The Impact of Couple Therapy on Service Utilization among Military Veterans: The Moderating Roles of Pretreatment Service Utilization and Premature Termination

Madsen, Joshua W.; Tomfohr‐Madsen, Lianne; Doss, Brian D.

doi:10.1111/famp.12234

Cited by 10 publications

(9 citation statements)

References 73 publications

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“…Currently, there are no reliable economic estimates associated with reductions in relationship distress beyond improvements in physical health or depression or reductions in service utilization. While these estimates are starting to emerge (e.g., Law & Crane, ; Madsen et al., ), the existing estimates were considered too preliminary to provide an accurate and comprehensive cost‐effectiveness analysis of each intervention compared to no treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a study of cognitive, behavioral, and emotionally‐focused couple therapy interventions in VAMCs found that improvements in relationship satisfaction yielded important mental and physical health benefits such as decreased substance use and fewer depressive symptoms (Doss et al., ). As a result, those who were moderate or heavy users of mental health or physical health services before couple therapy saw significant reductions in frequency of these visits, thereby reducing healthcare costs (Madsen, Tomfohr‐Madsen, & Doss, ).…”

Section: Cost‐effectivenessmentioning

confidence: 99%

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Relative Cost Effectiveness of In‐Person and Internet Interventions for Relationship Distress

et al. 2018

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While the efficacy of couple therapy has been repeatedly demonstrated, most distressed couples do not seek treatment. To improve reach and overcome barriers to therapy, Integrative Behavioral Couple Therapy (IBCT) was translated into a web‐based program, OurRelationship (OR). While both IBCT and OR have been shown to improve relationship and individual functioning, the goal of the present study was to compare the relative cost effectiveness of these two treatment modalities. In IBCT, 74% of couples experienced reliable improvement, compared to 55% of couples in OR. Within‐group Cohen's d effect sizes during treatment for relationship satisfaction were d = 0.87 for IBCT and d = 0.96 for OR. Relative cost effectiveness analyses revealed that even at the highest expense estimates for OR and the lowest expense estimates for IBCT, OR was more cost effective in creating reliable improvement once at least 229 couples were served and was more cost effective in creating large‐size effects once at least 153 couples were served. Cost‐effectiveness increases for both IBCT and OR as more couples are served; however, this cost savings occurs at a much more rapid rate for OR. These findings demonstrate that despite higher initial development costs, Internet programs are a cost‐effective option for dissemination either as a stand‐alone service or as an initial intervention in a stepped care model with more intensive in‐person services.

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Section: Discussionmentioning

confidence: 99%

Section: Cost‐effectivenessmentioning

confidence: 99%

Relative Cost Effectiveness of In‐Person and Internet Interventions for Relationship Distress

et al. 2018

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“…Indeed, an important measure of successful couple and family therapy can be attributed to therapists’ skills in engaging and retaining their clients (Robbins et al, 2003), with retention in treatment consistently related to successful treatment outcomes (Robbins et al, 2006). For example, one study of couple therapy found that those couples who stayed in therapy and did not drop out prematurely experienced a significantly greater decrease in healthcare utilization than those couples who dropped out prematurely, suggesting greater benefits from continuing in therapy (Madsen et al, 2017).…”

Section: Review Of the Literaturementioning

confidence: 99%

Therapist effects on dropout in couple therapy

Willis¹,

Miller

Anderson

et al. 2021

J Marital Family Therapy

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Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.

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“…A final consideration is that these findings are building on an accumulating literature showing that couples interventions are cost-effective and have associated secondary gains. Previous studies have shown that mental health and medical service utilization decrease following couple therapy, particularly in high utilizers [66][67][68]. Additionally, in the case of family therapy, secondary declines in service utilization have been observed even in individuals who did not participate directly in therapy [69].…”

Section: Implications and Future Directionsmentioning

confidence: 99%

Improved Child Mental Health Following Brief Relationship Enhancement and Co-Parenting Interventions During the Transition to Parenthood

Tomfohr‐Madsen

Giesbrecht

Madsen

et al. 2020

IJERPH

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The transition to parenthood has been identified as a significant relationship stressor. Many couples report declines in relationship satisfaction and difficulty with individual stress and co-parenting—problems that have been associated with both child temperament as well as emotional and behavioral problems. Several parenting and relationship interventions have been developed to buffer against these difficulties. In the current study, we report secondary analyses of a randomized controlled trial of brief (6-h) interventions that focused on improving either relationship satisfaction or co-parenting, delivered during pregnancy and the early postpartum period. In this trial, 90 opposite-sex couples (180 participants), who were pregnant with their first child, and were assessed as being at high risk for declines in relationship satisfaction, were randomized to receive either (1) a relationship intervention, (2) a co-parenting intervention, or (3) an information control. At 12 months postpartum, couples who received either the relationship or co-parenting intervention rated their infants as having lower negative emotionality and as having fewer externalizing symptoms compared to the information-only control. Lower externalizing symptoms at 12 months were, in turn, associated with reduced externalizing symptoms at 24 months postpartum. Whereas, lower ratings of child negative emotionality at 12 months were associated with reduced internalizing symptoms at 24 months postpartum. These results indicate that brief relationship or co-parenting interventions delivered during the transition to parenthood have secondary benefits for child mental health.

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The Impact of Couple Therapy on Service Utilization among Military Veterans: The Moderating Roles of Pretreatment Service Utilization and Premature Termination

Cited by 10 publications

References 73 publications

Relative Cost Effectiveness of In‐Person and Internet Interventions for Relationship Distress

Relative Cost Effectiveness of In‐Person and Internet Interventions for Relationship Distress

Therapist effects on dropout in couple therapy

Improved Child Mental Health Following Brief Relationship Enhancement and Co-Parenting Interventions During the Transition to Parenthood

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