This article evaluates the efficacy, effectiveness, and clinical significance of empirically supported couple and family interventions for treating marital distress and individual adult disorders, including anxiety disorders, depression, sexual dysfunctions, alcoholism and problem drinking, and schizophrenia. In addition to consideration of different theoretical approaches to treating these disorders, different ways of including a partner or family in treatment are highlighted: (a) partner-family-assisted interventions, (b) disorder-specific partner-family interventions, and (c)more general couple-family therapy. Findings across diagnostic groups and issues involved in applying efficacy criteria to these populations are discussed.Since the 1970s, there has been a major shift in knowledge regarding the effectiveness of couple-based and family-based interventions for treating adult mental health problems. During this period, various theoretical perspectives have been articulated, specific manual-based intervention strategies have been developed, and controlled treatment outcome investigations have explored a number of specific issues of importance. The current article examines the empirical status of these couple-and family-based interventions for treating (a) marital distress and (b) adult individual diagnosable disorders. More explicitly, the primary goal of this article is to use the criteria put forth by Chambless and Hollon (1998) to evaluate the efficacy, clinical significance, and effectiveness of various interventions that involve a couple or family format.The criteria provide a unifying framework for evaluating the wide variety of psychological interventions. As we reviewed the literature on couple-and family-based interventions, we became aware that there were a number of decisions that had to be made with regard to the application of these criteria. Given that other reviewers may have interpreted and applied the Chambless and Hollon (1998) guidelines in a different manner, we begin this We thank Emily Sartor for her assistance in the preparation of this article.Correspondence concerning this article should be addressed to Donald H. Baucom, Davie Hall CB 3270, Psychology Department, University of North Carolina, Chapel Hill, North Carolina 27599-3270. Electronic mail may be sent via Internet to email@example.com by articulating how we have applied them so that the reader can better understand the bases of our conclusions.One of the major decisions that affects the empirical status of an intervention involves what investigations to include in reviewing the literature. In determining the efficacy status of a treatment, we restricted our consideration to published investigations. Attempts to obtain a comprehensive set of findings from conference presentations, unpublished dissertations, and so forth necessarily result in an incomplete and potentially skewed set of data. At times, unpublished findings are cited if mey help to make a certain point or clarify issues, but they are not considered in dete...
We present a vision of clinical science, based on a conceptual framework of intervention development endorsed by the Delaware Project. This framework is grounded in an updated stage model that incorporates basic science questions of mechanisms into every stage of clinical science research. The vision presented is intended to unify various aspects of clinical science toward the common goal of developing maximally potent and implementable interventions, while unveiling new avenues of science in which basic and applied goals are of equally high importance. Training in this integrated, translational model may help students learn how to conduct research in every domain of clinical science and at each stage of intervention development. This vision aims to propel the field to fulfill the public health goal of producing implementable and effective treatment and prevention interventions.
Recent research suggests that marital quality predicts the survival of patients with heart failure (HF), and it is hypothesized that a communal orientation to coping marked by first-person plural pronoun use (we talk) may be a factor in this. During a home interview, 57 HF patients (46 men and 16 women) and their spouses discussed how they coped with the patients' health problems. Analysis of pronoun counts from both partners revealed that we talk by the spouse, but not the patient, independently predicted positive change in the patient's HF symptoms and general health over the next 6 months and did so better than direct self-report measures of marital quality and the communal coping construct. We talk by the patient and spouse did not correlate, however, and gender had no apparent moderating effects on how pronoun use predicted health change. The results highlight the utility of automatic text analysis in couple-interaction research and provide further evidence that looking beyond the patient can improve prediction of health outcomes.
We investigated first-person plural pronoun use (we-talk) by health-compromised smokers and their spouses as a possible implicit marker of adaptive, problem-resolving communal processes. Twenty couples in which one or both partners used tobacco despite one of them having a heart or lung problem participated in up to 10 sessions of a smoking cessation intervention designed to promote communal coping, where partners define smoking as "our" problem, rather than "your" problem or "my" problem, and take collaborative action to solve it. We used the Linguistic Inquiry Word Count automatic text analysis program to tabulate first-person pronoun use by both partners from transcripts of a pretreatment marital interaction task and later intervention sessions. Results indicated that pretreatment we-talk by the patient's spouse predicted whether the patient remained abstinent 12 months after quitting, and residualized change in we-talk by both partners during the course of intervention (controlling for baseline levels) predicted cessation outcomes as well. These findings add to evidence regarding the prognostic significance of partner we-talk for patient health and provide preliminary documentation of communal coping as a possible mechanism of change in couple-focused intervention.
Psychological distress and marital quality were assessed with male (n=128) and female (n=49) congestive-heart-failure patients and their spouses. Hopkins Symptom Check List-25 scores were in the distressed range for 57% of patients and 40% of spouses. This role difference was greater for men than women, and a gender difference (more distress in women than men) was greater for spouses than patients. The patient's distress, but not the spouse's, reflected the severity of the patient's illness, and distress for both partners correlated negatively with ratings of marital quality. Female-patient couples reported better relationship quality than male-patient couples, however, and a mediation analysis indicated that the gender difference in spouse distress could be explained by marital quality. Results highlight the contextual nature of CHF distress and suggest that role differences in distress vary by gender.
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