Cognitive‐Behavioral Couple Therapies: Review of the Evidence for the Treatment of Relationship Distress, Psychopathology, and Chronic Health Conditions

• DOI: http://doi.org/10.1111/famp.12227
• Date: 01 September 2016
• Published date: 01 September 2016
• Author: Donald H. Baucom,Matthew J. Cohen,Melanie S. Fischer

Cognitive-Behavioral Couple Therapies: Review of

the Evidence for the Treatment of Relationship

Distress, Psychopathology, and Chronic Health

Conditions

MELANIE S. FISCHER*

DONALD H. BAUCOM*

MATTHEW J. COHEN*

To read this article in Spanish, please see the article’s Supporting Information on Wiley Online Library

(wileyonlinelibrary.com/journal/famp).

Cognitive-behavioral couple therapy (CBCT) is an approach to assisting couples that

has strong empirical support for alleviating relationship distress. This paper provides a

review of the empirical status of CBCT along with behavioral couple therapy (BCT), as

well as the evidence for recent applications of CBCT principles to couple-based int erven-

tions for individual psychopathology and medical conditions. Several meta-analyses and

major reviews have confirmed the efficacy of BCT and CBCT across trials in the United

States, Europe, and Australia, and there is little evidence to support diff erential effective-

ness of various forms of couple therapy derived from behavioral principles. A much smal-

ler number of effectiveness studies have shown that successful implementation in

community settings is possible, although effect sizes tend to be somewhat lower than those

evidenced in randomized controlled trials. Adapted for individual problems, cognitive-

behavioral couple-based interventions appear to be at least as effective as individual cog-

nitive behavioral therapy (CBT) across a variety of psychological disorders, and often

more effective, especially when partners are substantially involved in treatment. In addi-

tion, couple-based interventions tend to have the unique added benefit of improving rela-

tionship functioning. Findings on couple-based interventions for medical conditions are

more varied and more complex to interpret given the greater range of target outcomes

(psychological, relational, and medical variables).

Keywords: Cognitive-Behavioral Couple Therapy; Behavioral Couple Therapy;

Couple-based Interventions; Relationship Distress

Fam Proc 55:423–442, 2016

Cognitive-behavioral couple therapy (CBCT) is an approach to assisting couples that

has strong empirical support for alleviating relationship distress and addressing indi-

vidual difficulties in a relationship context. CBCT has evolved over decades, drawing

heavily from earlier behavioral couple therapy (BCT), individual cognitive therapy, and

*Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Correspondence concerning this article should be addressed to Melanie S. Fischer, Department of

Psychology and Neuroscience, University of North Carolina at Chapel Hill, Davie Hall, CB#3270, Chapel

Hill, NC 27599-3270. E-mail: msfi@email.unc.edu.

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Family Process, Vol. 55, No. 3, 2016 ©2016 Family Process Institute

doi: 10.1111/famp.12227

basic cognitive and social psychology research on information processing.

1

Although early

BCT approaches focused almost exclusively on promoting behavior change (Jacobson &

Margolin, 1979; Liberman, 1970; Stuart, 1969), CBCT has expanded to include interven-

tions that directly address cognitions and emotions as well. As a result, therapists have

available a broad range of interventions based on a well-conceptualized understanding of

each couple’s needs (Epstein & Baucom, 2002). This conceptualization employs a broad

contextual perspective that takes into account (a) the well-being of both partners as indi-

viduals, (b) the couple as a unit, and (c) the couple’s environment in which they exist.

Across these three domains, behaviors, cognitions, and emotions are viewed as interre-

lated and equally important in relationship functioning (Epstein & Baucom, 2002). Con-

sistent with this framework, a healthy relationship is viewed as one that contributes to

the growth and well-being of both partners; the couple forms a well-functioning team, and

the couple responds adaptively to the demands and resources of their physical and social

environment (Baucom, Epstein, Kirby, & LaTaillade, 2015). Consequently, CBCT practi-

tioners carefully assess a variety of factors within these various domains, and relationship

distress is viewed as a unique confluence of individual, couple, and environment factors

specific to each couple.

Hence, an effective treatment plan must take this unique set of factors into account and

employ cognitive, emotional, and behavioral interventions as appropriate to address rele-

vant concerns. For example, interventions may focus on altering behaviors directly

through skill-based strategies, including communication training such as decision -making

or problem-solving skills to address problematic behaviors. Similarly, the therapist might

employ guided behavior change to target specific domains such as suggesting date nights

to increase potentially pleasurable activities without any new skills required. Cogn itive

interventions to address distorted views of the relationship can be implemented through

guided discovery (which involves providing the couple with new experiences that will lead

to different perspectives on the relationship) or more typical cognitive interventions such

as Socratic questioning. Finally, a therapist might employ a range of in and out of session

interventions to (a) contain emotions when they are too high or poorly regulated or (b)

heighten emotions and their expression when the couple is distant or approaches issues

from an extreme intellectual perspective that is problematic. Treatment is not manual-

ized, but rather relies on a therapist’s ability to craft a flexible treatmen t plan tailored to

each couple based on a thorough case conceptualization that takes the above factors into

account.

Consistent with this contextual perspective, race/ethnicity, gender, sexual orientation,

ability status, SES, and other characteristics related to each partner’s identity and cul-

tural background are an integral part of the case conceptualization, taking into account

individual, couple, and environmental factors of the relationship. Unfortunately, there

still is a lack of treatment research which has explored how behavioral couple therapies

can be delivered most effectively to meet the needs of a diverse range of couples. While

more treatment research on couples who are traditionally underrepresented in clinical

1

Because behavioral approaches to intervening with couples have evolved over time and different terms

have been employed, we use the following terms in describing interventions. The term “behavioral couple

therapy” (BCT) is used to describe early versions of intervention that focused almost exclusively on behav-

ioral interventions with little direct focus on cognitions or emotions (Christensen’s group refers to this

same approach as traditional behavioral couple therapy or TBCT). The term “cognitive-behavioral couple

therapy” (CBCT) is used when discussing multifaceted approaches which incorporate behavioral, cogni-

tive, and emotional interventions based within a broad behavioral theoretical model, such as the model

proposed by Baucom and Epstein (Baucom & Epstein, 1990; Epstein & Baucom, 2002), which is also the

approach the current authors have implemented. Finally, the term “behaviorally based interventions” is

used more inclusively to refer to any behaviorally oriented couple-based intervention, including BCT and

CBCT.

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