functioning and health among sexual minorities, including both observational and intervention studies; and b) present an integrated model of relationship functioning and health for same-sex couples that can be used as a basis for further studies on sexual minority dyads, as well as the development of novel couple-based interventions to optimize the health promoting effects of relationships.
Purpose
During the COVID-19 pandemic, there has been an increase in cases of intimate partner violence (IPV) related to stay-at-home orders, as well as the financial and emotional stress many individuals are experiencing. With limitations on group gatherings, typical in-person prevention and intervention resources, such as anger management groups or batterer intervention programs, may be inaccessible to people in need of resources.
Method
In order to understand effective options for reducing risk when face-to-face interventions are not feasible, we conducted a meta-analysis to examine the effects of online programs aimed at improving participants’ well-being and reducing IPV risk. Six studies were identified in databases using key search terms.
Results
Change score comparisons revealed that online programs reduced participants’ anger, depression, emotional IPV perpetration, and physical IPV perpetration significantly more than control groups.
Discussion
Findings suggest that online resources can help motivated individuals struggling with anger and/or at risk for IPV perpetration.
Experimental tests of the association between relationship functioning and physical health are limited. Although associations are hypothesized to be partially mediated through improved psychological functioning, tests are mostly limited to lab‐based studies. The present study evaluated relational and psychological mediators of change in perceived health in a sample of 742 low‐income couples (1,484 individuals) who participated in a randomized controlled trial of two online relationship education programs and a waitlist control group. Results partially supported the Strengths and Strains Model of Relationships and Physical Health. Relationship functioning and some psychological functioning were mediators of change in perceived health. Future research is needed to understand how relationship functioning improved perceived health through mediators other than psychological functioning tested here.
Psychological research has been at the forefront of efforts to document, understand, and prevent sexual harassment, sexual coercion, sexual violence, and intimate partner abuse on college campuses. Collectively, these various forms of gender-based violence and misconduct (GBVM) are highly prevalent on college campuses and exert wide-ranging negative effects on students' mental health and academic success. A recent resolution by the American Psychological Association outlined the field's research contributions and ongoing commitment to help prevent campus sexual assault. Our article builds on this initiative by offering 10 recommendations to psychology researchers, educators, and practitioners to address critical gaps in GBVM knowledge and practice through novel applications of psychology. These recommendations include: (a) Develop interventions to reduce and prevent faculty-perpetrated GBVM; (b) encourage and support professional sanctions for credibly accused faculty perpetrators of GBVM; (c) explore alternative models of graduate student mentorship; (d) develop improved risk prediction models for GBVM perpetration; (e) enhance selective and indicated prevention focused on individual and contextual risk; (f) support improvements in institutional responses to Title IX cases; (g) study the experiences and needs of student populations traditionally underrepresented in GBVM research, including racial/ethnic minority, sexual minority, and religious minority students, international students, and returning (nontraditional) students; (h) refine and disseminate campus interventions to promote relationship skill development; (i) refine and disseminate classroom-based prevention models; and (j) train and support the next generation of antiviolence scholars, clinicians, educators, and activists. Illustrative examples of these ongoing efforts are provided throughout the article and within a summary table. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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.
In recent years, same-gender group-based relationship education has emerged as a viable intervention to prevent relationship distress among same-gender couples. However, many of these programs are conducted in metropolitan areas and lack the ability to reach rural populations. The current study sought to investigate whether two wide-reaching web-based heteronormative relationship education programs could positively impact same-gender relationships. In a sample of 49 same-gender couples, heteronormative relationship education had small (Cohen's d = 0.16-0.39) but reliably positive effects on key areas of relationship functioning and perceived stress relative to a waitlist control group. Additionally, when same-gender couples were matched with different-gender individuals with similar baseline characteristics, no reliable differences between the two groups emerged even though the program effects were sometimes half as large for same-gender couples. Finally, same-gender participants were as satisfied with the program as the matched different-gender individuals. Though the results of the present study indicate that heteronormative relationship education can be helpful for same-gender couples, additional tailoring should be undertaken to ensure that same-gender couples experience as much benefit as possible. Estimates from the current study could be used in future studies to detect what might be small-sized differences.
Cognitive defusion may enhance healthy coping with negative self-referential thoughts amongst college students. However, research is needed to examine how to effectively introduce and teach defusion to this population. The current pilot study tested the usability of and satisfaction with the d-FUSE program, a single-session, web-based program for a mixed sample of undergraduates and its effectiveness in producing improvements in cognitive defusion and self-criticism. In an undergraduate sample (N = 141), the d-FUSE program was found to be useable and satisfactory. Program engagement rendered significant reductions in the believability of and emotional discomfort produced by negative self-referential thoughts. Further improvements to program development and administration are considered.
Cet article 1 présente l’ensemble de la démarche qui a donné lieu à la mise en ligne d’un programme éducatif visant l’enrichissement des relations conjugales et familiales des adultes qui vivent une recomposition familiale. Des recensions des écrits portant à la fois sur les défis vécus par les couples-parents de familles recomposées et les programmes de prévention offerts à cette population ont été réalisées. Les conclusions tirées de ces recensions constituent les fondements du programme d’éducation en ligne La famille recomposée : une équipe à bâtir qui est brièvement décrit dans cet article.
Relationship maintenance encompasses a wide range of activities that partners use to preserve their relationships. Despite the importance of these efforts, considerably more empirical focus has been devoted to starting (i.e. initiation) and ending (i.e. dissolution) relationships than on maintaining them. In this volume, internationally renowned scholars from a variety of disciplines describe diverse sets of relationship maintenance efforts in order to show why some relationships endure, whereas others falter. By focusing on 'what to do' rather than 'what not to do' in relationships, this book paints a more comprehensive picture of the forms, functions, and contexts of relationship maintenance. It is essential reading for scholars and students in psychology, communication, human development and family science, sociology, and couple/marriage and family therapy.
This study examined the hypothesis that romantic competence (RC) skills would be demonstrated behaviorally during dating couple problem solving interactions. A coding system was developed for RC behavior, and its validity was examined through its association with relationship satisfaction and negative affect expressed. A total of 106 emerging adult dating couples in different‐sex relationships were assessed using the Romantic Competence Interview for Emerging Adults, and they participated in a dyadic problem‐solving interaction coded for RC behavior and negative affect. Men's behavioral RC was positively associated with both his and his partner's satisfaction. Behavioral RC was also more associated with satisfaction than was negative affect. Implications for the utility of teaching RC skills in young couples are discussed.
Background: Given the prevalence of anxiety, depression, and stress among university students, it is important to assess the effectiveness of prevention programs for these problems. Beyond examining effect sizes, applying a common elements approach can enhance our understanding of which practice elements are most frequently included in symptom-reducing programs. Method: This review examined effective (i.e., outcome-producing) prevention programs targeting depression, anxiety, and/or stress in university students. Programs could be delivered in a group-based, online/computer-delivered, or self-administered format and at the universal, selective, or indicated prevention level. Results: The resulting sample of 62 articles covered 68 prevention programs for college, graduate, or professional students across 15 countries. Average effect sizes for programs were moderate (overall g = 0.65), regardless of delivery format or prevention level. The most common practice elements (overall and for programs producing large effects) were: psychoeducation (72%), relaxation (69%), and cognitive monitoring/restructuring (47%). Many programs were limited by: (a) symptom target-outcome mismatches, (b) disproportionately female samples, and (c) inconsistently reported adherence data. Limitations: Commonness of practice elements across outcome-producing interventions does not imply their extensiveness nor unique contribution to effectiveness. Coding was based on information in articles rather than manuals, and inter-rater reliability was moderate for some practice elements. Conclusion: The outcome-producing prevention programs in our sample had common practice elements and produced moderate reduction in symptoms overall. Future research of depression, anxiety, and stress prevention programs for university students can investigate practice elements’ unique and combined impact on outcomes, further explore under-tested practice elements, and use findings to inform intervention design.
Background:
College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment.
Objective:
This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs.
Methods:
We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias.
Results:
A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies.
Conclusions:
Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.
Web-based programs that focus on values, a core process within acceptance and commitment therapy (ACT), may be a promising approach to cultivate positive psychosocial adjustment among undergraduates. The current study tested the usability, acceptability, and receptivity of the Living Your Values (LYV) program, a single-session, web-delivered, self-guided values intervention for undergraduates and its utility to promote valued-living and psychological well-being. In an undergraduate sample (N = 133), while the LYV program was deemed moderately usable, acceptability and receptivity findings were more attenuated. At follow-up (n = 98), a significant pre-intervention to follow-up increase in valued-living was evidenced both overall and for leisure/recreation/community/citizenship values. No significant changes in psychological well-being were demonstrated. Further program development considerations are discussed.
Background
Symptoms of depression, anxiety, and distress are more common in undergraduates compared to age-matched peers. Mental ill health among students is associated with impaired academic achievement, worse occupational preparedness, and lower future occupational performance. Research on mental health promoting and mental ill health preventing interventions has shown promising short-term effects, though the sustainability of intervention benefits deserve closer attention. We aimed to identify, appraise and summarize existing data from randomized control trials (RCTs) reporting on whether the effects of mental health promoting and mental ill health preventing interventions were sustained at least three months post-intervention, and to analyze how the effects vary for different outcomes in relation to follow-up length. Further, we aimed to assess whether the effect sustainability varied by intervention type, study-level determinants and of participant characteristics.
Material and Methods
A systematic search in MEDLINE, PsycInfo, ERIC, and Scopus was performed for RCTs published in 1995–2015 reporting an assessment of mental ill health and positive mental health outcomes for, at least, three months of post-intervention follow-up. Random-effect modeling was utilized for quantitative synthesis of the existing evidence with standardized mean difference (Hedges’ g ) used to estimate an aggregated effect size. Sustainability of the effects of interventions was analyzed separately for 3–6 months, 7–12 months, and 13–18 months of post-intervention follow-up.
Results
About 26 studies were eligible after reviewing 6,571 citations. The pooled effects were mainly small, but significant for several categories of outcomes. Thus, for the combined mental ill health outcomes, symptom-reduction sustained up to 7–12 months post-intervention (standardized mean difference (Hedges’ g ) effect size (ES) = −0.28 (95% CI [−0.49, −0.08])). Further, sustainability of symptom-reductions were evident for depression with intervention effect lasting up to 13–18 months (ES = −0.30 (95% CI [−0.51, −0.08])), for anxiety up to 7–12 months (ES = −0.27 (95% CI [−0.54, −0.01])), and for stress up to 3–6 months (ES = −0.30 (95% CI [−0.58, −0.03])). The effects of interventions to enhance positive mental health were sustained up to 3–6 months for the combined positive mental health outcomes (ES = 0.32 (95% CI [0.05, 0.59])). For enhanced active coping, sustainability up to 3–6 months was observed with a medium and significant effect (ES = 0.75 (95% CI [0.19, 1.30])).
Discussion
The evidence suggests long-term effect sustainability for mental ill health preventive interventions, especially for interventions to reduce the symptoms of depression and symptoms of anxiety. Interventions to promote positive mental health offer promising, but shorter-lasting effects. Future research should focus on mental health organizational interventions to examine their potential for students in tertiary education.
Face-to-face prevention-focused relationship education programs have generally been efficacious in improving couples’ communication and relationship satisfaction. Computer-based interventions have furthered the dissemination of these interventions, so anyone with access to a computer can participate in the intervention. One of the next steps in this line of research is finding affordable and convenient ways to disseminate this information. One possibility is text messaging. The current study examined the feasibility of utilizing text messages as a dissemination tool for relationship enhancement. In this study, 128 married individuals were randomly assigned to a control condition (n = 64), where relationship-related text messages were not received, or to a treatment condition (n = 64), where relationship-related text messages were received. Individuals assigned to the treatment condition responded positively toward the intervention. Participants’ dropout and retention rates were promising, and 99% of the participants supplied authentic phone numbers. Participants reported the intervention helped them make changes in their relationship, and that the text messages’ content was beneficial to their relationship. Strengths, limitations, and ideas for future research are discussed, as well as the implications for utilizing text messages as a dissemination tool for preventative relationship education.
Despite recent policy initiatives and substantial federal funding of individually oriented relationship education programs for youth, there have been no meta-analytic reviews of this growing field. This meta-analytic study draws on 17 control-group studies and 13 one-group/pre-post studies to evaluate the effectiveness of relationship education programs on adolescents’ and emerging adults’ relationship knowledge, attitudes, and skills. Overall, control-group studies produced a medium effect (d = .36); one-group/pre-post studies also produced a medium effect (d = .47). However, the lack of studies with long-term follow-ups of relationship behaviors in the young adult years is a serious weakness in the field, limiting what we can say about the value of these programs for helping youth achieve their aspirations for healthy romantic relationships and stable marriages.
A skills-based model of healthy relationship functioning—romantic competence (RC)—is described. Its association with relationship and individual well-being was examined in three studies of emerging adults using the Romantic Competence Interview for Emerging Adults (RCI–EA), which measures competence as the interplay of three skill domains. Across studies (women [n = 102], women and men [n = 187], romantic couples [n = 89]), RC was associated with greater security, healthier decision making, greater satisfaction, and fewer internalizing symptoms. The RCI–EA skill domains formed a latent factor and were associated with self-reports reflective of RC, supporting the construct's validity. The RC construct may thus provide a theory-driven, overarching way to characterize healthy romantic functioning that can reduce negative outcomes.
Although Hispanic couples experience marital distress at similar rates when compared to non-Hispanic couples, there is a disparity in the field in terms of access to evidence-based interventions for Hispanic couples. Given known associations between marital distress and individual emotional and physiological symptomatology, and barriers to obtaining behavioral health care, improving access to marital interventions through primary care services, using an integrated care model, is promising. A key component to an integrated behavioral health care approach would be to teach physicians about screening tools for marital distress. Many empirically supported, brief screening measures exist, and through routine use by medical professionals, marital distress could be more easily detected and treated. Once risk for marital distress is determined, the next step for low-distress couples would be for health professionals to provide information and education about marital health, including marital distress prevention programs. If this step is not sufficient, the second step would be to provide couples with information about brief or web-based interventions. Finally, for more severely distressed couples, an appropriate referral would be to empirically supported, in-person treatment. There are a variety of evidence-supported options for treating couple/marital distress. Few programs are directly tailored to the needs of Hispanic couples, but suggestions for possible modifications or specific issues to be addressed are reviewed in this chapter. Future research is needed to make adaptations to empirically supported interventions that are more culturally sensitive.
In this multisite study, we used a randomized controlled trial to examine how a relationship education intervention affected emerging adults' maladaptive relationship beliefs, mutuality, relationship decision making, relationship quality, and psychological distress. In addition, we explored whether one intervention modality (i.e., facilitated group discussion) was more/less effective than another (i.e., self-facilitated online) and whether there were differential effects for participants in a relationship. We found that the facilitated group evidenced a decline in maladaptive relationship beliefs and an improvement in deliberate decision making. Moreover, facilitated group participants in a relationship reported higher levels of mutuality. Contrary to our hypothesis, there were no changes in relationship quality or psychological distress. Implications for the content and delivery of relationship education for emerging adults are discussed.
The uses of technology-delivered mental health treatment options, such as interventions delivered via computer, smart phone, or other communication or information devices, as opposed to primarily face-to-face interventions, are proliferating. However, the literature is unclear about their effectiveness as preventive interventions for higher education students, a population for whom technology-delivered interventions (TDIs) might be particularly fitting and beneficial. This meta-analytic review examines technological mental health prevention programs targeting higher education students either without any presenting problems (universal prevention) or with mild to moderate subclinical problems (indicated prevention). A systematic literature search identified 22 universal and 26 indicated controlled interventions, both published and unpublished, involving 4763 college, graduate, or professional students. As hypothesized, the overall mean effect sizes (ESs) for both universal (0.19) and indicated interventions (0.37) were statistically significant and differed significantly from each other favoring indicated interventions. Skill-training interventions, both universal (0.21) and indicated (0.31), were significant, whereas non-skill-training interventions were only significant among indicated (0.25) programs. For indicated interventions, better outcomes were obtained in those cases in which participants had access to support during the course of the intervention, either in person or through technology (e.g., email, online contact). The positive findings for both universal and indicated prevention are qualified by limitations of the current literature. To improve experimental rigor, future research should provide detailed information on the level of achieved implementation, describe participant characteristics and intervention content, explore the impact of potential moderators and mechanisms of success, collect post-intervention and follow-up data regardless of intervention completion, and use analysis strategies that allow for inclusion of cases with partially missing data.
Formal and informal relationship help-seeking is becoming increasingly common. This article discusses seven forms of relationship help-seeking: couple therapy, couple relationship education, self-help books, internet resources, other media sources, talking with clergy, and talking with friends and family. The purpose of this literature review is to organize the relationship help-seeking research, bring to light some of the less accessible research, and offer recommendations to researchers and practitioners regarding the efficacy and reach of relationship help-seeking. In addition, differences in relationship help-seeking based on gender are explored and current relationship help-seeking trends are discussed. 2016
Formal and informal relationship help-seeking is becoming increasingly common. This article discusses seven forms of relationship help-seeking: couple therapy, couple relationship education, self-help books, internet resources, other media sources, talking with clergy, and talking with friends and family. The purpose of this literature review is to organize the relationship help-seeking research, bring to light some of the less accessible research, and offer recommendations to researchers and practitioners regarding the efficacy and reach of relationship help-seeking. In addition, differences in relationship help-seeking based on gender are explored and current relationship help-seeking trends are discussed.
This article describes a revised Conflict Tactics Scales (the CTS2) to measure psychological and physical attacks on a partner in a marital, cohabiting, or dating relationship; and also use of negotiation. The CTS2 has (a) additional items to enhance content validity and reliability; (b) revised wording to increase clarity and specificity; (c) better differentiation between minor and severe levels of each scale; (d) new scales to measure sexual coercion and physical injury; and (e) a new format to simplify administration and reduce response sets. Reliability ranges from .79 to .95. There is preliminary evidence of construct validity.
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)
Considering the popularity of marriage enrichment programs, it is important for clinicians and marriage educators to know which programs have received empirical support. Using criteria established for determining empirically supported treatments (ESTs), we provide a comprehensive review of the outcome research on 13 specific marital enrichment programs. Only four programs could be considered “efficacious,” three were found to be “possibly efficacious,” and six were considered “empirically untested.”
This article reports the 4- and 5-year follow-up results of evaluating the effects of a marital distress prevention program. The program, Prevention and Relationship Enhancement Program (PREP), is a 5-session program designed to teach couples effective communication and conflict management skills. At the 5-year follow-up, intervention, as compared with control, couples had higher levels of positive and lower levels of negative communication skills and lower levels of marital violence. Data are also presented on couples who declined the program. Issues are discussed concerning selection effects, change mechanisms, and future directions for prevention research.
The present study took a critical look at a central construct in couples research: relationship satisfaction. Eight well-validated self-report measures of relationship satisfaction, including the Marital Adjustment Test (MAT; H. J. Locke & K. M. Wallace, 1959), the Dyadic Adjustment Scale (DAS; G. B. Spanier, 1976), and an additional 75 potential satisfaction items, were given to 5,315 online participants. Using item response theory, the authors demonstrated that the MAT and DAS provided relatively poor levels of precision in assessing satisfaction, particularly given the length of those scales. Principal-components analysis and item response theory applied to the larger item pool were used to develop the Couples Satisfaction Index (CSI) scales. Compared with the MAS and the DAS, the CSI scales were shown to have higher precision of measurement (less noise) and correspondingly greater power for detecting differences in levels of satisfaction. The CSI scales demonstrated strong convergent validity with other measures of satisfaction and excellent construct validity with anchor scales from the nomological net surrounding satisfaction, suggesting that they assess the same theoretical construct as do prior scales. Implications for research are discussed.
This study provides evidence for the reliability and validity of a 7-item constructive communication subscale of the Communication Patterns Questionnaire (CPQ-CC, Christensen & Sullaway, 1984). Seventy married couples completed the CPQ and participated in videotaped problem-solving discussions. The constructiveness of spouses' behavior during the videotaped problem-solving discussions was rated by trained observers. The CPQ-CC had high internal consistency and moderately high agreement between spouses. The CPQ-CC also was strongly associated with observer ratings of the spouses' constructiveness during videotaped problem-solving discussions. Finally, the CPQ-CC was strongly associated with spouses' self-reported marital adjustment. These data support the reliability and validity of this brief self-report measure of constructive communication.
This study evaluated the efficacy of a computer-based relationship focused preventive intervention (ePREP) relative to a depression and anxiety focused computer-based preventive intervention (CBASP) and a control group. Ninety-one young adults in dating relationships were randomly assigned to one of the three conditions. Assessments were conducted at baseline and at an eight week follow up. Participants in the ePREP and CBASP interventions experienced significantly reduced symptoms of depression and anxiety and significant improvements in relationship relevant variables relative to controls. The outcomes from the two treatment conditions did not significantly differ from one another. These findings suggest that computer-based preventive interventions may be a viable and efficacious means for preventing depression, anxiety, and relationship distress.
This study tested the hypothesis that, analogous to married individuals, college students in committed romantic relationships experience greater well-being than single college students. In a sample of 1,621 college students, individuals in committed relationships experienced fewer mental health problems and were less likely to be overweight/obese. There were no significant differences between groups in frequency of physical health problems. Examination of 2 models suggested that being in a committed romantic relationship decreases problematic outcomes largely through a reduction in sexual partners, which in turn decreases both risky behaviors and problematic outcomes. These results are discussed in the context of how premarital dating relationships may contribute to understanding of the observed association between marriage and well-being.
The current study evaluated Couple CARE, a flexible delivery relationship education program. Fifty-nine couples were randomly assigned to either Couple CARE or a control condition and assessed on relationship self-regulation, satisfaction and stability, and communication. Retention, engagement, and satisfaction with the program were all high. As predicted, Couple CARE increased relationship satisfaction and stability and increased report of relationship self-regulation, but did not have the predicted effect on communication.
Relationship and marriage education has been primarily developed for and offered to middle-class committed couples. Increasing government funding of these programs raises questions about the extent to which these curricula and programs need to be adapted for low-income populations. We review the limited body of relevant research and program experience to identify the challenges and guiding principles that need to be addressed when offering these programs to more diverse populations.
This research was designed to examine the efficacy of a brief cognitive-behavioral psychoeducation model as an intervention
for depressive and anxious symptoms, based on the Cognitive-Behavioral Analysis System of Psychotherapy (CBASP). One hundred
fifty two participants were randomly assigned to the control and prevention groups. These participants completed symptom ratings
of depression and anxiety at baseline, and again eight weeks later. Multivariate Analysis of Covariance (MANCOVA) revealed
a significant effect of group, with the intervention group showing lower symptom scores at the follow-up session. The implications
of this study include the development of the CBASP method as a computer-based prevention and intervention strategy.
Research studies focusing on the psychometric properties of the Beck Depression Inventory (BDI) with psychiatric and nonpsychiatric samples were reviewed for the years 1961 through June, 1986. A meta-analysis of the BDI's internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for nonpsychiatric subjects. The concurrent validitus of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were also high. The mean correlations of the BDI samples with clinical ratings and the HRSD were 0. 72 and 0.73, respectively, for psychiatric patients. With nonpsychiatric subjects, the mean correlations of the BDI with clinical ratings and the HRSD were 0.60 and 0.74, respectively. Recent evidence indicates that the BDI discriminates subtypes of depression and differentiates depression from anxiety.
The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.
In 2 studies, newlyweds reported whether they had participated in premarital counseling and provided data on known risk factors for marital dysfunction. Couples who participated in premarital programs were not at greater risk for marital difficulties, and in some cases participating husbands were at lower risk for marital difficulties compared with husbands who did not participate. Longitudinal data indicated that couples who participated in premarital programs did not have better marital outcomes than couples who did not participate. The present article also addresses the need to develop procedures that will increase at-risk couples' participation in premarital programs and to improve the effectiveness of these programs in community settings.
Perhaps the most complex and controversial role for the computer in clinical practice is as a treatment medium in which the computer effectively replaces the psychotherapist. This article outlines the historical development of computer treatment, from dialogue generators in the 1960s through to the interactive, multimedia programs of the 2000s. In evaluating the most recent developments in computer treatment, we present a small meta-analytic study demonstrating large effect sizes in favor of computer treatments for anxiety and depression for pre/post outcomes and treatment as usual/waitlist comparators. Next, we review studies of the cost effectiveness of computer treatments. Finally, we outline the implications for research, policy, and practice of this new generation of treatment options.
This study assessed participant satisfaction with two interpretation formats and the effects of taking the RELATionship Evaluation (RELATE) on single young adults' premarital relationships. Thirty-nine engaged or seriously dating couples were assigned to one of three groups: (a) those who took RELATE and interpreted the results themselves, (b) those who took RELATE and participated in an interpretation session with a therapist, or (c) a control group. Results showed that taking RELATE with therapist assistance had a significant positive effect on perceived relationship satisfaction, commitment, opinions about marriage, feelings about marriage, and readiness for marriage. Positive effects also included increased awareness of strengths and challenges, improved couple communication, and the expectation of the prevention of future relationship problems. Taking RELATE without therapist assistance produced a small initial drop in relationship satisfaction followed by a marked improvement over time. Both genders approved of two interpretation formats-self-interpretation and therapist-assisted interpretation-with males slightly preferring therapist assistance. These results add to the literature on the usefulness of brief assessment techniques as effective interventions with premarital couples.
Fighting for your marriage
- H J Markman
- S M Stanley
- S L Blumberg
Markman, H. J., Stanley, S. M., & Blumberg, S. L. (2001).
Fighting for your marriage. San Francisco: Jossey-Bass.