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A Review of Marital Intimacy-Enhancing Interventions among Married Individuals

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Background: Lack of intimacy is currently the main concern rather than main concern of the experts in psychology and counseling. It is considered as one of the most important causes for divorce and as such to improve marital intimacy a great number of interventions have been proposed in the literature. Intimacy training and counseling make the couples take effective and successful steps to increase marital intimacy. No study has reviewed the interventions promoting marital intimacy after marriage. Thus, this review study aimed to classify the articles investigating the impact of interventional programs on marital intimacy after marriage. Search Methods: In April 2015, we performed a general search in Google Scholar search engines, and then we did an advanced search the databases of Science Direct, ProQuest, SID, Magiran, Irandoc, Pubmed, Scopus, Cochrane Library, and Psych info; Cumulative Index to Nursing and Allied Health Literature (CINAHL). Also, lists of the references of the relevant articles were reviewed for additional citations. Using Medical Subject Headings (MESH) keywords: Intervention (Clinical Trials, Non-Randomized Controlled Trials, Randomized Controlled Trials, Education), intimacy, marital (Marriage) and selected related articles to the study objective were from 1995 to April 2015. Clinical trials that evaluated one or more behavioral interventions to improve marital intimacy were reviewed in the study. Main Results: 39 trials met the inclusion criteria. Eleven interventions had follow-up, and 28 interventions lacked follow-up. The quality evidence for 22 interventions was low, for 15 interventions moderate, and for one intervention was considered high. Findings from studies were categorized in 11 categories as the intimacy promoting interventions in dimensions of emotional, psychological, physical, sexual, temporal, communicational, social and recreational, aesthetic, spiritual, intellectual intimacy, and total intimacy. Authors’ Conclusions: Improving and promoting communication, problem solving, self-disclosure and empathic response skills and sexual education and counseling in the form of cognitive-behavioral techniques and based on religious and cultural context of each society, an effective step can be taken to enhance marital intimacy and strengthen family bonds and stability. Health care providers should consider which interventions are appropriate to the couple characteristics and their relationships.
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Global Journal of Health Science; Vol. 8, No. 8; 2016
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
74
A Review of Marital Intimacy-Enhancing Interventions among
Married Individuals
Maryam Kardan-Souraki
1,2
, Zeinab Hamzehgardeshi
3,4
, Ismail Asadpour
5
, Reza Ali Mohammadpour
6
& Soghra
Khani
3,7
1
Faculty of Nasibeh Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
2
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
3
Department of Midwifery and Reproductive Health, Faculty of Nasibeh Nursing and Midwifery, Mazandaran
University of Medical Sciences, Sari, Iran
4
Research Center of Traditional Medicine, Mazandaran University of Medical Sciences, Sari, Iran
5
Department of Counseling, Faculty of Psychology and Educational Sciences, Kharazmi University, Karaj, Iran
6
Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
7
Research Center of Diabetes, Mazandaran University of Medical Sciences, Sari, Iran
Correspondence: Soghra Khani, Department of Midwifery and Reproductive Health, Nasibeh Nursing and
Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran. Tel: 98-11-3336-8916. E-mail:
s.khani@mazums.ac.ir; khanisog343@gmail.com
Received: September 12, 2015 Accepted: November 21, 2015 Online Published: December 17, 2015
doi:10.5539/gjhs.v8n8p74 URL: http://dx.doi.org/10.5539/gjhs.v8n8p74
Abstract
Background: Lack of intimacy is currently the main concern rather than main concern of the experts in
psychology and counseling. It is considered as one of the most important causes for divorce and as such to
improve marital intimacy a great number of interventions have been proposed in the literature. Intimacy training
and counseling make the couples take effective and successful steps to increase marital intimacy. No study has
reviewed the interventions promoting marital intimacy after marriage. Thus, this review study aimed to classify
the articles investigating the impact of interventional programs on marital intimacy after marriage.
Search Methods: In April 2015, we performed a general search in Google Scholar search engines, and then we
did an advanced search the databases of Science Direct, ProQuest, SID, Magiran, Irandoc, Pubmed, Scopus,
Cochrane Library, and Psych info; Cumulative Index to Nursing and Allied Health Literature (CINAHL). Also,
lists of the references of the relevant articles were reviewed for additional citations. Using Medical Subject
Headings (MESH) keywords: Intervention (Clinical Trials, Non-Randomized Controlled Trials, Randomized
Controlled Trials, Education), intimacy, marital (Marriage) and selected related articles to the study objective
were from 1995 to April 2015. Clinical trials that evaluated one or more behavioral interventions to improve
marital intimacy were reviewed in the study.
Main Results: 39 trials met the inclusion criteria. Eleven interventions had follow-up, and 28 interventions
lacked follow-up. The quality evidence for 22 interventions was low, for 15 interventions moderate, and for one
intervention was considered high. Findings from studies were categorized in 11 categories as the intimacy
promoting interventions in dimensions of emotional, psychological, physical, sexual, temporal, communicational,
social and recreational, aesthetic, spiritual, intellectual intimacy, and total intimacy.
Authors’ Conclusions: Improving and promoting communication, problem solving, self-disclosure and
empathic response skills and sexual education and counseling in the form of cognitive-behavioral techniques and
based on religious and cultural context of each society, an effective step can be taken to enhance marital intimacy
and strengthen family bonds and stability. Health care providers should consider which interventions are
appropriate to the couple characteristics and their relationships.
Keywords: intervention, intimacy, marital
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1. Introduction
Marriage is a transient phase in one's life and has always been emphasized as the paramount social ritual in order
to meet the emotional needs of people (Dildar, Sitwat, & Yasin, 2013; Nayeri, Lotfi, & Noorani, 2014). In
contemporary society, the incentives to marriage include the need to love and have intimate relationship with a
partner, to have a companion in life, to satisfy psychological needs, and to increase joy (Soltani, Molazadeh,
Mahmoodi, & Hosseini, 2013; Tavakol, Zarei, & Zeinali Pour, 2014).
Intimacy includes different meanings based on age, sex, education, and culture, and there is no consensus among
researchers on the root concept of intimacy which makes its definition difficult (Martin & Tardif, 2014; Mitchell,
2007). Bagarozzi (2001) defines intimacy as proximity, similarity and a personal romantic or emotional
communication that requires knowledge and understanding of another person to express thoughts and feelings
(Bagarozzi, 2001).
Intimacy is strongly associated with the quality of couples’ life and is often referred to as a basic psychological
need and one of the key characteristics of marital communication which impacts on marital adjustment and
mental health, such as reducing the risk of depression, increasing happiness and well-being, and providing a
useful satisfactory life of a person. Besides, it is a strong predictor of physical health, such as low level of
diseases and impoverishment of diseases (Boden, Fischer, & Niehuis, 2010; Dandurand & Lafontaine, 2013;
Moreira, Crespo, Pereira, & Canavarro, 2010; Nainian & Nik-Azin, 2013). In a study was shown that marital
intimacy is effective on marital satisfaction (Greeff, Hildegarde, & Malherbe, 2001; Kim, 2013). Intimacy acts as
a mediator between the effects of daily stress in relations between spouses (Harper, Schaalje, & Sandberg, 2000).
There is a significant positive correlation between sexual satisfaction and marriage commitment with intimacy
(Taghiyar, Mohammadi, & Zarie, 2015). In contrast, lack of intimacy is one of the most common causes of
distress and collapse among couples, negatively impacting on relations between the couples and, thereby, leading
to incompatibility and causes stress, and brings about psychological maladaptation, depression, and emotional
disorders mental disorders (Duffey, Wooten, Lumadue, & Comstock, 2004; Kim, 2013; Yoo, Bartle-Haring, Day,
& Gangamma, 2014). Dearth of intimacy is one of the most devastating problems that is difficult to be treated in
the relationships (Whisman, Dixon, & Johnson, 1997). Weinberger et al. (2008) also showed that lack of
intimacy in couples is the most important predictor of divorce in elderly (Weinberger, Hofstein, & Whitbourne,
2008). Thus, it can be stated that the consequences of failure in intimacy are manifold and physical divorce
mainly arises from failure in intimacy (Duffey et al., 2004).
Therapists have described on various aspects that may negatively influence marital stability such as
communication difficulty, unrealistic expectations from marriage and the spouse, lack of intimacy, and lack of
expressing affection (Motavali, Ozgoli, Bakhtiari, & Alavimajd, 2010; Shahrestany, Doustkam, Rahbarda, &
Mashhadi, 2013). Taking the fact for the granted that in many societies today family is the prominent source of
comfort for people and taking the fact that in the modern society the family is faced with the challenges, the most
important of which is the loss of marital intimacy, into account, an interventional program is helpful to prevent
these problems and heighten intimacy (Farbod, Ghamari, & Majd, 2014). To enhance () intimacy in couples,
educational approaches may support () (Oulia, Fatehizadeh, & Bahrami, 2006). It believed that Education and
counseling per se may make the couples take effective and successful steps to increase marital intimacy
(Hosseini Zand, SHafi Abadi, & Soudani, 2013). In Iran, some interventions are done to increase marital
intimacy. For example, In a study was shown that training communication skills can enhance intimacy and
quality in marital life (Farbod et al., 2014). Moreover, KhanjaniVeshki et al. (2012) concluded that sex education
is effective in increasing sexual intimacy (Khanjani Veshki, Botlani, Shahsiah, & Sharifi, 2012). Duffey et al.
(2004) also showed that sharing dreams and events between couples contributes to an increase in intimacy in
couples (Duffey et al., 2004). According to the researchers search in the databases available, no study has
reviewed the interventions promoting marital intimacy after marriage thus far. To address the latter the aim of
this review is to classify the articles investigating the impact of interventional programs on marital intimacy after
marriage.
2. Method
2.1 The Criteria Considered for This Review
2.1.1 Type of Study
Clinical trials that evaluated one or more behavioral interventions to improve marital intimacy were reviewed in
the study. Trials that focused on people with drug abuse and chronic health conditions, such as cancer, were
excluded. The reason for their exclusion pertains to statistical population. This is because training and counseling
to them were not proportionate to type of disorder in individuals and may not be applied for all spouses. Like
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educations and counselings that focused on people with breast cancer or prostate cancer. There was no other
exclusion criterion.
2.1.2 Type of Participants
Married men and women or couples.
2.1.3 Type of Interventions
Interventions can have different formats such as verbal communication or written methods, individual or group
counseling as well as using different types of technology, such as providing educational CDs. Intervention can be
provided in a clinic or in the community and can target men, women, or couples. The comparison can be
performed between the intervention under the study and another behavioral intervention, usual care or without
any intervention.
2.1.4 Type of the Measured Result
Our interest outcome was increasing intimacy. All trials that yielded this result were incorporated in the study.
2.1.5 Type of Intimacy Assessment Tools
To evaluate interventions, different intimacy questionnaires can be applied such as:
Marital Intimacy Questionnaire Thompson and Walker Marital Intimacy Questionnaire (MIQ) (den Broucke &
Vertommen (1995), Waring Intimacy Questionnaire (WIQ), Personal Assessment of Intimacy in Relationships
inventory, Oulia’s Couples intimacy questionnaire, and Bagarozzi’s Marital Intimacy Needs Questionnaire.
2.2 Search Method
In April 2015, we performed a general search in Google Scholar search engines followed by an advanced search
was done in the below databases:
ProQuest, Science Direct, SID, Irandoc, Magiran, Pubmed, Cochrane Library, Scopus, and Psych info;
Cumulative Index to Nursing and Allied Health Literature (CINAHL).
Keywords were arranged based on Medical Subject Headings (MeSH) to search in Medline and based on
non-mesh keywords in other databases including: Intervention (Clinical Trials, Non-Randomized Controlled
Trials, Randomized Controlled Trials, and Education), intimacy and marital (Marriage).
Also, lists of the references of the relevant articles were reviewed for additional citations. Selected related
articles to the study objective were from 1995 to April 2015.
2.3 Interventions Quality
The quality of evidence was evaluated. At first, the quality of the intervention design, implementation, and
reports was evaluated. Quality of intervention downgraded for each of the following studies: 1) implementing
intervention in less than two sessions , 2) the accuracy of reported interventional information for fewer than three
items (Table 1), and 3) lack of follow-up (Lopez, Hiller, Grimes, & Chen, 2012; Lopez, Steiner, Grimes, &
Schulz, 2013). The quality of the interventions evidence was recorded (Table 2) among the overall assessments
of the quality of evidence (Table 3), the quality trials were considered high, then in the case of any of the
following, one level of the quality of evidence was downgraded, A) lack of information on random sequence,
allocation concealed, or lack of allocation concealed B) low quality interventions, and c) loss of more than 20%
at follow-up. We considered a positive level for the studies that performed blinding procedures (Lopez et al.,
2012).
Table 1. Intervention fidelity information
Study
Provider
credentials
Provider
education
Standardized delivery
Delivery
adherence
Hosseinian (2012) -----* -----
1.5 hour session of
communication skill based
on Miller Theory
-----
Asadpour (2012) Consultant -----
12 sessions of emotionally
focused couple therapy that
each session lasted 2/5 hours
step by step and
along with weekly
assignments and
regular exercises
p
rovided b
y
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Study
Provider
credentials
Provider
education
Standardized delivery
Delivery
adherence
consultants
Zarepour (2010) ----- -----
The structure of sessions and
trainings materials presented
at each session were taken
from Davison and Goldfried,
Jacobson and Margolin,
Miller et al., Bernstein and
Bernstein, and was
introduced during 6 weeks
of one hour sessions
Training sessions
were presented
based on training
curriculum
Salimi (2012) ----- -----
sex education was presented
in cognitive behavioral
method during 6 sessions
each lasted two hours
Training sessions
were presented
based on training
curriculum
Nasr Isfahani (2013) ----- -----
meaning - focused workshop
in 10 sessions of 90 minutes
Once a week and
based on the
curriculum
Etemadi (2006) consultant -----
10 sessions of one-hour
couple therapy based on
cognitive behavioral
techniques
Step by step and
though weekly
assignments
Ebrahimi (2011) ----- -----
Communication enrichment
program during 10 sessions
of 1.5 hours
One session in a
week
Rezaei (2013) researcher -----
7 sessions of Islamic
lifestyle training with an
emphasis on the family
system
Twice a week
sessions for 90
minutes each time
Shakarami (2014) ----- -----
6 sessions of two hours sex
education in the form of
speech, asking questions,
group discussion and
presentation of assignments
Weekly program
and based on the
curriculum
Ghadam kheir (2013) ----- -----
8 sessions of intervention
based on
intellectual-emotional
behavior therapy
For eight weeks,
every week for an
hour and a half in
groups
Mazlomi (2012) ----- -----
Marriage enrichment
preventive program
designed by Mies and
presented during 7 weeks
Every week one
communication
skill was taught to
couples.
Etemadi (2014) ----- -----
Eight sessions of an hour
and a half of group training
based on communication
therapy approach
Weekly program
and based on the
curriculum
Hosseini Zand (2013) researcher -----
10 sessions of two hours of
Islamic couple therapy
training
Implemented once
a week and in
three stages
Shariatzadeh (2014) researcher -----
10 training sessions based
on choice theory
-----
Oulia (2006) ----- -----
6 sessions of 90-minute of
marital life enrichment
training
Sessions were
hold step by step
and weekly
BabaeiGarmkhani(2014) ----- -----
8 sessions of 90-minute of
cognitive behavioral group
training
Twice a week and
based on the
curriculum
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Study
Provider
credentials
Provider
education
Standardized delivery
Delivery
adherence
Botlani (2010) ----- -----
8 attachment-based couple
therapy sessions
Once a week and
each session 90
minutes
Hosseini (2013) ----- -----
8 sessions of 90-minute of
solution-focused group
counseling
Weekly and based
on the curriculum
Nasr Isfahani (2010) ----- -----
7 sessions of 90 minute of
teaching concepts of choice
theory
Once a week and
based on the
curriculum
Bahrami (2009)
offered
under the
counseling
and leading
of the
supervising
professor
-----
the 6 session 2-hr group
enrichment program training
Weekly
Durana (1997) therapist
Leaders are
license mental
health
professional
The standard 4-month
PAIRS format
Weekly or
biweekly 3 hour
sessions and 4 or
5 weekend
workshop lasting
about 21 hours.
Khanjani veshki (2012) counselor -----
6 sessions of sex education.
Format and content
identified for sessions
Sex training was
presented step by
step for men and
women
Duffey (2004) researcher -----
offering of the
intimacy-building ,
dream-sharing workshop
and workbook used to the
interventional group an
intimacy-building and
event-sharing workshop
presented to the control
treatment group
a four hour dream
sharing workshop
Nayari (2014) ----- -----
8 sessions of Transactional
Analysis that each session
lasted 1/5 hours
Training sessions
were presented
based on training
curriculum
Hajian (2013) ----- -----
An intensive course of
solution-focused couples
therapy was presented
within six sessions that each
session lasts 1.5 hours
Sessions for 2.6
months with
giving
assignments and
feedbacks that
presented based
on Objectives
listed for each
visit.
Nasirnejhad karaj(2014) ----- -----
Training positive thinking
skills during 8 sessions that
each session lasted 1/5
hours. Format and content
identified for sessions
Weekly sessions
Mami (2015) consultant -----
ten sessions of 60 minutes
couples therapy and
cognitive-behavioral
techniques
Weekly sessions
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Study
Provider
credentials
Provider
education
Standardized delivery
Delivery
adherence
Farbod (2014) ----- -----
12 sessions to enhance
communication skills based
marriage and family therapy
No information
Mohamadi (2013) ----- ----- ----- -----
Coutta (2002) A couple
A couple
trained and
husband had a
Divinity degree
with an
emphasis in
psychology and
counseling.
A weekend marriage
enrichment program With
emphasis on Integrative
Couple Therapy (ICT)
developed by Neil Jacobson
and Andrew Christensen.
Training session
were presented
based on training
curriculum
Nasirnejhad [Tehran]
(2014)
----- -----
8 sessions of 1.5 hours
training positive thinking
skills. Format and content
identified for sessions
twice a week
Sharifian (2011) ----- -----
12 sessions of couple
communication program
(CCP) that each session
lasted 2 hours
once a week
Hickmon (1997)
first author
and a couple
The husband
was in his final
week of a
masters' degree
program in
Bible and
Religion,
training to be a
family life
minister.
In the Adventure group,
Waring's (1984) 8
components of marital
intimacy in the design was
used
two-day weekend
Soltani (2013) ----- -----
8-10 sessions 120 minutes of
emotionally focused couple
therapy( EFCT)
EFCT has 3 stages
and 9 steps.
Denton (2000) therapist
Therapist was
provided with
12 hr of
training in
emotion
focused therapy
that covered the
theory and
techniques of
the approach.
8 sessions of emotion
focused therapy (EFT) that
each session lasted 50
minutes
Weekly
Karimi (2012) ----- ----- -----
weekly
Yousefi (2014) counselor
trained
counselor
in the
Counseling
Center
8 sessions of 1 hour based
on Format and content
identified
for sessions
Two times a week.
Momeni Javid (2014) ----- -----
9 sessions that each session
lasted 1 hour. Format and
content identified for
sessions.
per week
*No information
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Table 2. Quality of intervention* evidence
Study Sessions <= 2
Having
Follow-up
Intervention fidelity < 3
items
Quality1
Hosseinian (2012) --- -1 -1 Low (-2)
Asadpour (2012) --- -1 ---
Moderate
(-1)
Zarepour (2010) --- -1 -1 Low (-2)
Salimi (2012) ---- -1 -1 Low (-2)
N
asr Isfahani (2013) --- -1 -1 Low (-2)
Etemadi (2006) --- -1 ---
Moderate
(-1)
Ebrahimi (2011) --- --- -1
Moderate
(-1)
Rezaei (2013) --- -1 ---
Moderate
(-1)
Shakarami (2014) --- --- -1
Moderate
(-1)
Ghadam Khei
r
(2013) --- -1 -1 Low (-2)
Mazlomi (2012) --- -1 -1 Low (-2)
Etemadi (2014) --- -1 -1 Low (-2)
Hosseini Zand (2013) --- --- --- High (0)
Shariatzadeh (2014) --- -1 -1 Low (-2)
Oulia (2006) --- -1 -1 Low (-2)
Babaei Garmkhani (2014) --- -1 -1 Low (-2)
Botlani (2010) --- --- -1
Moderate
(-1)
Hosseini (2013) --- -1 -1 Low (-2)
N
asr Isfahani (2010) --- -1 -1 Low (-2)
Bahrami (2009) --- --- --- High (0)
Durana (1997) --- --- --- High (0)
Khanjani Veshki (2012) --- -1 ----
Moderate
(-1)
Duffey (2004) -1 -1 ---- Low (-2)
Nayari (2014) --- --- -1
Moderate
(-1)
Hajian (2013) --- -1 -1 Low (-2)
N
asirnejhad Karaj (2014) --- -1 -1 Low (-2)
Mami (2015) --- -1 ---
Moderate
(-1)
Farbod (2014) --- -1 -1 Low (-2)
Mohamadi (2013)
N
o
information
-1 -1 Low (-2)
Coutta (2002)
N
o
information
--- --- High (0)
N
asirnejhad Tehran
(2014)
--- -1 -1 Low (-2)
Sharifian (2011) --- --- -1
Moderate
(-1)
Hickmon (1997) --- -1 ---
Moderate
(-1)
Soltani (2013) --- -1 -1 Low (-2)
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Study Sessions <= 2
Having
Follow-up
Intervention fidelity < 3
items
Quality1
Denton (2000) --- -1 ----
Moderate
(-1)
Karimi (2012) --- -1 -1 Low (-2)
Yousefi (2014) --- --- --- High (0)
Momeni Javid (2014) --- --- -1
Moderate
(-1)
*
Quality of the studies downgraded for each of the following studies: 1) implementing intervention in less than
two sessions, 2) lack of follow-up, 3) the accuracy of reported interventional information for fewer than three
items
Table 3. Quality of evidence*
Study
Randomization;
allocation
concealment
Losses >
20%
Blinding Quality
of evidence1
Intervention
quality
Quality of
evidence1
Hosseinian (2012) -1
N
o information ---- -1 Low(-2)
Asadpour (2012) -1
N
o information ----- ----- Moderate(-1)
Zarepour (2010) -1
N
o information --- -1 Low(-2)
Salimi (2012) -1
N
o information --- -1 Low(-2)
N
asr Isfahani (2013) -1
N
o information --- -1 Low(-2)
Etemadi (2006) -1
N
o information --- --- Moderate(-1)
Ebrahimi (2011) -1
N
o information --- --- Moderate(-1)
Rezaei (2013) -1
N
o information --- --- Moderate(-1)
Shakarami (2014) -1
o information --- --- Moderate(-1)
Ghadam Khei
r
(2013) -1
N
o information --- -1 Low(-2)
Mazlomi (2012) -1
N
o information --- -1 Low(-2)
Etemadi (2014) -1 --- --- -1 Low(-2)
Hosseini Zand (2013) -1
N
o information --- --- Moderate(-1)
Shariatzadeh (2014) -1
N
o information --- -1 Low(-2)
Oulia (2006) -1 --- --- -1 Low(-2)
Babaei Garmkhani
(2014)
-1 No information --- -1 Low(-2)
Botlani (2010) -1
N
o information --- --- Moderate(-1)
Hosseini (2013) -1
N
o information --- -1 Low(-2)
N
asr Isfahani (2010) -1
N
o information --- -1 Low(-2)
Bahrami (2005) -1
N
o information --- --- Moderate(-1)
Durana (1997) -1 --- --- --- Moderate(-1)
Khanjani Veshki
(2012)
-1 No information --- --- Moderate(-1)
Duffey (2004) -1
N
o information --- -1 Low(-2)
N
ayari (2014) -1
N
o information --- --- Moderate(-1)
Hajian (2013) -1
N
o information --- -1 Low(-2)
N
asirnejhad Karaj
(2014)
-1 No information --- -1 Low(-2)
Mami (2015) -1
N
o information --- --- Moderate(-1)
Farbod (2014) -1
N
o information --- -1 Low(-2)
Mohamadi (2013) -1
N
o information --- -1 Low(-2)
Coutta (2002) -1 -1 --- --- Low(-2)
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Study
Randomization;
allocation
concealment
Losses >
20%
Blinding Quality
of evidence1
Intervention
quality
Quality of
evidence1
N
asirnejhad Tehran
(2014)
-1 No information --- -1 Low(-2)
Sharifian (2011) -1
N
o information --- --- Moderate(-1)
Hickmon (1997) -1
N
o information +1 --- High(0)
Soltani (2013) -1
N
o information --- -1 Low(-2)
Denton (2000) -1 -1 --- --- Low(-2)
Karimi (2012) -1
N
o information --- -1 Low(-2)
Yousefi (2014) -1
N
o information --- --- Moderate(-1)
Momeni Javid (2014) -1
N
o information --- --- Moderate(-1)
*Quality could be high, moderate, low, or very low. We considered these RCTs to be high quality then
downgraded a level for each of the following: A) lack of information on random sequence, allocation concealed,
or lack of allocation concealed B) low quality interventions (Table 2), c) loss of more than 20% at follow-up. We
upgraded one level for the studies that performed some blinding.
Table 4. Characteristics of excluded studies
Stud
y
Reason for exclusion
Amber (2011) Trial focused on couples with cance
r
Leclerc Trial focused on young adults with first psychological episode
Chambers (2014) Trial focused on men with localised prostate cancer and their female partners
Zarei (2014)
Trial focused on spouses of wa
r
-disabled affiliated with markers and self
sacrifices
Jun (2011) Trial focused on Breast Cancer Survivors
Heather (2013) Trial focused on men with localised prostate cance
r
Robertson (2014) Trial focused on Patients with prostate cancer and their partners
Reese (2012) Trial focused on couple who had facing colorectal cancer.
Reese (2014) Trial focused on couple who had facing colorectal cancer.
Julia (2009) Trial focused on Patients with breast cance
r
Jung (2005) Trial focused on male patients with spinal cord injuries
Kerri (2012) Trial focused on prostate cancer survivors (PCS) and their spouses
Manne (2004) Trial focused on women with breast cancer and their partners
N
ho (2013) Trial focused on Women with Gynecologic Cancer and Their Husbands
Otto (2015) Trial focused on women with breast cancer and their intimate partners
Gol (2013) Trial focused on depressed patients
DeMarco (2009) Trial focused on women living with or at risk for HIV.
Manne (2011) Trial focused on Men Diagnosed with Prostate Cancer and Their Partners
Hummel (2015) Trial focused on b
r
east cancer survivors
Sidddons (2013) Trial focused on men with localised prostate cancer.
Edward (1995) Trial focused on depressed married women
Babapour Kheiroddin
(2012)
Trial focused on chemical patient couples
Hamedi (2011) Trial focused on addic
t
ed man and their Wives.
Sadrejahani (2009) Trial focused on addicts and their wives
Kazemian (2013) Trial focused on infertile Couples
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Table 5. The intimacy-enhancing interventions in different dimensions
Dimension Intervention Authors
Emotional intimacy
Communication skill Hosseinian (2012), Mazlomi (2012)
Relationship Therap
y
Etemadi (2014)
Relationship enhancement progra
m
Ebrahimi (2011)
Marital enrichmen
t
Oulia (2006), Bahrami (2009)
Solution-focused couples therapy Hajian (2013)
Solution-Focused Group Counseling Hosseini (2013)
Cognitive-
b
ehaviour couple therap
y
Etemadi (2006)
Training of Islamic Lifestyle Rezaei (2013)
Emotional focused couple therap
y
Soltani (2013), Asadpour (2012)
(narrative therapy) Mohamadi (2013)
Psychological intimacy
Communication skill Hosseinian (2012), Mazlomi (2012)
Relationship enhancement progra
m
Ebrahimi (2011)
Marital enrichmen
t
Oulia (2006), Bahrami (2009)
Solution-focused couples therapy Hajian (2013)
Solution-Focused Group Counseling Hosseini (2013)
Cognitive-
b
ehavior couple therap
y
Etemadi (2006)
Training of Islamic Lifestyle Rezaei (2013)
Emotional focused couple therap
y
Soltani (2013), Asadpour (2012)
Problem Solving Training Zarepour (2010)
Physical intimacy
Communication skill Hosseinian (2012), Mazlomi (2012)
Relationship enhancement progra
m
Ebrahimi (2011)
Relationship Therap
y
Etemadi (2014)
Problem Solving Training Zarepour (2010)
Solution-focused couples therapy Hajian (2013)
Training of Islamic Lifestyle Rezaei (2013)
Emotional focused couple therap
y
Soltani (2013), Asadpour (2012)
Sexual intimacy
Communication skill Hosseinian (2012), Mazlomi (2012
Relationship enhancement progra
m
Ebrahimi (2011)
Solution-focused couples therapy Hajian (2013)
Solution-Focused Group Counseling Hosseini (2013)
Cognitive-
b
ehavior couple therap
y
Etemadi (2006)
Training of Islamic Lifestyle Rezaei (2013)
Islamic couple therapy Hosseini Zand (2013)
Sex education
Shakarami (2014), Salimi (2012), Khanjani
veshki (2012)
Attachmen
t
-
b
ased couple therapy Botlani (2010)
Emotional focused couple therap
y
Soltani (2013), Asadpour (2012)
Training Positive Thinking
N
asiri Nejad (2014)
Temporal intimacy
Emotional focused couple therap
y
Soltani (2013)
Communication skill Mazlomi (2012)
Solution-Focused Group Counseling Hosseini (2013)
Communicational
intimacy
Relationship enhancement progra
m
Ebrahimi (2011)
Solution-focused couples therapy Hajian (2013)
Marital enrichmen
t
Oulia (2006), Bahrami (2009)
Training of Islamic Lifestyle Rezaei (2013)
Emotional focused couple therap
y
Soltani (2013), Asadpour (2012)
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Dimension Intervention Authors
(narrative therapy) Mohamadi (2013)
Social-Recreational
intimacy
Communication skill Hosseinian (2012), Mazlomi (2012)
Relationship enhancement progra
m
Ebrahimi (2011)
Marital enrichmen
t
Oulia (2006), Bahrami (2009)
Emotionally focused couple therap
y
Asadpour (2012)
Training of Islamic Lifestyle Rezaei (2013)
Aesthetic intimacy Communication skill Mazlomi (2012)
Spiritual intimacy
Communication s
k
ill Hosseinian (2012), Mazlomi (2012)
Relationship enhancement progra
m
Ebrahimi (2011)
Marital enrichmen
t
Oulia (2006), Bahrami (2009)
Emotionally focused couple therap
y
Asadpour (2012)
Training of Islamic Lifestyle Rezaei (2013)
Intellectual intimacy
Communication skill Hosseinian (2012), Mazlomi (2012)
Relationship enhancement progra
m
Ebrahimi (2011)
Marital enrichmen
t
Oulia (2006), Bahrami (2009)
Emotional focused couple therap
y
Soltani (2013), Asadpour (2012)
Problem Solving Training Zarepour (2010)
Solution-focused couples therapy Hajian (2013)
Total intimacy
Communication skill
Farbod (2014), Sharifian (2011), Karim I
(2012)
Problem Solving Training Zarepour (2010)
Training solution-focused couples
therapy
Hosseini (2013)
Dream sharing Duffey (2004)
Marital enrichmen
t
Coutta(2002), Hickmon (1997)
Training Positive Thinking
N
asirnejhad (2014)
Cognitive- behavior couple therapy
Mami (2015), Etemadi (2006),
BabaeiGarmkhani (2014)
Meaning-centered training
N
asr Isfahani (2013)
Choice theory training
N
asr Isfahani (2010)
Rational - emotional behavioral
therapy
Ghadam kheir (2013)
Foot massage Uhm (2010)
Rogers Self Theory and Ellis
Rational Theory
Yousefi (2014)
Group training of transactional
analysis
Nayeri (2014)
Enhancing marital intimacy Durana (1997)
Emotion focused therapy Denton (2000)
3. Search Results
Sixty six sources were provided by the search from 1995 to April 2015. After reviewing the various titles and
abstracts, 25 studies were excluded from review due to the lack of consideration of study criteria (the 25 studies
that were excluded from review included 9 studies in the USA, 6 from Iran, 2 from Canada, 3 in each of
Australia and Korea, whereas 1 was completed in each of England and the Netherlands, although they focusing
on respondents with drug abuse and chronic health conditions) (Table 4). Finally, 39 trials met the inclusion
criteria (Figure 1). The total number of participants was 1981 people, and the number of participants in each
study was from 24 to 216 people. Average number of participants in each trial was 50.79 people. Thirty three
studies were conducted in Iran, and the six others were conducted in America and Korea. Sixteen trials focused
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on women, 20 trials focused on couples, and 3 trials focused on men and women. Studies varied in provided
educating content and format.
Eleven interventions had follow-up (Bahrami, Oulia, & Isanezhad, 2009; Botlani, Ahmadi, Bahrami, Shahsiah,
& Mohebbi, 2010; Coutta, 2001; Durana, 1997; Ebrahimi, Sanaei Zaker, & Nazari, 2011; Hosseini Zand et al.,
2013; Momeni Javid, Soveyzi, & Mousavi, 2014; Nayeri et al., 2014; Shakarami, Davarniya, Zahrakar, & Gohari,
2014; Sharifian, Najafi, & Shaghaghi, 2011; Yousefi & Kiani, 2014) and 28 interventions lacked follow-up. Time
of interventions was from one 4-hour workshop (Duffey) to 120-hour interventions for 4 to 5 months (Durana).
The quality of interventions was high in five studies, moderate in 13 studies was, and low in 20 studies. However,
due to the limitations in the language in one study (the full text of the article was in Korean), it was not feasible
to ensure the quality of the intervention (Table 2). The quality evidence was low for 22 interventions, moderate
for 15 interventions, and high for one intervention (Table 3). Findings from studies were categorized in 11
categories as the intimacy promoting interventions in dimensions of emotional, psychological, physical, sexual,
temporal, communicational, social and recreational, aesthetic, spiritual, intellectual intimacy, overall dimension,
and total intimacy and are shown in Table 5.
Figure 1. Result of the search
4. Discussion
4.1 Emotional Intimacy
emotional intimacy has been described as to share all the emotions, both positive and negative feelings with the
spouse (Bagarozzi, 2001). Studies show that training and enriching the communication skills and communication
therapy can contribute to the promotion of emotional intimacy (Ebrahimi et al., 2011; Etimadi, Jafari, & Seyah,
2014; Hosseinian, Yazdi, & Tabatabaei, 2012; Mazlomi, Dolatshahi, & Nazari, 2012). In these studies,
participants were trained in some of the most important skills including conflict resolution by understanding the
hidden needs and feelings of the spouse, understanding how to ask the needs and expectations, Identification of
the impact of incorrect beliefs and expectations of spouses on the creation of conflicts and reduction of intimacy
and active listening (Mazlomi et al., 2012), increasing self-awareness, knowing the spouse, getting familiar with
each other's needs and losses, renewing the memories of the past and improving the relations (Etimadi et al.,
2014) and training communication skills based on Miller's theory. So that in this plan, women were instructed
the skills of speaking so as to convey information to the spouse, skills of listening, and skills of problem solving
and planning in order to solve problems and identify effective communication styles (Hosseinian et al., 2012).
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Solution-focused training plays an important role in increasing this dimension of intimacy. In this study, the
couples were trained in six 90-minute training sessions to improve relationships and communication, evaluate
the level of marital conflict and the nature of the problem, detect the chief complaint and define the problem, set
a goal, examine solutions, formulate circles to find the solutions of the problems, and give the old and common
solutions using intensive courses of couple therapy along with doing some homework in each session (Hajian &
Mohammadi, 2013). The study showed that group counseling in the solution-focused method enhances the
emotional intimacy (Hosseini, Majd, & GHamari, 2013). The other studies also stated that emotion-focused
couple therapy can promote this dimension of intimacy (Asadpour, Nazari, Zaker, & Shaghaghi, 2012; Soltani et
al., 2013). The 9-stage emotion-focused therapy of couples consists of description of the issues related to the
conflict, identification of negative interaction circle that causes distress in couples, access unexplored emotions
that are based on interactive conditions, formulation of the problem baced on emotion, like anger, disgust, fear,
happiness, sadness and surprise. and attachment-focused needs, increase of the understanding of self emotions
and personal needs that have been ignored, increase of accepting experiences of each spouse by the other party,
creation of new ways of communicating, facilitation of expressing emotional needs and demands, facilitation of
the development of new solutions for old problems and finally integration and reinforcement of new situations
(Asadpour et al., 2012; Soltani et al., 2013).
Etemadi et al. (2006) showed in their study that the use of cognitive-behavioral techniques can promote
emotional intimacy. In the cognitive behavioral techniques, participants were studied in terms of having
unrealistic expectations and beliefs about intimacy and sexual relationships and the destructive effects of such
behaviors on feelings, eliminating misunderstandings arising from misconceptions or different understanding,
assessing the problems associated with the message sender and receiver and training communication skills,
creating empathic understanding and active listening comprehension skills, training problem solving skills, and
exploring the conflicts between spouses weekly and along with assignments (Etemadi, Navvabi Nezhad, Ahmadi,
& Farzad, 2006). Other interventions to promote emotional intimacy can be pointed out as narrative therapy
(Mohammadi, Sohrabi, & Aghdam, 2013), the Islamic lifestyle (Rezaei et al., 2013), and enriching the marital
life (Bahrami et al., 2009; Oulia et al., 2006).
4.2 Psychological Intimacy
Psychological intimacy involves sharing personal issues, information, hopes, fears, desires, and feelings about
the self with a spouse (Bagarozzi, 2001). The study of Ebrahimi et al. (2011) showed that enriching
communication plays an important role in enhancing this dimension of intimacy. Here, in the relationship
enrichment program, expressive skills, empathic listening, correct simultaneous way of speaking and listening
and comparing it with the non-skilled dialogue, conflict resolution skill, self -change skill, and the skill of
helping the spouse to change of the participants of the study were investigated (Ebrahimi et al., 2011). The
studies of Hosseinian et al. (2012) and Mazlomi et al. (2012) came across results in line with the study of
Ebrahimi (2011) and showed that enriching communication skills contributes to a rise in intimacy. Education of
problem-solving skill among couples leads to increasing psychological intimacy (Zarepour, 2010), that is in line
with the study of Hajian (2013) (Hajian & Mohammadi, 2013). Zarepour performed the education of
problem-solving skill in order to take a positive and optimistic attitude towards the problem and the ability of the
couples to deal with it, identify problems and obstacles to solve the problem, identify realistic objectives agreed
by the couples, evaluate each solution and select the best solution, and implement the selected solution in the real
life (Zarepour, 2010). Other interventions that can promote the psychological intimacy can be emotion focused
couple therapy skill (Asadpour et al., 2012; Soltani et al., 2013) and the Islamic lifestyle approach. The Islamic
life style approach is based on Islamic rules and principles more expounded on in the following sections. (Rezaei
et al., 2013)
4.3 Physical Intimacy
Physical intimacy is the partner’s need to physical contact such as hugging, holding hands and non-sexual touch
(Bagarozzi, 2001). Education of problem-solving skill is effective in increasing this dimension of intimacy
(Zarepour, 2010). The studies of Hajian (2013) and Hosseini (2013) were consistent with the study of Zarepour
(2010) and showed that solution-focused training leads to increasing physical intimacy (Hajian & Mohammadi,
2013; Hosseini et al., 2013). Emotion-focused couple therapy can promote the physical intimacy of the couples
(Asadpour et al., 2012). The study of Soltani (2013) is also in line with the study of Asadpour (Soltani et al.,
2013). Other interventions that can promote the physical intimacy can be communication enriching (Ebrahimi et
al., 2011; Etimadi et al., 2014; Hosseinian et al., 2012; Mazlomi et al., 2012) and Islamic lifestyle training
(Rezaei et al., 2013).
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4.4 Sexual Intimacy
Sexual intimacy involves the expression of thoughts, feelings, and desires that have sexual nature and are
planned to arouse sexual stimulation and sexual satisfaction (Bagarozzi, 2001). One of the ways to increase
sexual intimacy is to present sex education to couples (Shakarami et al., 2014). Education and counseling in
sexual dimension cause the couples to get enough awareness in this field and take effective steps to deal with
their sexual problems and promote sexual intimacy (Zand et al., 2013). Sex education based on
cognitive-behavioral techniques is effective to improve sexual intimacy (Veshki et al., 2012). Sex education
increases sexual intimacy (Salimi & Fatehizadeh, 2012; Shakarami et al., 2014). In sex education, participants
become familiar with physiology and sexual behavior and also receive education on topics such as modifying the
myths about sexual matters, shaping the sexual intimacy and appropriate sexual techniques, and getting familiar
with some of the most common sexual disorders (Shakarami et al., 2014). In addition, in the study of Salimi
(2012), participants received trainings such as relaxation and fantasy skill, attention and awareness of the
Sensory symptoms, expression of emotion and self -sexual expression, establishment of sexual intimacy,
increase of positive self-talk, communication skill, increase of positive interactions, and problem solving (Salimi
& Fatehizadeh, 2012).
Couples’ communication skill improvement increased sexual intimacy (Mazlomi et al., 2012). The study of
Hosseinian (2012) and Ebrahimi (2011) are in line with the study of Mazlomi (2012) (Ebrahimi et al., 2011;
Hosseinian et al., 2012). While Etemadi (2014) showed that communication therapy does not improve the sexual
intimacy (Etimadi et al., 2014). Nasiri Nejad (2014) found that educating positive thinking is conducive to sexual
function and sexual intimacy of the spouses. In this study, participants were first familiarized with the need to
positive thinking, different coping styles, and the ways to forming thinking and attitudes. The participants were
then familiarized with their negative thoughts and modification techniques and also with positive thinking and its
effect on the life based on cognitive-behavioral technique. Applying the ABC theory of, (The ABC Model A
major aid in cognitive therapy is what Albert Ellis (1957) called the ABC Technique of Irrational Beliefs. The
first three steps analyze the process by which a person has developed irrational beliefs including: A - Activating
Event or objective situation, B - Beliefs and C - Consequence. Ellis believes that it is not the activating event (A)
that causes negative emotional and behavioral consequences (C). Rather, a person interprets these events
unrealistically and, therefore, has an irrational belief system (B) that helps cause the consequences (C) (McLeod,
2008)). The participants were trained in forming positive thoughts for example: 1) Im responsible and in control
of my life. 2) Circumstances are what they are, but I can choose my attitude towards them. And 3) Every
challenge that comes along is an opportunity to learn and grow. 4) I am getting better every day.). Training
techniques to stop negative thoughts, boosting self confidence, and adding laughter and sports to life were other
positive thinking techniques which were relied upon (Nejad, Nazari, & Bahrainian, 2014) .Other interventions to
promote sexual intimacy can be solution-focused training (Hajian & Mohammadi, 2013; Hosseini et al., 2013),
use of cognitive-behavioral techniques (Etemadi et al., 2006), the Islamic lifestyle (Rezaei et al., 2013), couple
therapy (Zand et al., 2013), couple therapy based on attachment (Botlani et al., 2010) and emotion-focused
couple therapy (Asadpour et al., 2012; Soltani et al., 2013).
4.5 Temporal Intimacy
Temporal intimacy indicates the extent to which couples tend to spend their daily time with their spouses on
intimate activities (Bagarozzi, 2001). The study of Soltani et al. (2013) showed that emotion-focused couple
therapy can promote this dimension of (Soltani et al., 2013). The first hypotheses on excitement-based
treatments contend that the most effective factor in creating and maintaining marital intimacy is the type of the
existing chain of excitement. Johnson (2004) predicts that excitement-based treatment (emphasizing sympathy,
self-expression, deep understanding of one’s self needs and the partner’s needs, acceptance, expression of ideas
and feelings and creation of an emotional environment, all of which are considered as essential elements in an
intimate relationship) can play a powerful role in increasing intimacy in couples (Hamedi, Abadi, Navabinejad,
& Delavar, 2013). Other interventions that can be pointed out to increase intimacy are communication skill
training (Mazlomi et al., 2012) and solution-focused group counseling, in Solution-based treatment focuses on
the activities both of the spouses enjoy and encourages them to do those activities again. Recommending the
couple to walk and have recreation together without the presence children can be significant help to them in an
optimal use of their time (Hosseini et al., 2013).
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4.6 Communication Intimacy
Communication intimacy is defined as the creation of a relationship with respect, commitment, and positive
emotions in such a way that the spouses feel valued and respected in this communication (Oulia et al., 2006).
Bahrami (2009) carried out a study with the purpose of enriching marital life, and the intervention group was
trained to have intimacy, improve sex issues, manage household, restructure cognition, and learn conflict
resolution skill. The results showed that training marital life enrichment enhances communication intimacy
(Bahrami et al., 2009). The results of the study of Oulia (2006) are consistent with the above study (Oulia et al.,
2006). Hajian (2013) reported that group solution-focused training is related to promoting communication
intimacy by promoting intimacy (Hajian & Mohammadi, 2013). Other study also showed that communication
enrichment is associated with increased communication intimacy (Ebrahimi et al., 2011; Hosseinian et al., 2012).
Moreover, Soltani (2013) stated that the emotion-focused therapy increased communication intimacy (Soltani et
al., 2013) that the study of Asadpour (2012) is consistent with the above study (Asadpour et al., 2012). Other
interventions promoting communication intimacy include narrative therapy (Mohammadi et al., 2013) and
Islamic lifestyle (Rezaei et al., 2013).
4.7 Social-Recreational Intimacy
Social recreational intimacy requires involving the spouse in responsibilities, passing holidays, enjoyable
activities and leisure time, and expressing experiences and daily events (Bagarozzi, 2001). It was shown in the
studies that communication skill training increases this dimension of intimacy (Ebrahimi et al., 2011; Hosseinian
et al., 2012; Mazlomi et al., 2012); however, Etemadi (2014) showed that communication therapy has no positive
effect in promoting social recreational intimacy (Etimadi et al., 2014). Asadpour (2012) demonstrated that
emotion-focused couple therapy can promote social recreational intimacy while Soltani (2013) stated that
emotion-focused couple therapy has no significant effect on increasing this type of intimacy (Asadpour et al.,
2012; Soltani et al., 2013). In emotion-focused couple therapy, the first hypotheses on excitement-based
treatments contend that the most effective factor in creating and maintaining marital intimacy is the type of the
existing chain of excitement. Johnson (2004) predicts that excitement-based treatment (emphasizing sympathy,
self-expression, deep understanding of one’s self needs and the partner’s needs, acceptance, expression of ideas
and feelings and creation of an emotional environment, all of which are considered as essential elements in an
intimate relationship) can play a powerful role in increasing intimacy in couples (Hamedi et al., 2013). Rezaei
(2013) showed in his study that the Islamic lifestyle training increases recreational intimacy between spouses and
that a summary of Islamic lifestyle training content includes the definition of marital intimacy, expression of
couples’ expectations from their marital life, Islam’s idea about intimacy and the ways to increase it, verbal and
nonverbal communications of the spouses, role of forgiveness in the conjugal life, guidance in order to enhance
the relationships among couples, rights of spouses towards each other and respecting the boundaries in the
families, sex customs in Islam and respect for privacy in sexual relationships, procedures of creating peace in the
family, and methods of conflict resolution in the family (Rezaei et al., 2013).
4.8 Aesthetic Intimacy
Aesthetic intimacy needs sharing feelings, thoughts and beliefs that are Beautiful exciting in one’s opinion
(Aesthetic intimacy needs sharing feelings, thoughts, and beliefs which are beautiful excitements in one’s
opinion, such as wonders of nature and the cosmos, music, art, poetry, etc. (Bagarozzi, 2001). Mazlomi (2012)
demonstrated in that communication skill training can promote the aesthetic intimacy (Mazlomi et al., 2012),
while the study of Etemadi (2006), which was performed to evaluate the effect of cognitive behavioral
techniques training on intimacy and the intervention group, was trained skills of communication, problem
solving, and conflict. Besides, cognitive factors showed that the above skills do not have any effects on
improving this dimension of intimacy (Etemadi et al., 2006).
4.9 Spiritual Intimacy
Religious intimacy is described as to express your thoughts, feelings, beliefs and experiences about religion,
supernatural issues, moral values, life after death, and the relationship with God for your spouse (Bagarozzi,
2001). Mazlomi et al. (2012) showed that promoting communication skill of couples increases the intimacy in
this dimension (Mazlomi et al., 2012). The other studies are in line with the study of Mazlomi (2012) (Ebrahimi
et al., 2011; Hosseinian et al., 2012), while Etemadi et al. (2014) reported that communication therapy does not
improve religious intimacy (Etimadi et al., 2014). Asadpour (2012) also showed that emotion-focused couple
therapy can promote religious intimacy; on the other hand Soltani (2013) showed that emotion-focused couple
therapy has no significant effect on increasing this dimension of intimacy (Asadpour et al., 2012; Soltani et al.,
2013). Also Oulia (2006) reported that the marital life enrichment can promote religious intimacy that is in line
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with the study of Bahrami (2009) (Bahrami et al., 2009; Oulia et al., 2006). The results of the study of Rezaei et
al. (2013) also showed that religious intimacy is effective in improving the Islamic lifestyle (Rezaei et al., 2013).
4.10 Intellectual Intimacy
Intellectual intimacy is the need to transfer and restate important thoughts and beliefs with the spouse (Bagarozzi,
2001). The study showed that enrichment of marital life can promote the intellectual intimacy (Oulia et al., 2006).
The other study is in line with the above study (Bahrami et al., 2009). The results of the study of Mazlomi et al.
(2012) stated that improving the communication skill of couples increases intellectual intimacy (Mazlomi et al.,
2012). The other studies are in line with the study of Mazlomi (2012) (Ebrahimi et al., 2011; Hosseinian et al.,
2012), while Etemadi et al. (2014) showed that the communication therapy has no effect on the promotion of
intellectual intimacy (Etimadi et al., 2014). Zarepour (2010) showed that training problem-solving skill leads to
the improvement of intellectual intimacy between the couples (Zarepour, 2010). Solution-focused training of the
couples can promote this aspect of intimacy (Hajian & Mohammadi, 2013). Emotion focused therapy increases
this dimension of intimacy (Soltani et al., 2013), which is in line with the study of Asadpour et al. (2012).
4.11 Total Intimacy
Momeni Javid et al. (2014) reported that training marital life promoting skills has an effective role to improve
marital intimacy (Javid et al., 2014). The results of the other studies are in line with this study (Farbod et al.,
2014; Karimi, Hasani, Soltani, Dalvand, & Zohdi, 2012; Sharifian et al., 2011). Moreover, Zarepour (2010)
showed that promoting problem-solving skill in couples is associated with increasing the overall intimacy that
the study of Hosseini (2013) is in line with it (Hosseini et al., 2013; Zarepour, 2010). Sharing dreams and events
can promote total intimacy (Duffey et al., 2004). Marital life enrichment of couples increases the intimacy that is
in line with the study of Hickmon (1997) (Coutta, 2001; Hickmon Jr, Protinsky, & Singh, 1997). Enrichment of
intimacy promoting program increases marital intimacy (Durana, 1997). The study reported that the use of
cognitive-behavioral techniques enhances the intimacy of the couples which is consistent with the other studies
(Babaei Garmkhani, Madani, & Lavasani, 2014; Etemadi et al., 2006; Mami, Roohandeh, & Kahareh, 2015).
Emotion focused therapy can promote intimacy (Denton, Burleson, Clark, Rodriguez, & Hobbs, 2000) and
emotional intellectual behavioral therapy can promote intimacy (Ghadam kheir, Ghamari Givi, Niloofar, &
Sepehri Shamlo, 2013). Education of choice theory concepts increases marital intimacy (Nasr Isfahani, 2010),
while the results of the study of Shariatzadeh (2014) suggested that the effect of training choice theory in group
method was not significant to increase marital intimacy (Shariatzadeh, Tabrizi, & Ahghar, 2014). Other intimacy
promoting interventions include positive thinking (Nasiri Nejad, Tork, Zahedi Rad, Nazari, & Korivand, 2014),
meaning focused training (N. Nasr Isfahani, Etemadi, & Shafie Abadi, 2013) foot massage (Uhm, 2010), Rogers
and Ellis psychotherapy (Yousefi & Kiani, 2014) and group training of transactional analysis (Nayeri et al.,
2014).
5. Conclusion
Overall, it can be stated from reviews that since intimacy involves the exchange of deep feelings and personal
and private thoughts, promoting communication skill can play an important role in promoting intimacy in
couples. In addition, according to the point that problem solving skill helps couples to evaluate the solutions to
their problems and find more sense of cooperation and empathy, it could be accounted for as one of the most
important factors for increasing the agreement and intimacy in couples. The depth of intimacy that people
understand in their communications depends on their ability to handle correct, effective, and clear
communications with the expression of feelings, needs, and desires.
Based on the results, it can be expressed that self-disclosure and empathic response can also increase intimacy
because; when people trust each other and share their thoughts, feelings, and internal reality, it helps them
strengthen the intimate communication in couples. Also, it can be concluded from studies that sex education and
counseling helps the couples gain sufficient knowledge in this area and take effective steps to deal with sexual
problems and enhance their intimacy. Generally, by promoting communication, problem solving, self-disclosure,
empathic response skills, and sexual education and counseling in the form of cognitive-behavioral techniques,
based on religious and cultural context of each society, an effective step can be taken to enhance marital intimacy
and strengthen family bonds and stability. Therefore, it is recommended to provide and present counseling
training packages to increase marital intimacy tailored to the cultural context of the society.
5.1 Implications for Practice
The majority of the interventions that promoted marital intimacy were quasi experimental. Interventions need to
be adapted to other environments and tested again. Health care providers should consider which interventions are
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appropriate to the couple characteristics and their relationships and then use them.
5.2 Application in Research
The quality of many of the interventions was low and medium and did not have enough follow-up. The
researchers need to design high-quality clinical trials with long-term follow-up period appropriate to the setting
and resources. Also the processes of randomization and concealments are applied in designing interventions. It is
also recommended that researchers measure effectiveness of interventions in raising marital intimacy.
6. Acknowledgements
The current review is a part of MSc. Degree in Midwifery Counseling, Maryam Kardan-Souraki. This project
was mainly funded and supported by Mazandaran University of Medical Sciences, Grant No212. We appreciate
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran for supporting narrative
review protocol section.
Conflict of Interest
The authors declare that there is no conflict of interests regarding the publication of this paper.
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... All humans need to communicate with others. Communication and relation with others mean sharing, sympathy, and intimacy, and intimacy in physical terms means sexual pleasure (1). The depth of intimacy which two persons make in their relationship depends on their ability in clear, correct, and effective transfer of thoughts, feelings, needs, wishes, and wants (2). ...
... It seems that conducting studies consistent with Iranian-native culture can be useful in resolving sexual problems in different socioeconomic groups and keeping family health (13). Lack of knowledge on sexual issues can result in an unpleasant life, divided family, divorce, deviation, and psychological problems (1). Incorrect sexual performances in couples can result from a lack of sexual knowledge, sexual skills, and relationship skills (14). ...
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Background: Sexual intelligence is one of the most vital topics in research and clinical fields. Therefore, the existence of a suitable instrument for measuring these structures is an inevitable necessity. This study designed a valid and reliable sexual intelligence scale. Methods: In this instrumental research, 225 students of Payame Noor University were selected by purposeful sampling and answered the questionnaire. A baseline questionnaire with 36 questions was provided to the participants. SPSS software, statistical analysis of factor analysis and correlation coefficient were used for data analysis. Results: In an exploratory factor analysis that was done on 19 materials of this test, results revealed 4 factors. Initial examination in this test showed that 4 important and prominent factors were found after rotation and by considering the sloping line diagram. Conclusion: The present study showed that the designed tool is of sufficient competence and can be used in clinical research and diagnosis.
... Intimacy is defined as closeness, similarity, an emotional and personal romantic relationship that require comprehension of the individual [1]. Although the meaning of intimacy may vary according to age, gender, education, and culture, it comprises various dimensions including emotional, psychological, physical, sexual, timewise, communicational, social, intellectual, and spiritual [2]. The level of experienced intimacy in the relationships significantly influence individuals' social development and adoption [3,4], mental and physical health [5]. ...
... A positive relationship between the couples is found to serve as a protective factor of the mental health and psychological health of couples [12]. A lack of satisfaction in an intimate relationship between couples is one of the most important reasons that push people to get psychotherapy [13] and is a ground for divorce [2,14]. ...
... Bagarozzi (2001) defines intimacy as proximity, similarity and a personal romantic or emotional communication that requires knowledge and understanding of the other. Kardan-Souraki et al. (2016) claim that intimacy is associated with couple life quality; it is often referred to as being a basic psychological need, and it is one of the key characteristics of marital communication --impacting marital adjustment and mental health. Impacts on mental health include reducing of the risk of depression, increasing happiness and well-being (Kardan-Souraki et al., 2016). ...
... Kardan-Souraki et al. (2016) claim that intimacy is associated with couple life quality; it is often referred to as being a basic psychological need, and it is one of the key characteristics of marital communication --impacting marital adjustment and mental health. Impacts on mental health include reducing of the risk of depression, increasing happiness and well-being (Kardan-Souraki et al., 2016). ...
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Influential on women's sexual behavior and function, pregnancy plays a significant role along with intimacy in health, quality of life, and well-being. This phenomenon, in turn, is influenced by psychological, physiological, and marital relations as well as sociocultural effects. Therefore, the goal of this study was to investigate the roles of women's sexual satisfaction and intimacy after pregnancy and childbirth. In order to examine this goal, eight-month pregnant women in Shiraz, Iran, were selected during 2017 and 2018 for descriptive and causal-comparative analysis. Data were collected at two stages during pregnancy and eight months after delivery and measured using the Sexual Satisfaction Questionnaire (LSSQ; Larson et al., 1998) and the Marital Intimacy Needs Questionnaire (Bagarozzi, 1997). The data analyses reported descriptive and inferential statistics. The outcome of the current research has shown that sexual intimacy, physical intimacy, and aesthetic intimacy were significantly different between pregnancy phase (higher scores) and after delivery. Additionally, sexual satisfaction was rated significantly different pre and post-delivery, which can indicate that women and their sexual partners should be aware of the impact of healthy sexual intimacy during and after childbirth.
... Inclusion criteria for the husbands were as follows: 1) aged 20 years and older; 2) absence of a medical history of tumours; 3) full knowledge of patient's diagnosis and treatment; 4) ability to communicate and complete the study; 5) understand and agree to voluntarily participate in this study. The sample size was estimated based on a review of marital intimacy-enhancing interventions among married individuals, which indicated that the sample size was feasible in the range of 24 to 216 cases [21]. The average annual hospital admissions with GC of the oncology hospital sampled in this study was approximately 4200, with a sample size determined of 42 couples for two groups respectively at the rate of 1% [29]. ...
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Objective To evaluate the effectiveness of a nurse-led couples intervention on the marital quality of couples coping with gynecological cancer. Methods Couples coping with gynecological cancer were randomly allocated to the intervention (n = 51) and the control (n = 53) group. The intervention group received the nurse-led couples intervention developed based on the Preliminary Live with Love Conceptual Framework plus routine nursing care. The control group received only routine nursing care. Marital quality, including marital satisfaction, marital communication, and sexual life, were measured using Olson Marital Quality Questionnaire at 3 timepoints (baseline, 2- and 3-months following baseline). Generalized estimating equation was used to examine the effectiveness of the intervention in improving marital quality. Results Patients and husbands in the intervention group had significantly improved marital satisfaction scores (Waldχ² = 11.109, P = 0.001; Waldχ² = 4.849, P = 0.028); the interaction between intervention and time had a significant effect on the marital communication of both patients and their husbands (Waldχ² = 6.214, P = 0.045; Waldχ² = 15.460, P < 0.001). Patient-reported and husband-reported sexual life was not significantly influenced by the intervention (Waldχ² = 0.167, P = 0.683; Waldχ² = 3.215, P = 0.073). Conclusions The nurse-led couples intervention based on the Preliminary Live with Love Conceptual Framework improved marital satisfaction and marital communication, but not sexual life, of couples coping with gynecological cancer. The provision of professional sexual health psychology training for nurses may be crucial if nurse-led models are to truly support the sexual health of couples coping with gynecological cancer. Registration: Registered with www.chictr.org.cn (ChiCTR2000034232).
... Intimacy is the core of romantic relations, and researchers have conceptualized this construct (7). For instance, Kardan-Souraki et al. (8) consider intimacy to consist of nine dimensions, including emotional, social/recreational, sexual, intellectual, psychological, physical, spiritual, aesthetic, and temporal dimensions. Intimacy problems are an important reason for seeking marital counseling, and promoting intimacy is often a goal of couples therapy and marital counseling. ...
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... Marital intimacy, which is the need for love and intimacy and establishing an intimate relationship with the spouse and satisfying emotional and psychological needs, is among the main reasons for today's marriages. In other words, although intimacy is not limited to the marital relationship, most people marry for the sake of intimacy [11]. Despite the change in the institution of the family and its functions, the main reasons for marriage and family formation have remained largely the same [12]. ...
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Background: The quality of marital relationship and family function is a major global concern, especially in Iran. Indigenous contexts should be considered for identifying problems and effective measures. Objectives: The aim of this study was to determine the effect of an indigenous intervention program for strengthening happiness experiences on marital satisfaction, marital intimacy, and couples' happiness experiences. Methods: This was a quasi-experimental study with a pretest-posttest, follow-up design and a control group. The study population included all couples living in Zanjan, from whom a sample of 30 couples was selected. The participants were divided into the intervention and control groups (n=15 per group). The intervention program was designed based on local capacities and qualitative study of happy couples. In the experimental group, the indigenous intervention of strengthening happiness experiences was performed. ENRICH Marital Satisfaction Questionnaire (short form), Thompson and Walker Intimacy Scale, and Yousefi Afrashteh Happiness Experience Questionnaire were used to collect data. Univariate analysis of covariance was used to analyze the data. Results: The results showed that the designed indigenous intervention program had a positive effect on the three dependent variables of marital satisfaction (F=128 and size P
... Significant evidence indicates how interpersonal relationships such as intimacy and emotional attachment can act as motivating factors for engaging in sexual activities (5). Therefore, intimacy is recognized as an essential emotional need of the couples and the main reason for marital satisfaction (6). In fact, sexual satisfaction and intimacy are very strongly related to each other (7). ...
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Randomly selected samples of practicing couple therapists who were members of the American Psychological Association's Division 43 or the Association for Marriage and Family Therapy completed a survey of couple problem areas and therapeutic issues encountered in couple therapy. Therapists rated problem areas in terms of occurrence, treatment difficulty, and damaging impact. A composite of these 3 dimensions suggested that the most important problems were lack of loving feelings, power struggles, communication, extramarital affairs, and unrealistic: expectations. Comparison of the findings with therapist ratings obtained by S. K. Geiss and K. D. O'Leary (1981) suggests considerable stability in presenting problems in couple therapy over the past 15 years. Therapist-generated characteris tics associated with negative outcome were also identified, the most common being partners' inability or unwillingness to change and lack of commitment.
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Background and aim: Intimacy in couples has beneficial effects on physical and psychological health. This study investigated the effectiveness of training relationship enhancement program on increasing intimacy in dual-career couples. Material and Method: This was a quasi-experimental study with pretest, posttest and control group. The research population included female elementary school teachers who had married for 5 to 10 years, in Sanandaj City. 30 women were selected randomly from eligible volunteers and were randomly assigned to experimental and control groups. The experimental group used the relationship enhancement program for ten 1.5 hour sessions (one session/week) while the control group did not do any training. Marital intimacy questionnaire was used as a measurement tool and the groups completed it three times in pretest, posttest and follow up test. Data were introduced in to SPSS software and analyzed by covariance analysis. Results: Our results showed that training relationship enhancement program led to increased intimacy and all intimacy subscales (emotional, intellectual, physical, social-recreational, relational, spritual, psychological, sexual and general) between dual-career couples significantly (p<0/05). Conclusion: The training relationship enhancement program can be used to increase intimacy in dual-career couples.
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Objective: this study aimed to analyze changes in woman's perceived marital quality and intimacy (communication and engagement dimensions) throughout the breast cancer trajectory. We also sought to explore differences between patients and controls on these variables, as well as to investigate the predictive role of initial intimacy and quality of life (QoL) on marital quality 6 months after the treatment's ending. Methods: the sample comprises of 47 breast cancer patients and 90 community controls. Data from the patients' group were collected at two time points: following breast surgery (T1) and 6 months after treatments had ended (T2). The perceived marital quality before the disease was also retrospectively assessed. The following measures were used: WHOQOL-BREF (psychological and social QoL); PAIR (communication and engagement) and a singleitem to assess perceived marital quality. Results: There was an increase in perceived marital quality from the retrospective assessment to T1, and no differences were found throughout the disease. With respect to intimacy, only communication decreased over time. When compared with controls, patients presented higher scores on communication and engagement dimensions (T1). A higher marital quality at T2 was predicted by a higher initial psychological QoL and higher initial levels of communication. Conclusions: the diagnosis of breast cancer does not appear to be associated with a decline in marital quality. Moreover, our findings highlighted the importance of sharing with a partner the cancer-related information, as well as the importance of maintaining a good psychological QoL at the beginning of the disease.
Article
The current study is a qualitative approach aims at exploring the marital conflicts and conflict resolution styles in dissatisfied married couples (DMC). Sample consisted of five dissatisfied married couples in district Gujrat, Pakistan. Convenient purposive sampling was used for selection of couples. Kansas Marital Satisfaction (KMS) Scale was used to assess dissatisfaction in marriage. Semi-structured interviews were conducted separately for husbands and wives at different times. Thematic analysis was used to identify themes across dissatisfied married couples and these were grouped under the relevant conflict resolution styles. Findings suggested DMC face different kinds of marital conflicts i.e. as aggressive spouse (husband) (80%), lack of cooperation, lack of spending time together, in-laws issues (respectively 60%), children issues (20%), decrease in effective communication and financial problems (respectively 40%). Moreover, both spouses of dissatisfied married couples actively use avoiding style of conflict resolution whereas both do not use accommodating, collaborating or compromising styles. However, competitive style is mostly used by dissatisfied husbands which indicates the dominant nature of males in our culture. Findings are significant in area of marital counseling to develop healthy conflict management skills to promote satisfaction in marriage.
Article
Objective: To determine the effect of training solution-focused couples therapy on dimensions of marital intimacy in Isfahan, Iran. Methodology: This experimental study was conducted on a control and a case group using a pretest and a post-test. The case group and the control group both consisted of seven couples who were selected through convenience random sampling. The measurement instruments included a 32-item questionnaire with 8 dimensions on marital intimacy and a 44-item questionnaire with three dimensions on marital commitment. The data were analyzed using ANCOVA (analysis of covariance) method. In this respect, the pretest and the post-test were conducted on both the case and the control groups; however, the independent variable (the solution-focused therapy) was only performed on the case group. Results: The results showed that training the solution-focused couples therapy affected the emotional intimacy, intellectual intimacy, physical intimacy, psychological intimacy, relationship intimacy, and sexual intimacy. Conclusion: It is concluded that solution-focused therapy which leads to a positive attitude toward life can be applied for couples who suffer from marital conflicts and cannot achieve intimacy in their marriage.