Cognitive-behavioural conjoint therapy versus prolonged exposure for PTSD in military service members and veterans: results and lessons from a randomized controlled trial.

Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD.The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive-Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders - provider's treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD.There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments.This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships.

Differential dropout from trial of couple versus individual therapy for PTSD.General pattern of improvements in relationship outcomes in couple therapy for PTSD.PTSD symptoms improved in the individual and couple therapy for PTSD.Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout by condition on trial analyses are discussed.

A pilot of couple HOPES within the U.S. Veterans Affairs Healthcare System: PTSD and relationship outcomes in veteran couples.

Conjoint interventions for posttraumatic stress disorder (PTSD) offer an opportunity to target symptoms' broader social impact, including couples' relationship satisfaction. Technology-assisted interventions may help overcome access to care barriers for couples. Couple Helping Overcome PTSD and Enhance Satisfaction (HOPES) is a coached internet-based couples' intervention for PTSD adapted from cognitive behavioral conjoint therapy, an evidence-based dyadic therapy for PTSD. This pilot study examined the implementation feasibility, acceptability, and preliminary efficacy of Couple HOPES in a sample of 15 United States veterans with PTSD and their romantic partners within a Veterans Affairs (VA) Medical Center setting. There were significant improvements in veterans' PTSD symptoms (self- and partner-reported) and both veterans' and partners' relationship satisfaction, though the effect sizes were small (all g's < .40). Importantly, the 73% retention rate and participant feedback at postassessment suggest this online adaptation may help couples overcome barriers to accessing care. More broadly, this pilot study helps answer questions regarding where digital health interventions fit into the continuum of PTSD care within the VA system. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Actor and partner effects of PTSD and relationship functioning in a recently traumatized sample.

A robust negative association exists between self-reported posttraumatic stress disorder (PTSD) and self-reported interpersonal relationship functioning. However, the extent to which each member of a dyad's subjective PTSD ratings influence the other's subjective relationship functioning ratings is less understood. The present study tested: (a) associations between self- and partner-PTSD severity ratings and relationship functioning ratings and (b) whether exposure to the index trauma, gender, and relationship type (i.e., intimate vs. nonintimate dyad) moderated these associations in a sample of 104 dyads of individuals with PTSD and a close significant other. Each partners' ratings of PTSD severity were uniquely and positively associated with their own (actor) and their partner's ratings of relationship conflict, but not support or depth. Gender moderated the partner effect; women's (but not men's) subjective PTSD severity were positively associated with their partners' subjective relationship conflict. There was a relationship type by actor effect interaction for relationship support, which indicated that perceptions of PTSD severity were negatively associated with each partner's perceptions of relationship support for intimate but not nonintimate dyads. Results support a dyadic conceptualization of PTSD in which both partners' perception of symptoms are important for relationship functioning. Conjoint therapies may be particularly potent for PTSD and relationship functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Subjective emotion trajectories in couple therapy and associations with improvement in relationship satisfaction.

Existing couple therapies are generally effective for reducing romantic relationship distress and divorce, but therapy outcomes remain poor for many. Outcomes can be improved through greater understanding of session-by-session therapeutic processes, particularly in real-world treatment settings. Modern couple therapy models commonly emphasize the importance of emotional experiences as key change processes, yet few empirical studies have tested the merits of this focus. The present study addresses this limitation by examining trajectories of subjective emotions and their association with change in a key relationship outcome, relationship satisfaction, among military veterans and their partners at a VA Medical Center. Partners rated their relationship satisfaction prior to couple therapy sessions and subjective emotions immediately after sessions. Consistent with hypotheses, both hard (e.g., anger) and soft (e.g., sadness) negative emotions decreased significantly over the course of therapy. Those couples with greater decreases in hard negative, but not soft negative, emotions showed significantly more improvement in relationship satisfaction. Positive emotions did not significantly change across couples in general, but those couples whose positive emotions did increase also showed more improvement in relationship satisfaction. These results suggest change in subjective emotions may be one process underlying improvement in couple therapy and lend empirical support to the emphasis on emotion-based change processes underlying acceptance-based and emotion-focused couple therapies.

Partner outcomes from an uncontrolled trial of Couple HOPES: A guided online couple intervention for posttraumatic stress disorder and relationship enhancement.

Posttraumatic stress disorder (PTSD) is associated with significant individual and relationship impairment for people with PTSD and their romantic partners. Conjoint treatments, such as cognitive behavioral conjoint therapy for PTSD (CBCT), are designed to address individual and relationship factors, yet significant barriers impede accessing in-person therapy. Couple HOPES (i.e., Helping Overcome PTSD and Enhance Satisfaction) is a coach-guided, online couple intervention for PTSD based on CBCT that was designed to address these barriers. Previous investigations have found preliminary efficacy of Couple HOPES for improving PTSD symptoms, relationship functioning, and some individual functioning domains for the partner with probable PTSD. However, no study to date has tested individual outcomes for romantic partners, which is needed to fully evaluate the intervention's promise. The current study tested these partner outcomes in a combined, uncontrolled sample of 27 couples. Intent-to-intervene analyses found significant improvements at postintervention in four of eight tested outcomes, including ineffective arguing, g = 0.74; anger, g = 0.32; perceived health, g = 0.67; and quality of life, g = 0.56. Depressive symptoms, generalized anxiety, alcohol misuse, and work functioning did not significantly change, gs = 0.17-0.42. Among participants who completed a 1-month follow-up assessment, generalized anxiety, g = 0.43, and perceived health, g = 0.73, significantly improved over follow-up, whereas anger, g = -0.48, lost gains previously made. Results were largely consistent in the completer sample. These findings show the potential of Couple HOPES to have broad benefits not only for individuals with probable PTSD but also for their romantic partners.

An uncontrolled trial of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement.

Novel interventions that overcome limited access to empirically supported psychotherapies for posttraumatic stress disorder (PTSD) are sorely needed. Couple helping overcome PTSD and enhance relationships (HOPES), a guided, online couple intervention drawing from cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson, 2012), was designed to decrease PTSD symptoms and improve relationship satisfaction. The present study is the first uncontrolled trial of 17 couples in which one partner was a military member, veteran, or first responder and had probable PTSD (PTSD + partner) based on self-report assessment. Intent-to-intervene analyses revealed significant improvements from pre- to postintervention in PTSD + partners' self-reported PTSD symptoms (g = .72), as well as their intimate partner's relationship satisfaction (g = .34) and behavioral accommodation of PTSD symptoms (g = .84). There were also significant improvements in PTSD + partners' depression (g = .43) and perceived relationship arguments (g = .62). There were similar results found in the completer sample. There were no adverse events and high satisfaction with the intervention in those who completed the evaluation. These findings provide additional initial data on the safety, feasibility, and efficacy of Couple HOPES. The similarities of intent-to-intervene and completer results, as well as the need for randomized controlled trial designs to test Couple HOPES, are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Time Spent Together in Intimate Relationships: Implications for Relationship Functioning.

Current models of relationship functioning often emphasize conflict with a particular focus on the behaviors that occur in that context. Much less is known about the impact of time spent interacting in the absence of conflict. The primary aim of this study is to test associations between time spent in various forms of daily interaction (engaging in a shared activity, talking, and arguing) and multiple relationship outcomes while controlling for positive and negative communication during conflict. The present sample consists of 49 married couples (N = 98 individuals). Data were analyzed using multilevel models to account for non-independence of the data. Consistent with previous literature, communication behaviors were related to relationship outcomes. After controlling for communication, couples who spent more time arguing per day were less satisfied in their relationships, and perceived greater negative qualities in their relationships. Finally, couples who spend a larger proportion of their time together talking reported greater satisfaction, perceived more positive qualities in their relationships, and experienced greater closeness. These findings suggest that low salience interactions account for unique variance in relationship functioning above and beyond what is currently studied. Future research is needed to determine possible mechanisms by which low salience interactions are related to relationship outcomes.

Initial outcomes of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement.

Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) is a guided, online couple intervention adapted from Cognitive-Behavioral Conjoint Therapy for posttraumatic stress disorder (PTSD). It was created to overcome a range of barriers to accessing evidence-based treatments for PTSD and the intimate relationship problems associated with it. This manuscript describes initial outcomes of the intervention in a series of 10 couples. Participants were military, veteran and first responders with probable PTSD and their intimate partners. Couples completed the program and measurements of PTSD, relationship satisfaction, and secondary outcomes at pre-, mid-, and post-intervention. Mean satisfaction for the program was high and it was completed by seven of ten couples. Participants with PTSD evidenced significant and large pre- to post-intervention effect size improvements in PTSD symptoms (g = 0.80) and perceived health (g = 1.13). They also exhibited non-significant but medium effect size pre- to post-intervention improvements in quality of life (g = 0.62), and depression (g = 0.53), and small effect size pre- to post-intervention improvements in argumentativeness (g = 0.43), anger (g = 0.31), and anxiety (g = 0.31). Partners reported significant and moderate pre- to post-intervention effect size improvements in relationship satisfaction (g = 0.68), and medium but not significant effect size improvements in accommodation of PTSD (g = 0.56). Results provide initial support for the feasibility, acceptability, and efficacy of Couple HOPES for improving PTSD and relationship satisfaction. However, more testing in larger samples, including with randomized controlled designs, is needed.

The development of Couple HOPES: a guided online intervention for PTSD and relationship satisfaction enhancement.

Background: Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) was created to help overcome a range of barriers to accessing psychotherapy for posttraumatic stress disorder (PTSD) and commonly associated intimate relationship problems. Objective: Couple HOPES is a guided, online self-help intervention adapted from Cognitive-Behavioural Conjoint Therapy for PTSD that aims to improve PTSD and enhance relationship satisfaction. Method/Results: This paper describes the processes and principles used to develop the Couple HOPES intervention platform as well as the coaching model and manual used to promote engagement and adherence to the intervention. Conclusions: Current research and future directions in testing Couple HOPES are outlined.

Antecedentes: HOPES para Parejas (Ayuda para Superar el TEPT y Mejorar la Satisfacción) fue creado para ayudar a superar un rango de obstáculos para acceder a psicoterapia para Trastorno de Estrés Postraumático (TEPT) y problemas íntimos de pareja comúnmente asociados.Objetivo: HOPES para Parejas es una intervención guiada en línea de autoayuda adaptada de la Terapia Cognitivo-conductual Conjunta/en pareja para TEPT, cuyo objetivo es mejorar el TEPT y la satisfacción en la relación.Método/Resultados: Este artículo describe los procesos y principios usados para desarrollar la plataforma de intervención HOPES para Parejas, así como el modelo de entrenamiento y el manual usado para promover el compromiso y adherencia a la intervención.Conclusiones: Se delinearon la investigación actual y direcciones futuras respecto al estudio de HOPES para Parejas.

A replication and extension of the interpersonal process model of demand/withdraw behavior: Incorporating subjective emotional experience.

The demand/withdraw (D/W) interaction pattern is a maladaptive cycle of behavior that is associated with a wide range of deleterious individual and relational outcomes. Partners' emotional responding during couple conflict has long been theorized to play a central role in the occurrence of D/W. The interpersonal process model of D/W behavior suggests that each partner's emotional responses are associated with their own as well as the other partner's behavior in the D/W cycle and that the nature of these associations varies across partners. A prior test of the interpersonal process model provided support for sex- and role-specific associations between vocal emotional expression and demanding and withdrawing behaviors. The current study expands the conceptual frame of the interpersonal process model by incorporating subjective emotional experience. Hypothesized associations between subjective emotional experience, emotional expression, and role-specific demanding and withdrawing behaviors were tested in a sample of 59 couples using an actor-partner interdependence model. Results reveal that spouses experience and express nonsignificantly different levels of negative affect but strongly differ in how the experience and expression of those emotions are related to demanding and withdrawing behaviors. High levels of women's demanding behavior were associated with the combination of experiencing and expressing high levels of negative affect, while high levels of men's withdrawing behavior were associated with experiencing high levels of negative affect but expressing low levels of negative affect. Implications of results for understanding emotional processes in maladaptive cycles and for clinical practice are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Negative Partner Attributions Moderate the Association between Heart Rate Reactivity During Relationship Conflict and Relationship Satisfaction.

Numerous theoretical models of relationship distress suggest that strong, negative reactions to conflict are directly associated with lower levels of relationship satisfaction. Consistent with this supposition, substantial evidence links higher levels of subjective negative emotion, more pronounced and frequent expressions of negative affect, and higher levels of negative communication behaviors to lower levels of relationship satisfaction (e.g., Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). However, the evidence linking stress-related physiological responding during relationship conflict and relationship satisfaction is less compelling than would be anticipated based on theory. We propose that these theoretically unexpected but empirically well-replicated findings may be the result of different patterns in association between physiological reactivity and relationship satisfaction for couples with varying styles in how they typically perceive unwanted behavior in one another. The present study tests negative attributions for undesirable partner behaviors as a moderator of the association between heart rate reactivity (HRR) during relationship conflict and relationship satisfaction in a sample of 60 married couples. A significant interaction emerged between HRR and negative attributions of partner behavior in predicting relationship satisfaction such that higher levels of HRR were associated with lower levels of relationship satisfaction for individuals who typically made more negative attributions for undesirable partner behaviors, but with higher levels of relationship satisfaction for individuals who typically made fewer negative attributions for undesirable partner behaviors. Implications for conceptualizing reactivity during relationship conflict and couple interventions are discussed.

Varios modelos teóricos de distrés relacional sugieren que las reacciones fuertes y negativas al conflicto están directamente asociadas con niveles más bajos de satisfacción con la relación. De acuerdo con esta suposición, hay pruebas sustanciales que vinculan los niveles más altos de emoción negativa subjetiva, las expresiones más marcadas y frecuentes de afecto negativo, y los niveles más altos de conductas de comunicación negativa con niveles más bajos de satisfacción con la relación (p. ej.: Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). Sin embargo, las pruebas que conectan la respuesta fisiológica relacionada con el estrés durante el conflicto en la relación y la satisfacción con la relación son menos convincentes de lo que se esperaría según la teoría. Proponemos que estos resultados teóricamente inesperados, pero bien reproducidos empíricamente, pueden ser el resultado de diferentes patrones que asocian la reactividad fisiológica y la satisfacción con la relación en el caso de las parejas con estilos variados en cuanto a cómo perciben normalmente el comportamiento no deseado en el otro. El presente estudio evalúa las atribuciones negativas para las conductas no deseadas de la pareja como moderadoras de la asociación entre la reactividad de la frecuencia cardíaca (RFC) durante el conflicto en la relación y la satisfacción con la relación en una muestra de 60 parejas casadas. Surgió una interacción significativa entre la RFC y las atribuciones negativas de la conducta de la pareja a la hora de predecir la satisfacción con la relación, de manera que niveles más altos de RFC estuvieron asociados con niveles más bajos de satisfacción con la relación en personas que normalmente hicieron más atribuciones negativas para las conductas no deseadas de la pareja, pero con niveles más altos de satisfacción con la relación para las personas que normalmente hicieron menos atribuciones negativas para las conductas no deseadas de la pareja. Se debaten las implicancias para conceptualizar la reactividad durante el conflicto en la relación y las intervenciones en la pareja.

Relative importance of conflict topics for within-couple tests: The case of demand/withdraw interaction.

Researchers commonly employ observational methods, in which partners discuss topics of concern to them, to test gender differences and other within-couple differences in couple conflict behavior. We describe a previously unidentified assumption upon which statistical tests in these observational studies are frequently reliant: whether each partner is more concerned or dissatisfied with the topic selected for them than the partner is. We term this the relative importance assumption and show that common procedures for selecting conflict discussion topics can lead to widespread violations of the assumption in empirical studies. Study 1 conducts a systematic review of the literature and finds that few existing studies ensure relative importance is met. Study 2 uses two empirical samples to estimate how often relative importance is violated when not ensured, finding it is violated in one third of interaction tasks. Study 3 examines the potential consequences of violating the relative importance assumption when testing within-couple differences in observed behavior, focusing on gender differences in the demand/withdraw pattern. Results show that these tests were profoundly impacted by violations of relative importance. In light of these violations, we conduct a more rigorous test of demand/withdraw theories and clarify previously inconsistent results in the literature. We recommend explicit consideration of relative importance for studies testing within-couple effects, provide methodological recommendations for selecting topics in future studies, and discuss implications for clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Incorporating physiology into the study of psychotherapy process.

Increasing evidence indicates that psychological factors important to therapy effectiveness are associated with physiological activity. Knowledge of the physiological correlates of therapy process variables has the potential to provide unique insights into how and why therapy works, but little is currently known about the physiological underpinnings of specific therapy processes that facilitate client growth and change. The goal of this article is to introduce therapy process researchers to the use of physiological methods for studying therapy process variables. We do this by (a) presenting a conceptual framework for the study of therapy process variables, (b) providing an introductory overview of physiological systems with particular promise for the study of therapy process variables, (c) introducing the primary methods and methodological decisions involved in physiological research, and (d) demonstrating these principles and methods in a case of therapeutic presence during couple therapy. We close with a discussion of the promise and challenges in the study of physiological correlates of therapy process variables and consideration of future challenges and open questions in this line of research. Online supplemental materials include additional resources for therapy process researchers interested in getting started with physiological research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Knowledge of suicide history, current depressive symptoms, and future suicide risk within couples.

Research on suicide prevention and intervention has overwhelmingly focused on the suicidal individual. However, suicidal individuals exist within interpersonal relationships. This study tests 1) how accurately members of romantic couples know each other's depression symptoms, suicide histories, and risk for future suicidal thoughts and behaviors and 2) whether couple-specific factors moderate those associations. Participants were 43 mixed-sex couples (N = 86 individuals) recruited for a larger study of National Guard or Reserves members and their partners. Participants reported on their own depression symptoms, suicide history and expectation of future suicide risk, as well as their perceptions of their partners' depression symptoms, suicide history and future suicide risk. Effects were tested for moderation by communication style and relationship satisfaction. Results suggest that many individuals knew about their partners' depression symptoms and past suicidal ideation (77%). In contrast, fewer were aware of their partners' future suicide ideation risk (44%) and the minority knew about past suicidal behavior (23%) or risk for future suicide attempt (14%). Associations were not moderated by positive or negative communication styles or relationship satisfaction. Taken together, these results suggest that while romantic partners share some parts of their suicide histories with each other, some aspects are kept private. Notably, regardless of communication style or relationship quality, results were consistent, suggesting that even couples in strong relationships may not be aware of each other's suicide history and risk. Implications for the development of couples-based suicide prevention interventions are discussed.

The effect of stress on empathic accuracy in romantic couples.

Accurately understanding the thoughts and feelings of romantic partners, termed empathic accuracy, is critical for optimal relationship functioning. Empathic failure is linked to common reasons couples seek therapy (Doss, Simpson, & Christensen, 2004; Jacobson & Christensen, 1996) and is either implicitly or explicitly a target of many couple therapies (e.g., Jacobson & Christensen, 1996). More specifically, couple therapies target partners' abilities to accurately understand one another preceding and during conflict, periods characterized by high levels of stress. The current study tests the hypothesis that acute stress can be harmful for empathic accuracy in romantic couples, and tests two competing path models of the impact of stress on accuracy. Results show that an acute stressor affected accuracy of men and women differently, impairing accuracy in women but not observably affecting men's accuracy. The effect of the stressor on empathic accuracy for women was mediated by curvilinear arousal, and men's accuracy was also associated with curvilinear arousal. This pattern of results suggests that moderate arousal is optimal for empathic accuracy for both men and women, but this effect was twice as large for women relative to men. These findings point toward potential avenues to improve existing couple therapies by incorporating strategies to mitigate the effects of stress, thereby increasing couples' ability to accurately understand one another in therapy. These findings also suggest strategies for couples to be optimally productive when having important relationship conversations by attending to their level of arousal. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cardiovascular Reactivity During Marital Conflict in Laboratory and Naturalistic Settings: Differential Associations with Relationship and Individual Functioning Across Contexts.

Cardiovascular reactivity during spousal conflict is considered to be one of the main pathways for relationship distress to impact physical, mental, and relationship health. However, the magnitude of association between cardiovascular reactivity during laboratory marital conflict and relationship functioning is small and inconsistent given the scope of its importance in theoretical models of intimate relationships. This study tests the possibility that cardiovascular data collected in laboratory settings downwardly bias the magnitude of these associations when compared to measures obtained in naturalistic settings. Ambulatory cardiovascular reactivity data were collected from 20 couples during two relationship conflicts in a research laboratory, two planned relationship conflicts at couples' homes, and two spontaneous relationship conflicts during couples' daily lives. Associations between self-report measures of relationship functioning, individual functioning, and cardiovascular reactivity across settings are tested using multilevel models. Cardiovascular reactivity was significantly larger during planned and spontaneous relationship conflicts in naturalistic settings than during planned relationship conflicts in the laboratory. Similarly, associations with relationship and individual functioning variables were statistically significantly larger for cardiovascular data collected in naturalistic settings than the same data collected in the laboratory. Our findings suggest that cardiovascular reactivity during spousal conflict in naturalistic settings is statistically significantly different from that elicited in laboratory settings both in magnitude and in the pattern of associations with a wide range of inter- and intrapersonal variables. These differences in findings across laboratory and naturalistic physiological responses highlight the value of testing physiological phenomena across interaction contexts in romantic relationships.

A multivariate dynamic systems model for psychotherapy with more than one client.

The dynamics of the give and take between therapist and client(s) is frequently of interest to therapy process researchers. Characterizing the ways that therapists respond to clients and clients respond to therapists can be challenging in therapeutic encounters involving a single therapist and a single client. The complexity of this challenge increases as the number of people involved in a therapeutic encounter increases not only because there are more people responding to one another but also because the patterns of responding can become more complex. This manuscript demonstrates how dyadic cross-lagged panel models can be extended to psychotherapeutic encounters involving 3 people and used to test processes that exist between dyadic subsets of the larger group as well as the group as one cohesive unit. Three hundred seventy-nine talk turns of fundamental frequency from a couple therapy session were modeled using 3 dyadic cross-lagged panel models, and each individual's respiratory sinus arrhythmia (RSA) was treated as a moderator. Although the regression coefficients for each dyadic subset (e.g., therapist-husband) were nonsignificant, an eigenvalue/eigenvector decomposition of the regression coefficients from the 3 dyadic cross-lagged panel models suggests that interdependence exists at the level of the whole group (i.e., therapist-husband-wife) rather than between pairs of individuals within the group (e.g., husband-wife). Further, an interaction involving husband's RSA suggested that interdependence involving the husband ceased when the husband displayed greater regulatory effort. This combination of statistical methods allows for clearly distinguishing between dyadic therapeutic processes and group-level therapeutic processes. (PsycINFO Database Record

Graphic methods for interpreting longitudinal dyadic patterns from repeated-measures actor-partner interdependence models.

Researchers commonly use repeated-measures actor-partner interdependence models (RM-APIM) to understand how romantic partners change in relation to one another over time. However, traditional interpretations of the results of these models do not fully or correctly capture the dyadic temporal patterns estimated in RM-APIM. Interpretation of results from these models largely focuses on the meaning of single-parameter estimates in isolation from all the others. However, considering individual coefficients separately impedes the understanding of how these associations combine to produce an interdependent pattern that emerges over time. Additionally, positive within-person, or actor, effects are commonly misinterpreted as indicating growth from one time point to the next when they actually represent decline. We suggest that change-as-outcome RM-APIMs and vector field diagrams (VFDs) can be used to improve the understanding and presentation of dyadic patterns of association described by standard RM-APIMs. The current article briefly reviews the conceptual foundations of RM-APIMs, demonstrates how change-as-outcome RM-APIMs and VFDs can aid interpretation of standard RM-APIMs, and provides a tutorial in making VFDs using multilevel modeling. (PsycINFO Database Record

Revised scoring and improved reliability for the Communication Patterns Questionnaire.

The Communication Patterns Questionnaire (CPQ; Christensen, 1987) is a widely used self-report measure of couple communication behavior and is well validated for assessing the demand/withdraw interaction pattern, which is a robust predictor of poor relationship and individual outcomes (Schrodt, Witt, & Shimkowski, 2014). However, no studies have examined the CPQ's factor structure using analytic techniques sufficient by modern standards, nor have any studies replicated the factor structure using additional samples. Further, the current scoring system uses fewer than half of the total items for its 4 subscales, despite the existence of unused items that have content conceptually consistent with those subscales. These characteristics of the CPQ have likely contributed to findings that subscale scores are often troubled by suboptimal psychometric properties such as low internal reliability (e.g., Christensen, Eldridge, Catta-Preta, Lim, & Santagata, 2006). The present study uses exploratory and confirmatory factor analyses on 4 samples to reexamine the factor structure of the CPQ to improve scale score reliability and to determine if including more items in the subscales is warranted. Results indicate that a 3-factor solution (constructive communication and 2 demand/withdraw scales) provides the best fit for the data. That factor structure was confirmed in the replication samples. Compared with the original scales, the revised scales include additional items that expand the conceptual range of the constructs, substantially improve reliability of scale scores, and demonstrate stronger associations with relationship satisfaction and sensitivity to change in therapy. Implications for research and treatment are discussed. (PsycINFO Database Record