Cognitive-behavioral couple therapy (CBCT) is an approach to assisting couples that has strong empirical support for alleviating relationship distress. This paper provides a review of the empirical status of CBCT along with behavioral couple therapy (BCT), as well as the evidence for recent applications of CBCT principles to couple-based interventions for individual psychopathology and medical conditions. Several meta-analyses and major reviews have confirmed the efficacy of BCT and CBCT across trials in the United States, Europe, and Australia, and there is little evidence to support differential effectiveness of various forms of couple therapy derived from behavioral principles. A much smaller number of effectiveness studies have shown that successful implementation in community settings is possible, although effect sizes tend to be somewhat lower than those evidenced in randomized controlled trials. Adapted for individual problems, cognitive-behavioral couple-based interventions appear to be at least as effective as individual cognitive behavioral therapy (CBT) across a variety of psychological disorders, and often more effective, especially when partners are substantially involved in treatment. In addition, couple-based interventions tend to have the unique added benefit of improving relationship functioning. Findings on couple-based interventions for medical conditions are more varied and more complex to interpret given the greater range of target outcomes (psychological, relational, and medical variables).
This article provides a rationale and empirical support for providing couple-based interventions when one partner in a relationship is experiencing individual psychopathology. Several investigations indicate that relationship distress and psychopathology are associated and reciprocally influence each other, such that the existence of relationship distress predicts the development of subsequent psychopathology and vice versa. Furthermore, findings indicate that for several disorders, individual psychotherapy is less effective if the client is in a distressed relationship. Finally, even within happy relationships, partners often inadvertently behave in ways that maintain or exacerbate symptoms for the other individual. Thus, within both satisfied and distressed relationships, including the partner in a couple-based intervention provides an opportunity to use the partner and the relationship as a resource rather than a stressor for an individual experiencing some form of psychological distress. The authors propose that a promising approach to including the partner in treatment involves (a) integrating intervention principles from empirically supported interventions for individual therapy for specific disorders with (b) knowledge of how to employ relationships to promote individual and dyadic change. Based on this logic, the article includes several examples to demonstrate how couple-based interventions can be focused on a specific type of psychopathology, including encouraging empirical findings for these interventions. The article concludes with recommendations for how clinicians and researchers can adapt their knowledge of couple therapy to assist couples in which one partner is experiencing notable psychological distress or diagnosable psychopathology.
Early therapeutic alliance is usually measured by the rating of a single session (between the third and the fifth sessions). However, there is a strong argument in favor of viewing early alliance as a developing process.This study examined the relationship between patient's rating of the helping alliance (HAq) at each session and therapy outcome. This comparison was repeated using patterns of alliance over the course of treatment. Patterns of therapeutic alliance development were detected by clustering ratings of a sample of N = 70 outpatients across four sessions of very brief psychotherapeutic intervention.Cluster analysis revealed two main patterns (shapes) of alliance development: (i) stable alliance, and (ii) linear growth pattern. These patterns are more predictive of symptom improvement and social adjustment than single ratings, whereas single ratings measuring the strength of alliance are more correlated with patient's satisfaction.
Social stress, particularly in the form of dyadic conflict, is a well-established correlate of substance use disorders (SUD). The neuropeptide oxytocin can enhance prosocial behavior and mitigate addictive behaviors. These effects may be, in part, a result of oxytocin's ability to attenuate hypothalamic-pituitary-adrenal (HPA) axis dysregulation. However, only one study to date has examined the effects of oxytocin on neuroendocrine reactivity or conflict resolution behavior among couples. Participants (N = 33 couples or 66 total participants) were heterosexual couples in which one or both partners endorsed substance misuse. Using a double-blind, placebo-controlled, repeated-measures design and an evidence-based behavioral coding system, we compared the impact of oxytocin (40 IU) vs. placebo on cortisol reactivity and conflict resolution behaviors. Among women, oxytocin attenuated cortisol response following the task. Oxytocin was also associated with increased Distress Maintaining Attributions and decreased Relationship Enhancing Attributions. Among men, oxytocin was associated with decreased Distress Maintaining Attributions, and both oxytocin and placebo yielded declines in Relationship Enhancing Attributions. The findings support emerging hypotheses that oxytocin may have differential effects in men and women, and indicate the need for future efforts to translate oxytocin's positive neurobiological effects into therapeutic behavioral changes.
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