Introduction to the Special Series: The Person and Marriage: Attending to Individual and Dyadic Concerns

Donald H. Baucom, University of North Carolina

The purpose of this series is to explore the complex interaction between individual and relationship functioning. Many individuals seeking psychotherapy present with individual diagnosable conditions. Yet they live in larger social units, one of the most important of which for many adults is marriage. Should these persons be treated in individual therapy, or should the partner be included in some manner in order to take important contextual and environmental factors into account? On the other hand, the majority of couples seeking marital therapy present to clinics with one or both persons having individual diagnosable disorders as well. How are such couples to be assisted? Is some form of marital therapy the intervention of choice, is individual therapy most appropriate, or should the two be combined in some manner? Finally, if marital therapy is the treatment of choice in any of these or other circumstances, what is the most effective way to promote change and/or acceptance from the individual partners? These are the issues addressed in this special series. Four of the five papers deal with individual psychopathology within the context of marriage. Two focus on depression and marriage; one evaluates the role of marriage in anxiety disorders; and another reviews the treatment of alcoholism within a marital context. The final paper addresses new ways to promote involvement of the individuals in marital interventions with the goal of increasing treatment effectiveness and maintenance.



Marital Therapy for Depression: Theoretical Foundation, Current Status, and Future Directions

Steven R. H. Beach, University of Georgia, Mark A. Whisman, Yale University, and K. Daniel O'Leary, The University at Stony Brook

The current paper examines the potential utility of marital therapy in the treatment of depression. First, three clinically useful models are outlined and practical concerns related to the use of marital therapy in the treatment of depression are addressed. Second, available outcome and process research on the use of marital therapy as a treatment for depression is reviewed in detail. We attend especially to the issue of specifying the population likely to respond most favorable to behavioral marital therapy (BMT). We conclude that BMT is a viable and useful form of intervention for a substantial sub-population of depressed persons. Recommendations for future research are provided.



Enhancing the Treatment and Prevention of Depression in Women: The Role of Integrative Behavioral Couple Therapy

Kelly Koerner, Stacey Prince, and Neil S. Jacobson, University of Washington

In this article we discuss the implications of recent theoretical work from the Stone Center (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991) and Jack (1991) for understanding the link between women's depression and marital distress. From this heuristic framework, we describe how recent improvements to traditional behavioral couple therapy represented in integrative behavioral couple therapy may enhance the treatment and prevention of women's depression.



Marital Therapy and Spouse-Involved Treatment With Alcoholic Patients

Timothy J. O'Farrell, Veterans Affairs Medical Center, Brockton and West Roxbury, and Massachusetts Harvard Medical School

The question of what is an optimal focus on relationship and individual issues is a central one for marital and spouse-involved treatment with alcoholic subjects. The major approaches in this area differ sharply on this point. The popular but untested family disease approach emphasizes the individual well being of the non-alcoholic spouse or family member with relatively little attention to the alcoholic patient's drinking or to the couple's relationship. The family systems approach, which also has not been researched to any degree, combines work on the drinking problem and on the couple relationship. The relatively well researched, and as yet infrequently used, behavioral marital therapy (BMT) methods emphasize the relationship to a greater degree than the other approaches. Only future research can determine whether the emphasis on the couple relationship in BMT needs to be balanced with a greater focus on individual issues for some or most alcoholic subjects and their spouses.



Marital Functioning and the Anxiety Disorders

Paul M. G. Emmelkamp and Coby Gerlsma, University of Groningen, The Netherlands

The present paper provides a review of the literature on the relationship between marital factors and anxiety disorders. The review is based on both a descriptive and quantitative analysis. Studies of the marital relationship and outcome of exposure therapy are reviewed, as are studies investigating the effects of exposure therapy on the partner and on the marital relationship. Results with respect to the effects of marital distress on outcome are inconclusive. Exposure does not have a negative impact on the partner or the relationship. In agoraphobia, spouse-sided therapy is no more effective than individual exposure therapy. In obsessive-compulsive patients, results are inconclusive.



Self-Regulation in Behavioral Couples' Therapy

W. Kim Halford, Matthew R. Sanders, and Brett C. Behrens, Behaviour Research and Therapy Centre, Department of Psychiatry, University of Queensland, Australia

Traditionally, practitioners of Behavioral Couples Therapy (BCT) conduct conjoint therapy sessions attempting to change both partners' behavior simultaneously. In this paper, we argue that often BCT implicitly focuses clients on changing their partners, which can be counter-productive, and describe a self-regulation model of marital functioning that emphasizes individual responsibility through self-identification of behavioral excesses and deficits, self-defined behavior change goals, self-determination of performance standards and providing suitable consequences. The self-regulation model can be applied within conjoint or individual therapy sessions addressing marital problems. From the self-regulation perspective, the process of marital therapy usually involves moving clients from a partner-blaming perspective, to a self-regulation model of marital problems. This shift in perspective encourages clients to identify changes they can make to improve their relationship rather than depending upon change by their partners.



The Psychophysiology of Motor Vehicle Accident Related Posttraumatic Stress Disorder

Edward B. Blanchard, Edward J. Hickling, Ann E. Taylor, Warren R. Loos, and Robert J. Gerardi, Center for Stress and Anxiety Disorders University at Albany-SUNY and Capital Psychological Associates

Fifty victims of recent motor vehicle accidents (MVAs) and 40 non-MVA controls participated in a psychophysiological assessment in which heart rate (HR), systolic and diastolic blood pressures, forehead EMG and electrodermal activity were measured during mental arithmetic, idiosyncratic audiotaped descriptions of the victim's own MVA, and a standard videotape of MVAs. The MVA victims were subdivided into 23 with full posttraumatic stress disorder (PTSD), 10 with sub-syndromal PTSD, and 17 without PTSD. HR response to the idiosyncratic audiotape reliably (p<.01) discriminated the full PTSDs from the other 3 groups; 74% of these subjects responded as compared to from 40% to 24% of the other 3 groups. It appears that HR response to idiosyncratic audiotapes has diagnostic clinical utility at the level of the individual subject.



Errorless Compliance to Parental Requests II: Increasing Clinical Practicality Through Abbreviation of Treatment Parameters

Joseph M. Ducharme, Surrey Place Centre and Clarke Institute of Psychiatry, Toronto, Ontario, Canada, Edite Pontes, Sharon Guger, Kim Crozier, Holly Lucas, and Michele Popynick, Surrey Place Centre, Toronto, Ontario, Canada

Ducharme and Popynick (1993) recently examined "errorless"compliance training, a treatment for serious noncompliance that requires no physical consequences, as an alternative to more conventional compliance training approaches. They demonstrated the efficacy of the intervention for producing increases in generalized compliance and reductions in maladaptive behavior in four children with developmental disabilities. The strategy was labor-intensive, however. In the present study, we examined an abbreviated version of errorless compliance training that was designed to increase the clinical efficiency of the intervention with four children with developmental disabilities and two nondelayed siblings. Treatment results and generalization were comparable to those found in Ducharme and Popynick (1993), indicating that the intervention can be condensed along several treatment parameters without loss of effects obtained with the expanded version. The findings also suggested the suitability of the intervention for children without developmental disabilities who exhibit serious noncompliance.



Errorless Embedding in the Reduction of Severe Maladaptive Behavior During Interactive and Learning Tasks

Joseph M. Ducharme, Surrey Place Centre and Clarke Institute of Psychiatry, Toronto, Ontario, Canada, Holly Lucas, and Edite Pontes, Surrey Place Centre, Toronto, Ontario, Canada

A 5-year-old girl diagnosed with autism exhibited aberrant behavior when exposed to specific interactive and learning tasks (subsequently referred to as "problem" tasks). In a multiple baseline across three tasks, we moderated the effects of the problem tasks on the behavior of the child by embedding intervals of these tasks into trials of a task associated with low levels of aberrant behavior (i.e., "moderating" task). Initial, problem tasks comprised only a small proportion of session time but were gradually increased in duration across sessions until the moderating task was completely faded. Maladaptive behavior was reduced by more than 60% for each task with the use of the intervention. Increases in on-task behavior and correct performance were also observed.



Does Behavioral Treatment of Social Phobia Lead to Cognitive Changes?

Michelle G. Newman, Stefan G. Hofmann, Werner Trabert, Walton T. Roth, and C. Barr Taylor, Stanford University and Department of Veterans Affairs Medical Center, Palo Alto

Little is known about specific effects of behavioral and cognitive treatment methods. The goal of this study was to examine the effect of a "pure" performance-based exposure treatment (i.e., without cognitive intervention) on the anxiety-related cognitions of subjects with social phobia (public speaking anxiety). Thirty-six such persons were recruited. Pairs of subjects matched by age, sex, and severity of phobia were randomly assigned to either a treatment or waiting-list control group. Eighteen people received a purely behavioral treatment for 8 sessions over a period of 8 weeks; 18 served as the wait-list control group. Before and after treatment, subjective, cognitive, and behavioral measures of anxiety were taken. Results showed that a purely behavioral treatment led to improvement in measures of behavioral, subjective, and cognitive anxiety. This research adds to the literature on cognitive or behavioral treatment of social phobia showing that cognitive restructuring can occur without specific cognitive treatment, and that interventions for phobia are not necessarily mode specific.