Toward a culturally sensitive application of Emotionally Focused Couples Therapy: A qualitative study of therapists' experience using EFT in Spanish-speaking countries/cultures.

The purpose of the current study was to identify specific ways Emotionally Focused Couples Therapy (EFT; S. Johnson) could be adapted to better meet the needs of clients in Spanish-speaking countries throughout Europe and the Americas. The results were drawn from responses to a qualitative questionnaire regarding the experiences of learning and applying EFT; 103 therapists in 12 different countries where Spanish is spoken responded to the survey. Overall, the results suggest that the therapists surveyed consider EFT to be a "good fit" for many Spanish-speaking clients because of its focus on emotion, attachment theory, close interpersonal relationships, and model-specific interventions that match cultural values. Participants suggested a few culture-specific modifications regarding how to access and process emotion with men in therapy, translation of key EFT concepts and phrases into Spanish, and navigating the intersection of two cultural values (respeto and personalismo). Fewer modifications were suggested by therapists as they discussed application of the model than while learning it.

They May Disapprove, but I Still Love You: Attachment Behaviors Moderate the Effect of Social Disapproval on Marital Relationship Quality.

The degree of approval for a relationship from one's social network has been shown to predict relationship outcomes. Additional research has shown that attachment can buffer the negative effects of various factors (e.g., depression) on relationships. Using an actor-partner interdependence model in an SEM framework, we research the effects of disapproval from parents and friends for one's relationship on marital relationship quality for self and partner in a sample of 858 married couples. We also examine whether each spouse's attachment behaviors can moderate these effects. Results indicated that one's own attachment behaviors moderate the effects of their own parents' and friends' disapproval on their self-reported relationship quality for both men and women. Partner's attachment behaviors moderate own friend's disapproval on self-reported relationship quality for men and women; additionally, the main effect of partner's friends' and parents' disapproval became nonsignificant with that test. The findings provide evidence that attachment behaviors of both partners play a role in buffering the negative effects of the social network disapproval on relationship outcomes. Clinical implications are discussed.

Se ha demostrado que el grado de aprobación de una relación desde la red social de una persona predice los resultados de las relaciones. Otras investigaciones han demostrado que el apego puede moderar los efectos negativos de varios factores (p. ej.: la depresión) en las relaciones. Utilizando un modelo de interdependencia actor-pareja en un marco de modelos de ecuaciones estructurales, investigamos los efectos de la desaprobación por parte de los padres y los amigos de la relación de una persona en la calidad de la relación conyugal para la persona y su pareja en una muestra de 858 parejas casadas. También analizamos si las conductas de apego de cada cónyuge pueden moderar estos efectos. Los resultados indicaron que las conductas de apego propias de la persona moderan los efectos de la desaprobación por parte de sus propios padres y amigos en la calidad de la relación autoinformada tanto en el caso de los hombres como en el de las mujeres. Las conductas de apego del cónyuge moderan la desaprobación de sus propios amigos en la calidad de la relación autoinformada tanto en el caso de los hombres como en el de las mujeres. Además, el efecto principal de la desaprobación por parte de los padres y los amigos del cónyuge se volvió no significativo con esa prueba. Los resultados ofrecen pruebas de que las conductas de apego de ambos integrantes de la pareja desempeñan un papel en la moderación de los efectos negativos de la desaprobación por parte de la red social en los resultados de las relaciones. Se debaten las implicancias clínicas.

Examining the Influence of Relational Aggression on Sexual Satisfaction With Attachment Behaviors as a Potential Mediator.

The purpose of this study was to investigate the relationship between relational aggression and sexual satisfaction, as well as to determine if attachment behaviors could mediate this relationship. Data came from the Relate Institute Questionnaire (RELATE) and were drawn from the matched-pair responses of 539 heterosexual married couples. Results showed the greater the perceived relational aggression, the lower the sexual satisfaction for both self and partner, regardless of gender. Mediation analyses suggest that attachment behaviors may be a mechanism through which relational aggression influences sexual satisfaction. Implications for clinicians and future research are discussed.

Does Improving Marital Quality Improve Sleep? Results From a Marital Therapy Trial.

For most adults, sleep is a dyadic behavior. Only recently have studies explored the dynamic association between sleep and relationship functioning among bed partners. The current study is the first to examine bidirectional associations between changes in insomnia and changes in marital quality over time, in the context of a marital therapy trial. Among husbands, improvements in marital satisfaction were associated with a 36% decreased risk of insomnia at follow-up. Regarding the reverse direction, counter-intuitively, wife baseline insomnia was associated with improvements in husbands' marital satisfaction, but only among the non-treatment-seeking comparison group. Results are discussed in terms of implications for sleep and marital therapy, and suggest that improving sleep may be an added benefit of improving the marital relationship.

Differentiating Between Attachment Styles and Behaviors and their Association with Marital Quality.

The purpose of this study was to distinguish between the influence of attachment styles and behaviors on marital quality for couples. Data were gathered from 680 couples in a married relationship. Results showed attachment style and behaviors predicted marital quality for both men and women, with higher levels of attachment related to greater quality. Attachment behaviors predicted more of the variance in quality than did styles. Specific implications regarding how therapists may wish to foster behaviors that promote attachment security in marriages are discussed.

The Acceptability of Relationship-Centered Communication Partner Training for Couples Impacted by Aphasia: A Mixed-Methods Pilot Investigation.

PURPOSE: This study explored the acceptability and impact of relationship-centered communication partner training (RC-CPT) in couples impacted by aphasia. In particular, couples considered whether discussing their relationship roles and responsibilities was important and relevant to the changes they desire. Preliminary quasi-experimental data regarding perceived communication confidence and the marriage relationship were also obtained. METHOD: Three couples participated in RC-CPT across two sessions. Surveys were used to measure communication confidence and the marital relationship before and after participation in RC-CPT. The quantitative findings were analyzed using descriptive statistics. Couples also participated in a semistructured interview about the acceptability of RC-CPT during a third session. The interviews were transcribed and analyzed using reflexive codebook analysis. RESULTS: Quantitative data indicated that participants generally maintained or improved self-rated accessibility, responsiveness, engagement, conflict resolution, and communication within their marriage after participating in RC-CPT. Additionally, individuals with aphasia demonstrated enhanced communication confidence scores. Qualitative analysis revealed three themes: (a) Impact on Communication, (b) Impact on Relationship, and (c) Impact on Psychosocial Well-Being. Feedback from participants regarding future development was also included. CONCLUSIONS: The convergence of quantitative and qualitative data supports the conclusion that couples experienced positive changes in their communication, relationship, and psychosocial well-being during the intervention, suggesting that RC-CPT has the potential to positively impact both communicative and psychosocial effects of aphasia on couples. Moreover, this study highlights the promise of RC-CPT as a relationship-centered counseling tool, warranting further exploratory and experimental research. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25937383.

The brief accessibility, responsiveness, and engagement (BARE) scale: a tool for measuring attachment behavior in couple relationships.

This article describes the purpose, reliability, validity, and potential clinical applications of the brief accessibility, responsiveness, and engagement (BARE) scale. In addition to focusing on the central attachment behaviors of accessibility and responsiveness, this instrument highlights the key role of engagement in couple bonding. The BARE is a short, systemic, self-report measure of attachment behaviors in couple relationships. Both classical testing theory and item response theory were used to test the psychometric properties of the instrument. The BARE demonstrated appropriate reliability and validity while maintaining its brevity and potential usefulness for clinicians and researchers. The BARE also accurately predicted the key relationship outcomes of stability and satisfaction. The data for this study were collected from the RELATE assessment (see www.relate-institute.org).

Efficacy of Emotionally Focused Therapy among Spanish-speaking couples: study protocol of a randomized clinical trial in Argentina, Costa Rica, Guatemala, Mexico, and Spain.

BACKGROUND: Couple relationship distress is common and associated with poor physical, psychological, and relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change. METHODS: We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a waitlist. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psycho-educational program based on EFT after completing the study. DISCUSSION: This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the USA and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT04277325. Registered on February 20, 2020.

Understanding the connection between spiritual well-being and physical health: an examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose.

Growing research has demonstrated a link between spiritual well-being and better health; however, little is known about possible physiological mechanisms. In a sample of highly religious healthy male and female adults (n = 100) ages 19-59 (m = 28.28) we examined the influence of spiritual well-being, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-Ex), on physiological risk factors for heart disease. Specifically we examined 24-h ambulatory blood pressure (BP), inflammation (hs-C-reactive protein), fasting glucose, and blood lipids. Regression analyses reveal that higher levels of spiritual-wellness (total FACIT-Sp-Ex score) was significantly related to lower systolic ambulatory BP (ß = -.345; P < .001), diastolic ambulatory BP (ß = -.24; P = .02), hs-C-reactive protein (ß = -.23; P = .04), fasting glucose (ß = -.28; P = .006), and marginally lower triglycerides (ß = -.21; P = .09) and VLDL (ß = -.21; P = .10) controlling for age, gender, and church attendance. Results remained generally consistent across the Meaning, Peace, Faith and Additional Spiritual Concerns subscales of the FACIT-Sp-Ex. Spiritual well-being may be cardio protective.

Family Adversity and Relationship Quality for Pacific Islanders and the Mediating Role of Coming to Terms, Self-Esteem, and Depression.

This study investigated the association between family of origin (FOO) adversities and relationship quality for Pacific Islanders as well as the potential intermediary role of coming to terms (CTT), depression, and self-esteem. The sample consisted of 226 self-identified Pacific Islanders who completed the RELATE assessment (see www.relate-institute.org). Results indicated that greater levels of FOO adversity predicted lower levels of CTT. However, higher levels of CTT in turn associated with higher self-esteem, and lower levels of depression. Results also indicated that greater FOO adversity associates with lower relationship quality indirectly. The clinical implications of these findings and directions for future research are discussed.

The relationship among couple relationship quality, physical functioning, and depression in multiple sclerosis patients and partners.

Using Engel's biopsychosocial model and family systems theory, this study explored the associations between multiple sclerosis (MS) patient and partner reports of physical functioning, depression, and couple relationship quality. Fifty-four couples recruited from the MS society completed self-report questionnaires about couple relationship quality, demographic data, and physical functioning. In regression analyses, couple relationship quality positively related to MS patient physical functioning and depression negatively related to MS patient physical functioning. Both MS patient and partner reports of couple relationship quality negatively related to depression scores in partners. While MS patient reports of couple relationship quality negatively related to MS patient depressions scores, partner reports of couple relationship quality were not significantly related. Depression and couple relationship quality were associated with MS patient physical functioning. Couples with higher relationship quality may be better able to cope with the stresses of MS. Thus, clinicians and health care providers need to include partners in MS patient treatment. Further research is needed to better explain causality between MS patient physical functioning, depression, and couple relationship quality.

Older couples' management of multiple-chronic illnesses: Individual and shared perceptions and coping in Type 2 diabetes and osteoarthritis.

Using data from interviews with 28 older couples in which 1 spouse was diagnosed with diabetes and osteoarthritis, we examined illness perceptions and coping activities as they relate to illness management and relationship resilience. Qualitative analysis of interview transcripts revealed categories of data related to perceptions, coping, and cross category comparisons. Findings suggest that couples experience both negative and positive perceptions of their illnesses, indicating a balance between the reality of their illness challenges and an optimistic outlook of the future. Coping activities included a variety of tasks and were performed by individuals, by both spouses in a shared effort, and by individuals and shared couple efforts. Findings highlight the complexity of individual and shared couple illness perception and couple efforts in managing multiple-chronic illnesses.

The Experience of Learning EFT in Spanish-speaking Countries: A Multi-National Replication Study.

This study is a multi-national follow-up to the original (Sandberg and Knestel (2011) Journal of Marital and Family Therapy, 37, 393-410) article on the process of learning Emotionally Focused Couples Therapy (EFT). A total of 102 clinicians from nine Spanish-speaking countries (Mexico, Costa Rica, Guatemala, Spain, Colombia, Argentina, Chile, Ecuador, and El Salvador) participated in the study. A comparison of results across the two studies revealed more similarities than differences. However, a few notable differences emerged from responses to qualitative questions, namely a heightened sense of appreciation for and resonance with the focus on core emotion in EFT and less frequent reports of difficulty learning and adapting to the model among Spanish-speaking therapists. These differences were consistent with common cultural values and forms of expression in Latin America and Spain. Results are discussed in terms of training, supervision, and future research as well.

Short-Term and Long-Term Effects of Training in EFT: A Multinational Study in Spanish-speaking Countries.

This study seeks to validate the cross-cultural effectiveness of emotionally focused couple therapy (EFT) training in a sample of Spanish-speaking clinicians. The 28-hr formalized training for EFT was offered in six different Spanish-speaking countries, covering Europe, North America, Central America, and South America. Two hundred and seven therapists of 14 different Spanish-speaking nationalities completed pre-training assessments, 153 of them completed post-training assessments, and 92 therapists also completed the follow-up assessment. Using multilevel growth modeling (MLM), results indicated that therapists experienced significant and positive changes in terms of EFT competence (knowledge and skill acquisition), mature empathy, self-compassion, and attachment over time. Implications for transnational EFT training, specifically in Spanish-speaking countries, are discussed.

Depression and communication processes in later life marriages.

OBJECTIVE: About six hundred and fourteen elderly people married to each other, average ages 66 and 63 respectively, in long term, mature marriages, lasting on the average 36 years, completed the Marital Satisfaction Inventory, Revised-MSIr (Snyder, D.K. 1999) and the short version of the Center for Epidemiological Studies Depression Scale (Kohout, F.J., Berkman, L.F., Evans, D.A., & Cornoni-Huntley, J. (1993). The purpose of this study was to determine whether depression in one or both spouses and poor affective and problem solving communication occur together. METHODS: Husbands and wives were divided into nine groups based on their levels of depression (hlow/wlow, hmed/wmed, hhigh/whigh, hhigh/wlow, hhigh/wmed, wlow/hhigh, and wlow/hmed, hmed/wlow, and hmed/whigh). Analysis of Variance was used to examine the difference in couple affective communication and problem solving scores from the MSIr (1999). RESULTS: The findings indicated that when husbands or wives are more depressed, both affective communication and problem solving processes are impaired for the couple. When both are depressed, affective communication and problem solving are worse than when only one is depressed, and both husband and wife communication scores are worse when one or both partners is depressed than when neither husband nor wife is depressed. CONCLUSION: While these findings do not point to cause, implications for providing mental health services (including marital therapy) or couple based education groups as supports to the depressed elderly and their spouses are recommended.

The impact of marital conflict on health and health care utilization in older couples.

This study tested the hypothesis that marital distress has a significant effect on health care utilization for older couples. Results from 536 intact couples in long term marriages showed men in dissatisfying marriages are more likely to utilize health care services; women in satisfying marriages are more likely to use health care services. There were no significant partner effects of marital quality on health problems or health care utilization. The association between husbands' marital quality and wives' health care utilization approached significance. Implications for future research and clinical practice, including gender differences, are discussed.

A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management.

Telehealth interventions are feasible and efficacious. While patients are the focus of both quantitative and qualitative studies that assess their response to telehealth, little is known about the view of providers of telehealth services. The purpose of this study was to better understand the experiences of providers and the factors that they perceive to contribute to the success of telehealth interventions as well as to their own satisfaction. Face-to-face or telephone interviews were conducted with 10 diabetes educators (nurses and dietitians) who served as providers of a telemedicine case management intervention for older adults who have diabetes. Qualitative analyses revealed that providers were very satisfied with their experience and felt their efforts with patients were generally successful. Providers also identified a number of unique benefits to telehealth interventions. These included opportunities for more frequent contact with patients, greater relaxation and information due to the ability to interact with the patients in their own homes, increased ability to reach the underserved, more timely and accurate medical monitoring, and improved management of data. The primary disadvantages of telehealth they identified were technology problems and a concern about the lack of physical contact with patients. Findings illustrate providers' perspectives on the unique advantages of telehealth and offer insight as to how to make telehealth interventions more effective, as well as more satisfying for those who do the day-to-day work of providing the interventions.

Baby with the Bathwater? Examining the Relationship between Video Game Use and Relationship Outcomes and the Moderating Effects of Attachment Behaviors among Married Casual Gamers.

We examined whether time together as a problem mediates the link between frequency of video game use and relational outcomes (relationship quality, relational aggression, physical aggression) among 431 married couples. We also examined the moderating effect of couple attachment behaviors on the association between time together as a problem and outcomes. There was no support for a direct or indirect relationship between gaming and outcomes; however, time together as a problem was consistently related to outcomes. Additionally, husband's and wife's attachment behaviors moderated the association between women's reports of time together as a problem and men's relational aggression. Clinical implications are discussed.

The importance of relationship processes for lowering BMI over time in women with type 2 diabetes in a randomized controlled trial.

OBJECTIVE: Weight change may be affected by dyadic processes within couple relationships. The aim of this secondary data analysis was to explore trends in BMI across time, and assess whether relationship processes (i.e., relationship satisfaction, positive problem-solving), predict BMI trajectories in men and women. METHODS: Data are from 268 participants in the Diabetes Support Project, a randomized trial of behavioral intervention for individuals with type 2 diabetes (T2D) in poor glycemic control. For secondary analyses, BMI was measured at pre-treatment (baseline), 4 months (post-treatment), 8 months, and 12 months. Multiple relationship variables were measured at all time points and were modeled as predictors and correlates of change in BMI across time. RESULTS: In general, BMI trajectories had higher starting values (intercepts) for females than for males in the sample (b = -2.51, p < .05), and slopes trended downward from pre-treatment to 12 months (b = -.09, p <  .05). Downward trajectories of BMI were more pronounced for women with higher relationship satisfaction (b = .05, p <  .05) and higher positive problem solving skills (b = .06, p < .05) at baseline. Change in relationship processes were not correlated with change in BMI across time. CONCLUSION: For women with T2D in this behavioral intervention study, relationship process scores at the beginning of treatment predicted changes in BMI over time, with better problem solving and higher relationship satisfaction at baseline related to steeper decreases in BMI across treatment. Additional research is needed to understand how improving relationship interaction prior to diabetes treatment may positively influence weight loss during treatment.

Diabetes management assisted by telemedicine: patient perspectives.

This qualitative research focuses on understanding the experiences of elderly patients with diabetes who participated in a telemedicine case management intervention, to better understand the barriers to success of telemedicine with the elderly. Telephone interviews were conducted with elderly patients with diabetes prior to and 6 and 12 months after participating in a case management intervention delivered via a computer that allowed them to teleconference with a nurse and dietitian, upload blood glucose and blood pressure data, and access educational materials. Qualitative analyses revealed that patients enrolled primarily because healthcare providers encouraged them. Their goals were to improve diabetes control, with few expectations of an effect on emotional health or family relationships. After involvement, they particularly valued the emphasis on monitoring of health outcomes and supportive contact with diabetes staff to encourage, remind, and answer questions. Findings illustrate the potential value of telemedicine with elderly patients with diabetes, if supported by primary care providers and including consistent, supportive interactions with knowledgeable diabetes healthcare providers.