McKenzie K. Roddy

A Randomized Controlled Trial of the Web-Based OurRelationship Program: Effects on Relationship and Individual Functioning

OBJECTIVE Within the United States, one third of married couples are distressed and almost half of first marriages (and more than half of unmarried cohabiting relationships) end in divorce/separation. Additionally, relationship distress has been linked to mental and physical health problems in partners and their children. Although couple therapy is effective in reducing relationship distress, it is utilized by less than one third of divorcing couples. Therefore, more accessible interventions for relationship distress are needed. METHOD This study tests the efficacy of the OurRelationship program, an 8-hr online program adapted from an empirically based, in-person couple therapy. In the program, couples complete online activities and have 4 15-min calls with project staff. Nationwide, 300 heterosexual couples (N = 600 participants) participated; couples were generally representative of the US in terms of race, ethnicity, and education. Couples were randomly assigned to begin the program immediately or to a 2-month waitlist control group. RESULTS Compared to the waitlist group, intervention couples reported significant improvements in relationship satisfaction (Cohens d = 0.69), relationship confidence (d = 0.47), and negative relationship quality (d = 0.57). Additionally, couples reported significant improvements in multiple domains of individual functioning, especially when individuals began the program with difficulties in that domain: depressive (d = 0.71) and anxious symptoms (d = 0.94), perceived health (d = 0.51), work functioning (d = 0.57), and quality of life (d = 0.44). CONCLUSIONS In a nationally representative sample of couples, the OurRelationship program was effective in significantly improving both relationship and individual functioning, suggesting it can substantially increase the reach of current interventions through its low-cost, Web-based format.

Using technology to enhance and expand interventions for couples and families: Conceptual and methodological considerations.

Technological advances provide tremendous opportunities for couple and family interventions to overcome logistical, financial, and stigma-related barriers to treatment access. Given technology’s ability to facilitate, augment, or at times even substitute for face-to-face interventions, it is important to consider the appropriate role of different technologies in treatment and how that may vary across specific instances of technology use. To that end, this article reviews the potential contributions of telemental health (aka, telehealth; e.g., videoconferencing to remotely deliver real-time services) and asynchronous behavioral intervention technologies (BITs; e.g., apps, web-based programs) for couple and family interventions. Design considerations—such as software and hardware requirements and recommendations, characteristics of intended users, ways to maximize engagement, and tips for integrating therapists/coaches—are included for both types of technology-based intervention. We also present suggestions for the most effective recruitment and evaluation strategies for technology-based couple and family interventions. Finally, we present legal and ethical issues that are especially pertinent when integrating technology into couple and family interventions.

Couples with Intimate Partner Violence Seeking Relationship Help: Associations and Implications for Self-Help and Online Interventions

In-person conjoint treatments for relationship distress are effective at increasing relationship satisfaction, and newly developed online programs are showing promising results. However, couples reporting even low levels intimate partner violence (IPV) are traditionally excluded from these interventions. To improve the availability of couple-based treatment for couples with IPV, the present study sought to determine whether associations with IPV found in community samples generalized to couples seeking help for their relationship and whether web-based interventions for relationship distressed worked equally well for couples with IPV. In the first aim, in a sample of 2,797 individuals who were seeking online help for their relationship, the levels and correlates of both low-intensity and clinically significant IPV largely matched what is found in community samples. In the second aim, in a sample of 300 couples who were randomly assigned to a web-based intervention or a waitlist control group, low-impact IPV did not moderate the effects of the intervention for relationship distress. Therefore, web-based interventions may be an effective (and easily accessible) intervention for relationship distress for couples with low-intensity IPV.

A Randomized Controlled Trial of Coach Contact During a Brief Online Intervention for Distressed Couples

The negative impacts of relationship distress on the couple, the family, and the individual are well-known. However, couples are often unable to access effective treatments to combat these effects-including many couples who might be at highest risk for relationship distress. Online self-help interventions decrease the barriers to treatment and provide couples with high quality, research-based programs they can do on their own. Using a combined multiple baseline and randomized design, the present study investigated the effectiveness of the Brief OurRelationship.com (Brief-OR) program with and without staff support in improving relationship distress and individual functioning. Results indicated the program produced significant gains in several areas of relationship functioning; however, these gains were smaller in magnitude than those observed in Full-OR. Furthermore, effects of Brief-OR were not sustained over follow-up. Comparisons between couples randomized to Brief-OR with and without contact with a staff coach indicated that coach contact significantly reduced program noncompletion and improved program effects. Limitations and future directions are discussed.

The online ourrelationship program for relationally distressed individuals: A pilot randomized controlled trial

Relationship distress has deleterious effects on mental health, physical health, and quality of life. Although many couples report relationship distress, one barrier to seeking services is that one member of a couple may be too busy or refuse to participate. Relationship interventions offered to individuals have shown promising efficacy, but, as most are offered in-person, barriers to their reach remain. To increase the reach of such interventions, the present pilot study examined the efficacy of a fully web-based relationship intervention for individuals (OR-I). The program was adapted from the couple version of the OurRelationship program (OR-C), which is effective in improving relationship and individual functioning (Doss et al., 2016). Results indicated that couples randomized to the OR-I program, compared with couples in a waitlist control group, saw significant improvement in quality of life (d = 0.69), work functioning (d = 0.44), and perceived health (d = 0.49) during treatment. Furthermore, gains in quality of life and perceived health for the intervention group were maintained over short-term follow-up. However, there were no significant improvements in relationship functioning or symptoms of depression or anxiety. When comparing the efficacy of OR-I and a demographically matched subsample of OR-C, results showed that change in outcomes did not significantly differ by program. Overall, with some adaptations, OR-I may be a viable option for individuals seeking relationship help. Limitations, potential adaptations, and future directions are discussed in-depth.

Sexual Assault and Dyadic Relationship Satisfaction: Indirect Associations Through Intimacy and Mental Health

Rates of child and adult sexual assault (SA) among women are staggering and place women at risk for intra- and interpersonal difficulties. However, the independent contributions of child and adult SA or the mechanisms of this risk are unknown. This study’s goal was to examine the indirect effects of child and adult SA on women’s own and partner’s relationship functioning through their impact on women’s mental health, emotional intimacy, and sexual intimacy. Results revealed that the association of women’s child SA with both her own and her partner’s relationship satisfaction operated through emotional intimacy. Considerations for the study of women with a history of SA in the context of couple functioning are discussed.

A meta-analysis of the effect of therapist experience on outcomes for clients with internalizing disorders

Abstract Objective: This meta-analysis synthesized the literature regarding the effect of therapist experience on internalizing client outcomes to evaluate the utility of lay providers in delivering treatment and to inform therapist training. Method: The analysis included 22 studies, contributing 208 effect sizes. Study and client characteristics were coded to examine moderators. We conducted subgroup meta-analyses examining the relationship of therapist experience across a diverse set of internalizing client outcomes. Results: Results demonstrated a small, but significant relationship between therapist experience and internalizing client outcomes. There was no relationship between therapist experience and outcomes in clients with primary anxiety disorders. In samples of clients with primary depressive disorders and in samples of clients with mixed internalizing disorders, there was a significant relationship between experience and outcomes. The relationship between therapist experience and outcomes was stronger when clients were randomized to therapists, treatment was not manualized, and for measures of client satisfaction and “other” outcomes (e.g., dropout). Conclusions: It appears that therapist experience may matter for internalizing clients under certain circumstances, but this relationship is modest. Continuing methodological concerns in the literature are noted, as well as recommendations to address these concerns.

Why do couples seek relationship help online? Description and comparison to in-person interventions

Couples are increasingly utilizing newly developed online adaptations of couple therapy; however, different presenting problems could drive couples to seek either online or in-person services. This study compared the presenting problems of 151 couples seeking an online couple intervention for relationship distress (OurRelationship) with responses from 147 couples seeking in-person couple therapy. Presenting problems were generally consistent across gender and whether or not the respondent was the initial help-seeker. Online and in-person samples frequently endorsed difficulties with communication and emotional intimacy; however, they differentially endorsed trust, time together, and child/parenting difficulties. Therefore, while basing online interventions on existing couple therapies is generally supported, efforts should be made to tailor online services to meet the unique needs of this population.

A randomized controlled trial of different levels of coach support in an online intervention for relationship distress

Recently-developed online interventions for relationship distress show promising results; however, the degree to which paraprofessionals need to be involved with web-based interventions for relationship distress remains unclear. The present study sought to determine if varying levels of coach contact moderated gains during the online OurRelationship program, which was previously shown to be effective by Doss and colleagues (2016). Three hundred fifty-six heterosexual couples (712 individuals) enrolled in the OurRelationship program and were randomized to a Low or High coach support condition. Couples in both conditions experienced significant improvements in relationship satisfaction as well as depressive and anxious symptoms (within-group d = 0.43-0.71). Using intent-to-treat analyses, there were no significant differences over the intervention between groups in improvements in relationship satisfaction or depressive symptoms. However, couples in the high-support condition reported significantly greater decreases in anxious symptoms. Furthermore, couples in the low-support group were significantly more likely to drop out prematurely. Overall, results indicated that minimal coach support may be a viable option to facilitate dissemination of online interventions for relationship distress. This study was registered on ClinicalTrials.gov (NCT03332875).

Maintenance of Gains in Relationship and Individual Functioning Following the Online OurRelationship Program

In the United States, more than 40% of marriages end in divorce and more than one third of intact marriages are distressed. Unfortunately, only a minority of couples seek couple therapy to improve their relationships. Online interventions, with their increased reach and reduced costs, offer the potential to improve relationships nationwide. The online OurRelationship program has been shown in previous nationwide studies to improve relationship and individual functioning. The present study examined whether initial gains in the OurRelationship program were maintained in the following year and whether the extent of maintenance varied across important demographic and individual factors. In this study, 151 distressed heterosexual couples (302 individuals) who were randomized to the OurRelationship program were assessed 3 and 12 months following the intervention. Initial gains in relationship satisfaction, relationship confidence, and negative relationship quality were maintained through 12 months; positive relationship quality significantly improved over follow-up. Furthermore, couples maintained their initial gains in depressive symptoms, perceived health, work functioning, and quality of life; anxious symptoms continued to significantly decrease over follow-up. Finally, there was no evidence that historically underserved groups-racial/ethnic minorities, lower income couples, or rural couples-experienced greater deterioration. In fact, Hispanic couples reported continued improvement in relationship confidence and negative relationship quality in the 12 months following the program. The ability of the OurRelationship program-an 8-hour, primarily self-help program-to create long-lasting improvements in distressed relationships indicates it may have the potential to improve the lives of distressed couples on a broad scale.