Jennifer M. Belus

Couple-based interventions for psychopathology: a renewed direction for the field.

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.

A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic stress disorder

BackgroundPosttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies.MethodsThe current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings.DiscussionFindings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation.Trial registrationClinicalTrials.gov: NCT01861769

The effect of a couple-based treatment for OCD on intimate partners.

BACKGROUND AND OBJECTIVES This study investigated the effect of a couple-based cognitive behavioral therapy (CBT) for the treatment of obsessive-compulsive disorder (OCD) on the intimate partners of patients. Previous research has shown this intervention to be efficacious in reducing OCD symptoms and comorbidities in patients. METHOD In an open-treatment trial, 16 couples completed the 16-session manualized treatment, and were followed up 6- and 12-months post-treatment. RESULTS Multilevel modeling analyses were conducted to examine change over time, and results indicated that relative to baseline, partners showed improvements in relationship functioning, communication, and criticalness in the short-term, and maintained their gains in communication skills over the long-term. LIMITATIONS The non-controlled design and small sample size limit the certainty of the studys findings. CONCLUSIONS Overall, this investigation offers preliminary evidence that including intimate partners in couple-based CBT for OCD has no negative effects on partners, and in fact, can provide them with residual positive effects.

Do Anger and Jealousy Mediate the Relationship Between Adult Attachment Styles and Intimate Violence Perpetration

Objective: The purpose of this study was to determine whether anger and jealousy mediate the relationship between adult attachment styles (i.e., dismissive, fearful, preoccupied, secure) and physical intimate partner violence (IPV) perpetration for both men and women. Method: Undergraduate students (n = 431) were sampled from a large Midwestern U.S. university. Results: Mediational analyses revealed that anger mediated the associations between each of the four attachment styles and violence perpetration for women. However, neither anger nor jealousy mediated the association between attachment and violence perpetration for men. Conclusions: Young women’s IPV perpetration appears more closely related to their emotional responses, in particular anger, but violence perpetration in young men does not necessarily seem to follow this pattern. These findings suggest specific strategies which may be useful for preventive efforts of violence perpetration in young adult women, such as anger-related emotion regulation skills training.

The Mediating Role of Attributions in the Association Between Intimate Relationship Distress and Depressive Symptoms in a Dating Sample of Undergraduate Students

The current study investigated the mediating role of depressogenic and intimate relationship distress-maintaining attributions in the association between depressive symptoms and relationship distress in an undergraduate dating sample. Results indicated that taken together, depressogenic and distress-maintaining attributions significantly mediated the association between depressive symptoms predicting relationship distress for women, but not men. Examination of the specific indirect effects revealed that distress-maintaining blame attributions had a significant indirect effect in this association for both men and women. Possible clinical implications for the treatment of depressive symptoms and relationship distress are discussed.

Measuring relationship functioning in South African couples: a strategy for improving HIV prevention efforts

ABSTRACT Over the past decade, there has been increased focus on targeting couples in HIV prevention efforts, particularly in sub-Saharan Africa where HIV transmission primarily occurs through heterosexual contact, in the context of intersecting alcohol use and intimate partner violence (IPV). However, little is known about couples’ general relationship functioning. This understanding is needed to augment couple-based HIV prevention programs and address risk for IPV. This paper presents data on domains of relationship functioning with 300 South African couples who were recruited for an HIV prevention study. Exploratory and confirmatory factor analyses were conducted to determine the relevance of 17 individual items, as well as the overall factor structure of the questions. Results revealed three independent factors of relationship functioning: relationship satisfaction, arguing, and open communication; an overarching construct of relationship functioning for these three domains was not observed in the data. Results provide insight into the structure of relationship functioning questions and subscales that can be used to assess South African adult romantic relationships. This may allow for a greater focus on aspects of relationships within couple-based HIV prevention programs going forward.

Staying Connected: An Examination of Relationship Maintenance Behaviors in Long-Distance Relationships

ABSTRACT Romantic long-distance relationships (LDRs) are becoming increasingly prevalent as individuals seek educational and employment opportunities across the globe. LDRs create unique challenges for couples, potentially impacting couple and individual well-being. It is important to understand efforts that LDR partners make to stay engaged, known as relationship maintenance behaviors (RMBs), and whether common RMBs facilitate or hinder relational and individual functioning. This study has two goals: (a) to examine whether RMBs predict relationship satisfaction and (b) to investigate whether relationship satisfaction mediates the association between RMBs and individual functioning. Eighty-seven adults in LDRs participated in our online survey. Results indicated that RMBs predicted relationship satisfaction, some negatively, and that relationship satisfaction was a mediator between RMBs and individual well-being.