A Randomized Controlled Trial of Coach Contact During a Brief Online Intervention for Distressed Couples

• Date: 01 December 2017
• Author: Kathryn M. Nowlan,McKenzie K. Roddy,Brian D. Doss
• Published date: 01 December 2017
• DOI: http://doi.org/10.1111/famp.12262

A Randomized Controlled Trial of Coach Contact

During a Brief Online Intervention for Distressed

Couples

MCKENZIE K. RODDY*

KATHRYN M. NOWLAN*

BRIAN D. DOSS*

The negative impacts of relationship distress on the couple, the family, and the individ-

ual are well-known. However, couples are often unable to access effective treatments to com-

bat these effects—including many couples who might be at highest risk for relationship

distress. Online self-help interventions decrease the barriers to treatment an d provide cou-

ples with high quality, research-based programs they can do on their own. Using a com-

bined multiple baseline and randomized design, the present study investigated the

effectiveness of the Brief OurRelationship.com (Brief-OR) program with and without staff

support in improving relationship distress and individual functioning. Results indicated

the program produced significant gains in several areas of relationship functioning; how-

ever, these gains were smaller in magnitude than those observed in Full-OR. Furthermore,

effects of Brief-OR were not sustained over follow-up. Comparisons between couples ran-

domized to Brief-OR with and without contact with a staff coach indicated that coach con-

tact significantly reduced program noncompletion and improved program effects.

Limitations and future directions are discussed.

Keywords: Couple Therapy; Online Intervention; Integrative Behavioral Couple Therapy;

Paraprofessional Contact

Fam Proc 56:835–851, 2017

Impacts of relationship distress are far reaching. Currently, 33% of first marriages and

62% of cohabitating relationships are likely to end in separation within 10 years (Bram-

lett & Mosher, 2002). Poor relationship functioning can negatively impact individual men-

tal health (Whisman, 2007), physical health (Robles, Slatcher, Trombello, & McGinn,

2013), and global life satisfaction (Be, Whisman, & Uebelacker, 2013). Consider ing

approximately one third of couples are considered to be distressed at any given time

(Whisman, Beach, & Snyder, 2008), the direct and indirect effects of relationship distress

are hard to overstate.

Recent meta-analyses have found couple therapy, including Behavioral Marital Therapy

with an effect size in the medium range (Cohen’s d=.59), to be superio r to no treatme nt

for relationship distress (Shadish & Baldwin, 2003, 2005). In a large randomized control

trial, Integrative Behavioral Couple Therapy (IBCT) and Traditional Behavioral Couple

Therapy (TBCT) showed benefits for initially distressed couples in relationship satisfaction

through 5-year follow-up and benefits for some couples in increasing individual functioning

*University of Miami, Coral Gables, FL.

Correspondence concerning this article should be addressed to McKenzie K. Roddy, Department of Psy-

chology, University of Miami, P.O. Box 248185 Coral Gables, FL 33124-0751. E-mail: mkr19@miami.edu.

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Family Process, Vol. 56, No. 4, 2017 ©2016 Family Process Institute

doi: 10.1111/famp.12262

(Christensen, Atkins, Baucom, & Yi, 2010; Christensen et al., 2004). Furthermore, individ-

ual functioning improved for couples during TBCT or IBCT (Christensen et al., 2004,

2010), but only to the extent that couples experienced improvements in relationship func-

tioning (Christensen et al., 2004). Additionally, couple therapy for military veterans has

been shown to result in significant decreases in individual psychological distress over the

course of therapy (Doss, Mitchell, Georgia, Biesen, & Rowe, 2015). Thus, by intervening at

the relationship level, couples can experience gains in individual domains as well.

Despite the encouraging research on couple therapy, many people who report relation-

ship distress do not seek treatment; only approximately 37% of divorced couples sought

therapy (Johnson et al., 2002). Furthermore, a 2015 nationally representative survey

showed that, of individuals who had contemplated divorce in the past 6 months, only

around 25% had sought couple therapy (The National Divorce Decision-Making Project,

2015). Thus, despite having efficacious treatments for relationship distress, many couples

are not accessing those services.

Self-Help Interventions

Considering the numerous barriers to treatment, self-help treatment has the potential

to reach larger and wider audiences than traditional couple therapy because couples do

not have to be in a specific location at a specific time with a mental health professional.

Furthermore, due to the decreased cost associated with self-help methods, couples may be

willing to seek assistance for problems when they are in their beginning or intermediate

stages. Although most self-help interventions will likely have reduced effect sizes com-

pared to in-person marriage counseling, their improved reach and cost effectiveness have

the potential to outweigh smaller effect sizes. One promising medium for self-help pro-

grams is the Internet.

Web-based interventions have high treatment fidelity and are cost effective (Titov,

2007). Meta analyses of online treatments for individual psychopathology show that these

treatments improve anxiety and depression, are well adhered to, and are acceptable to

participants (Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Christensen, Batterham,

& Calear, 2014). Several self-directed, web-based programs for enhancing relationship

functioning have also been developed. The ePREP program, based on principles of the

empirically supported in-person Prevention and Relationship Enhancement Program

(PREP; Markman, Stanley, & Blumberg, 2001), is a seven-hour program consisting of

1 hour of online content plus six hour-long homework assignments completed on a weekly

basis. When completed by one member of the dyad, ePREP reduced rates of reported inti-

mate partner violence (Braithwaite & Fincham, 2009) and decreased anxiety and psycho-

logical and physical aggression when compared to the waitlist control group (Braithwaite

& Fincham, 2007). When completed by both members of the dyad, ePREP resulted in

improved communication, reductions in self- and partner-reported assault, and a trend

toward decreases in psychological aggression (Braithwaite & Fincham, 2011). Another

self-help program for couples, Power of Two Online, yielded significant, but small,

improvements in relationship satisfaction (Hedges’ g=.24) and decreases in ineffective

arguing (Hedges’ g=.42) for those who completed the program (Kalinka, Fincham, &

Hirsch, 2012). However, over half of the participants discontinued by the second month,

and slightly more than half completed assessments at 2 months, making estimates of the

intent-to-treat efficacy difficult.

The Role of Therapist or Staff Contact

Investigations into the benefits of including limited therapist contact in self-guided pro-

grams are promising. Interventions for individuals with depression and anxiety disorders

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