Helping the female partners of men abusing alcohol: a comparison of three treatments.

AIM: To evaluate the effectiveness of three approaches to assisting the female partners of male problem drinkers with the stress imposed by the male's drinking. DESIGN: Participants were assigned randomly via random number tables to one of three treatment conditions: supportive counselling, stress management or alcohol-focused couples therapy. SETTING: The intervention took place at the Behaviour Research and Therapy Centre (BRTC), The University of Queensland. This research and training centre offers outpatient psychology services to the community. PARTICIPANTS: Sixty-one married women whose husbands drank heavily. Participants reported protracted alcohol problems, severe impact of alcohol on social functioning and severe marital distress. MEASUREMENT: The women's stress, alcohol consumption by the male, and relationship functioning were assessed at pre- and post-treatment and at 6-month follow-up. INTERVENTIONS: All three treatments involved 15 1-hour sessions with the woman. In the alcohol-focused couple therapy, attempts were made to engage the man in these sessions. RESULTS: Contrary to our predictions, there were few differences between the treatments. All three treatments were associated with reductions in the women's reported stress, with trends for somewhat greater reduction in the women's stress in the stress management and alcohol-focused couples therapy conditions than for supportive counselling. None of the treatments produced clinically significant reductions in men's drinking or relationship distress. CONCLUSION: The treatments ease stresses and burden but do not improve drinking or relationships. Limited power in the design restricted the capacity to detect differential treatment effects.

Can skills training prevent relationship problems in at-risk couples? Four-year effects of a behavioral relationship education program.

Eighty-three couples were stratified into groups at high and low risk for relationship distress and randomized to either the Self-Regulatory Prevention and Relationship Enhancement Program (Self-PREP) or a control condition. As predicted, there were differential effects of Self-PREP on high-risk and low-risk couples. Because of low statistical power, results must be interpreted cautiously, but at 1-year follow-up high-risk couples in Self-PREP showed trends toward better communication than control couples. However, there was no difference in the communication of Self-PREP and control low-risk couples. High-risk couples receiving Self-PREP exhibited higher relationship satisfaction at 4 years than control couples, but in low-risk couples relationship satisfaction was higher in the control condition. High-risk couples seemed to benefit from skills-based relationship education, but low-risk couples did not.

Maritally distressed women with alcohol problems: the impact of a short-term alcohol-focused intervention on drinking behaviour and marital satisfaction.

AIM: To evaluate the efficacy of a short-term alcohol-focused intervention for maritally distressed women, and to explore changes in relationship functioning. DESIGN: Participants were assigned randomly to an alcohol-focused treatment or to a waiting-list control group. The waiting-list control group began the intervention at 1-month follow-up. SETTING: The intervention took place at a research and training centre offering outpatient psychology services to the community. PARTICIPANTS: A sample of 32 women with alcohol and marital problems were recruited through the media. Participants reported protracted alcohol problems, moderate to severe impact of alcohol on social and occupational functioning, and moderate to severe marital distress. MEASUREMENTS: Measures of average alcohol consumption, marital distress, relational efficacy and depression were administered at pre- and post-therapy, and at 1, 6 and 12-month follow-up. INTERVENTION: The intervention involved six 1-hour sessions, consisting of clinical assessment, motivational interviewing, cognitive-behavioural strategies and relapse prevention. RESULTS: At 1-month follow-up, the intervention was associated with statistically significant improvements in alcohol consumption, marital satisfaction, relational efficacy and depression, and these effects were sustained at 12-month follow-up. CONCLUSIONS: At 1-month follow-up the intervention was associated with decreased alcohol consumption and depression, and increased marital satisfaction and relational efficacy, with evidence of maintained effects at 12-month follow-up. However, it is unlikely that reduced problem drinking and improved confidence in resolving problems were the only factors producing low marital quality in these couples. Further research is needed to identify those individuals who might benefit from marital interventions.

Repeating the errors of our parents? Family-of-origin spouse violence and observed conflict management in engaged couples.

Based on a developmental social learning analysis, it was hypothesized that observing parental violence predisposes partners to difficulties in managing couple conflict. Seventy-one engaged couples were assessed on their observation of parental violence in their family of origin. All couples were videotaped discussing two areas of current relationship conflict, and their cognitions during the interactions were assessed using a video-mediated recall procedure. Couples in which the male partner reported observing parental violence (male-exposed couples) showed more negative affect and communication during conflict discussions than couples in which neither partner reported observing parental violence (unexposed couples). Couples in which only the female partner reported observing parental violence (female-exposed couples) did not differ from unexposed couples in their affect or behavior. Female-exposed couples reported more negative cognitions than unexposed couples, but male-exposed couples did not differ from unexposed couples in their reported cognitions.

Individual psychopathology and marital distress. Analyzing the association and implications for therapy.

This article is a review of the association of individual and marital problems. The focus is on depression, alcohol abuse, anxiety disorders, and the functional psychoses, each of which interact with marital distress in important ways. Although the causal connections between these disorders and marital distress are complex and only particularly understood, the available evidence shows that individuals' and couples' problems often exacerbate each other. Consequently, regardless of whether the initial presentation is individual or couple focused, there is routinely a need to assess both individual and relationship functioning. Couples therapy, and in particular behavioral couples therapy (BCT), is an important element of effective treatment of depression, alcohol abuse, anxiety disorders, and the functional psychoses. The integration of couple and individual therapy presents a number of clinical challenges, and in concluding this article the authors provide guidelines for managing these challenges.

The ongoing evolution of behavioral couples therapy: retrospect and prospect.

Behavioral couples therapy (BCT) was first described thirty years ago, and the conceptual basis of the approach has been evolving ever since. Whilst BCT in its current form is a well established treatment for relationship problems, there are significant limitations to its efficacy, and there are a number of new developments intended to enhance the efficacy of the approach. Currently BCT primarily is a skills training therapy, targeting change in couple's interactions to promote greater relationship satisfaction. Current developments focus on broadening this traditional emphasis on changing couple interactions to greater attention to reducing negative emotional responses to partner behaviors (increasing acceptance), and increasing self-directed personal change efforts. Future developments of BCT are likely to pay greater attention to different types of couple interaction which are associated with sustained relationship satisfaction, the individual vulnerabilities partners bring to relationships, and the environmental stresses impinging upon the couple.

Time use of unemployed and employed single male schizophrenia subjects.

The poverty and lack of social role in the lives of many people with schizophrenia seem similar to those of people in long-term unemployment, raising the possibility that there may be some commonalities in their time use and community functioning. To test this possibility, the social anxiety, time use, and activity participation patterns of 16 male schizophrenia subjects were compared with those of matched samples of 16 long-term unemployed and 16 employed male subjects. The unemployed group and the schizophrenia group participated in less occupational role activity and more passive leisure than the employed group, but the schizophrenia group participated in less social life and active leisure and slept more than both other groups. The schizophrenia group also perceived less pleasure in "pleasant events," participated in fewer such events, and reported more difficulty in social situations than both other groups. The results suggest that unemployment and a lack of social role make only a modest contribution to low social functioning of people with schizophrenia and that a time-use diary is a useful measure for quantifying the social functioning of people with schizophrenia.

Preliminary results from a psychoeducational program to rehabilitate chronic patients.

Twenty-two chronic psychiatric patients enrolled in a psychoeducational rehabilitation program were assessed before and after the program to determine whether participation decreased severity of psychopathology and improved community functioning and quality of life. The program consisted of five 14-week modules that provided training in five skill areas: medication and symptom self-management, coping with anxiety and depression, social skills, living skills, and leisure skills. Most patients experienced significantly reduced psychopathology and negative symptoms and improved quality of life and community functioning. The program appears helpful to clients, and a controlled trial to further evaluate its effects is underway.

Social skills in schizophrenia: assessing the relationship between social skills, psychopathology and community functioning.

Social skills training (SST) has been widely used in attempts to rehabilitate chronic schizophrenic patients. The key assumption underlying SST is that social skills deficits are important determinants of the social isolation, poor social role functioning, and low quality of life characteristic of schizophrenic patients. To test this assumption, 89 patients meeting DSM-III-R criteria for schizophrenia were assessed on behavioural and self-report measures of social skills. A structured clinical interview, a self-report inventory of distress during social interaction, and self-monitoring of time in social interaction were used to assess social functioning. Positive psychotic symptoms were assessed in a standardised clinical interview. A structural equation modelling analysis showed that observed social skills predicted social functioning, and that this association was statistically independent of severity of psychotic symptoms. This finding is consistent with the hypothesis that social skills are important in the social functioning of patients with schizophrenia.

Generalization of occupational therapy effects in psychiatric rehabilitation.

Psychoeducation procedures dominate the treatment used by occupational therapists in psychiatric rehabilitation. The underlying assumption of skills training is that the skills taught generalize, that is, they persist beyond the treatment session and are used by the client in the community. This paper surveys occupational therapy literature to evaluate the generalization of skills taught to adult psychiatric clients by occupational therapists. Of the 77 studies reviewed, only 13 (17%) mentioned anything related to generalization. Seven of these articles statistically evaluated the outcome of skills training, but only four specifically assessed generalization of therapy. It is concluded that occupational therapists in psychiatry predominantly do not assess generalization of therapy. Discussion focuses on how four classes of generalization strategies (modifying the community environment, modifying the therapy environment, altering the style of therapy, and promoting client involvement) can enhance the effectiveness of occupational therapists in psychiatry.

A comparison of the generalization of behavioral marital therapy and enhanced behavioral marital therapy.

This study examined the generalization of behavioral marital therapy (BMT) and enhanced behavioral marital therapy (EBMT), which added cognitive restructuring, affect exploration, and generalization training to BMT. Couples' communication and cognitions were assessed in the clinic and at home. Both BMT and EBMT were effective in decreasing negative communication behaviors and cognition across settings, but there was little evidence of differential generalization or change between the treatments. A series of regression equations showed no significant association between the extent of change in communication or cognitions and change in frequency of marital disagreements or marital satisfaction. It is concluded that BMT results in impressive generalization of communication and cognitive change, but it remains to be demonstrated that these changes are crucial to improvements in marital satisfaction.

Effects of family environment on negative symptoms and quality of life of psychotic patients.

This study tested the hypothesis that negative symptoms and quality of life for patients with functional psychoses are associated with family environment. Fifty-seven first-admission patients with functional psychoses were assessed at hospital admission for severity of psychopathology and premorbid adjustment. Relatives residing with patients rated the family environment at admission and one month after discharge on the Family Environment Scale. Patients made the same ratings after discharge. Six months later, patients were reassessed on severity of psychopathology, negative symptoms, and quality of life. Multiple regression analyses showed that higher levels of positive emotional expressiveness in the family predicted milder and fewer negative symptoms and better quality of life at follow-up. The prediction was statistically independent of the initial severity of psychopathology or premorbid adjustment.

Self-management of diabetes mellitus: a critical review.

Diabetes has no known cure and is a leading source of morbidity and mortality. Clinical management involves patients managing a complex and variable regimen. This article reviews the determinants of effective self-management and the methods of promoting better self-management. Trait variables (e.g., personality and demographics) have been presumed to affect self-management, but evidence suggests they have little impact. The important determinants of self-management are transient situational factors such as psychological stress and social pressure to eat. Interventions to promote better self-management have reported initial improvements in blood glucose control, but the long-term effects are unclear. We conclude that self-management has been inadequately assessed and that attempts to improve self-management have relied excessively on providing information. More research is needed to clarify determinants of self-management, and interventions to improve self-management will need to change these determinants.

Psychological stress and blood glucose regulation in type I diabetic patients.

Fifteen Type I diabetic patients self-monitored daily mean blood glucose levels (BGL), psychological stress, diet, exercise, and insulin injections for a period of 8 weeks. Separate multiple-regression analyses were conducted for each subject to assess the predictability of BGL from stress reports, independent of the effects of diet, exercise, and insulin self-administration. Considerable individual variability in findings was evident, with stress predicting BGL in a statistically significant manner in 7 of the 15 subjects. Stress had a significant effect on BGL independent of diet, exercise, and insulin administration for each of these 7 subjects. Discussion focused on the problems of measuring the key self-management behaviors influencing BGL and on the possibility that a subgroup of diabetic patients may be BGL stress responders.

Attitudes that predict antinuclear-war activity in medical students.

The possibility of nuclear war may be the most significant threat to health in the world. Medical practitioners have played, and should continue to play, a leading role in raising awareness of this danger. In the present study, the attitudes that predict a specific antinuclear-war behaviour (that is, signing a letter to the Prime Minister of Australia to request more active political effort to prevent nuclear war) were studied in a group of 143 undergraduate medical students. Attitudes towards that particular behaviour were assessed by means of a questionnaire, and the differences in attitude between students who chose to sign and those who chose not to sign the letter were analysed statistically by means of discriminant analysis. The key differences in attitude between signers and non-signers of the letter was in their belief that such an action would achieve tangible positive outcomes. The results are discussed in terms of the need to target strategies of change for the specific attitudes which are likely to modify behaviour and to promote antinuclear behaviours in medical practitioners, which in turn may alter the behaviour of politicians.