Effectiveness of Couple Interventions in Marital Distress: A Systematic Review and Meta-Analysis
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Abstract
Background: Couple interventions focus on resolving relationship issues and improving partners' intimacy. Several intervention models are used on different occasions to deal with the issues. The present systematic review and meta-analysis investigated the effectiveness of such couple interventions dealing with marital distress.
Methods: Using the PRISMA guidelines for reporting systematic reviews and meta-analyses, a search was carried out to identify published articles in the areas of study. The meta-analysis investigated the effectiveness of couple interventions by comparing the post-intervention assessments of the experimental and control groups.
Results: The systematic review helped to identify twelve empirical studies published within the last ten years in the following databases: ScienceDirect, EBSCO, APA PsycINFO, NCBI, ProQuest, and Google Scholar. Meta-analysis showed a statistically significant overall effect size (Cohen's d = 0.85, 95% CI: 0.56 - 1.14). Cochran's Q showed that there was a substantial difference between the studies. There were signs of publication bias.
Conclusion: The current study revealed an overall large effect size, indicating that different couple interventions had a noticeable impact on distressed couples who received interventions as opposed to couples who did not receive any interventions.
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8. Ripley JS, Worthington Jr. EL (2014). Couple therapy: A new hope-focused approach. Illinois: InterVarsity Press.
9. Kanter JB, Schramm DG (2018). Brief interventions for couples: An integrative review. Family Relations, 67(2): 211–26.
10. Roddy MK, Walsh LM, Rothman K, et al (2020). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. J Consult Clin Psychol, 88(7): 583–96.
11. Samuel LS, Alene GD (2021). Effectiveness of marital couple interventions on marital conflict: A systematic review and meta-analysis of experimental studies. (Preprint), 1–20.
12. Johnson SM, Hunsley J, Greenberg L, et al (1999). Emotionally focused couples therapy: Status and challenges. Clin Psychol Sci Pract, 6(1): 67–79.
13. Koorankot J, Moosa A, Froerer A, et al (2022). Solution focused vs problem focused questions on affect and processing speed among individuals with depression. J Contemp Psychother, 52(4): 347–53.
14. Durães RSS, Khafif TC, Lotufo-Neto F, et al (2020). Effectiveness of cognitive behavioral couple therapy on reducing depression and anxiety symptoms and increasing dyadic adjustment and marital social skills: An exploratory study. Fam J, 28(4): 344–55.
15. Falconier MK (2015). TOGETHER-A couples’ program to improve communication, coping, and financial management skills: Development and initial pilot-testing. J Marital Fam Ther, 41(2): 236–50.
16. Molajafar H, Mousavi S, Lotfi R, et al (2015). Comparing the effectiveness of mindfulness and emotion regulation training in reduction of marital conflicts. J Med Life, 8(Spec Iss 2):111-116.
17. Rogge RD, Cobb RJ, Lawrence E, et al (2013). Is skills training necessary for the primary prevention of marital distress and dissolution? A 3-year experimental study of three interventions. J Consult Clin Psychol, 81(6): 949–61.
18. Markman HJ, Rhoades GK (2012). Relationship education research: Current status and future directions. J Marital Fam Ther, 38(1): 169–200.
19. Markman HJ, Hawkins AJ, Stanley SM, et al (2022). Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010–2019. J Marital Fam Ther, 48(1): 251–82.
20. Halford WK, Pepping CA, Petch J (2016). The gap between couple therapy research efficacy and practice effectiveness. J Marital Fam Ther, 42(1): 32–44.
21. Doss BD, Cicila LN, Georgia EJ, et al. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. J Consult Clin Psychol, 84(4): 285–96.
22. Nowlan KM, Roddy MK, Doss BD (2017). The online OurRelationship program for relationally distressed individuals : A pilot randomized controlled trial. Couple Family Psychol, 6(3): 189–204.
23. Fincham FD (2003). Marital conflict: Correlates, structure, and context. Curr Dir Psychol Sci, 12(1): 23–7.
24. Davis SD, Piercy FP (2007). What clients of couple therapy model developers and their former students say about change, part II: Model-independent common factors and an integrative framework. J Marital Fam Ther, 33(3): 344–63.
25. Rasoul H, Ali K, Esa J, Maryam M (2016). Effectiveness of self-regulation couple therapy intervention on marital satisfaction and partner abuse (Non-physical). Mediterr J Clin Psychol, 4(1): 1–12.
26. Ryan C, Epstein NB, Keitner GI, et al (2005). Evaluating and treating families: The McMaster approach. Now York: Routledge: Taylor & Francis Group.
27. Wood ND, Crane DR, Schaalje GB, et al (2005). What works for whom: A meta-analytic review of marital and couples therapy in reference to marital distress. Am J Fam Ther, 33(4): 273–87.
28. Liberati A, Altman DG, Tetzlaff J, et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol, 62(10): e1–34.
29. Snyder H (2019). Literature review as a research methodology: An overview and guidelines. J Bus Res, 104(3): 333–9.
30. Russo MW (2007). How to review a meta-analysis. Gastroenterol Hepatol (N Y), 3(8): 637–42.
31. Sutton AJ, Higgins JPT (2008). Recent developments in meta-analysis. Stat Med, 27(5): 625–50.
32. Shadish WR, Baldwin SA (2005). Effects of behavioral marital therapy: A meta-analysis of randomized controlled trials. J Consult Clin Psychol, 73(1): 6–14.
33. Amiri E, Jomehri F, Bagheri F (2017). The effectiveness of family therapy in hope therapy method on reducing marital conflict and couple marital disturbance. Iran J Educ Sociol, 1(6): 28–36.
34. Babakhani V, Navabinejad S, Shafiabady A, et al (2016). Effectiveness of training the McMaster model on mindfulness and marital conflicts of couples. Int J Behav Sci, 10(1): 18–23.
35. Fallahchai R, Fallahi M, Ritchie LL (2017). The impact of PREP Training on marital conflicts reduction : A randomized controlled trial with Iranian distressed couples. J Couple Relatsh Ther, 16(1):61–76.
36. Namagardi HD, Farzad V, Nooranipoor R (2022). Comparing the effectiveness of integrative behavioral couple therapy (IBCT) and affective reconstructive couple therapy (ARCT) on couples’ marital conventionalization and global distress. Journal of Fundamentals of Mental Health, 24(1): 39–46.
37. Rajani AA, Azizi DLS, Naeemi S, et al. (2016). The effect of cognitive behavioral couple therapy on reduction of marital conflicts and burnout of couples. The Turkish Online Journal of Design, Art and Communication, 6: 1649–55.
38. Sharif F, Soleimani S, Mani A, Keshavarzi S (2013). The effect of conflict resolution training on marital satisfaction in couples referring to counseling centers in Shiraz, southern Iran. , International Journal of Community Based Nursing & Midwifery, 1(1): 26–34.
39. McGuinness LA, Higgins JPT (2021). Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods, 12(1):55-61.
40. Snyder DK, Halford WK (2012). Evidence-based couple therapy: Current status and future directions. J Fam Ther, 34(3): 229–49.
41. Blow AJ, Karam EA (2017). The therapist’s role in effective marriage and family therapy practice: The case for evidence based therapists. Adm Policy Ment Health, 44(5): 716–23.
2. Falconier MK, Nussbeck F, Bodenmann G, et al (2015). Stress from daily hassles in couples: Its effects on intradyadic stress, relationship satisfaction, and physical and psychological well-being. J Marital Fam Ther, 41(2): 221–35.
3. Bodenmann G, Charvoz L, Cina A, et al (2001). Prevention of marital distress by enhancing the coping skills of couples: 1-year follow-up-study. Swiss J Psychol, 60(1): 3–10.
4. Blow AJ, Sprenkle DH, Davis SD (2007). Is who delivers the treatment more important than the treatment itself? The role of the therapist in common factors. J Marital Fam Ther, 33(3): 298–317.
5. Fia SD (2020). Efficacy of integrative behavioural couples therapy and cognitive behavioural therapy in reducing conflict and violence-related marital distress. Eur Sci J, 16(20): 66–77.
6. Hawkins AJ, Willoughby BJ, Doherty WJ (2012). Reasons for divorce and openness to marital reconciliation. J Divorce Remarriage, 53(6): 453–63.
7. Bradbury TN, Bodenmann G (2020). Interventions for Couples. Annu Rev Clin Psychol, 16: 99–123.
8. Ripley JS, Worthington Jr. EL (2014). Couple therapy: A new hope-focused approach. Illinois: InterVarsity Press.
9. Kanter JB, Schramm DG (2018). Brief interventions for couples: An integrative review. Family Relations, 67(2): 211–26.
10. Roddy MK, Walsh LM, Rothman K, et al (2020). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. J Consult Clin Psychol, 88(7): 583–96.
11. Samuel LS, Alene GD (2021). Effectiveness of marital couple interventions on marital conflict: A systematic review and meta-analysis of experimental studies. (Preprint), 1–20.
12. Johnson SM, Hunsley J, Greenberg L, et al (1999). Emotionally focused couples therapy: Status and challenges. Clin Psychol Sci Pract, 6(1): 67–79.
13. Koorankot J, Moosa A, Froerer A, et al (2022). Solution focused vs problem focused questions on affect and processing speed among individuals with depression. J Contemp Psychother, 52(4): 347–53.
14. Durães RSS, Khafif TC, Lotufo-Neto F, et al (2020). Effectiveness of cognitive behavioral couple therapy on reducing depression and anxiety symptoms and increasing dyadic adjustment and marital social skills: An exploratory study. Fam J, 28(4): 344–55.
15. Falconier MK (2015). TOGETHER-A couples’ program to improve communication, coping, and financial management skills: Development and initial pilot-testing. J Marital Fam Ther, 41(2): 236–50.
16. Molajafar H, Mousavi S, Lotfi R, et al (2015). Comparing the effectiveness of mindfulness and emotion regulation training in reduction of marital conflicts. J Med Life, 8(Spec Iss 2):111-116.
17. Rogge RD, Cobb RJ, Lawrence E, et al (2013). Is skills training necessary for the primary prevention of marital distress and dissolution? A 3-year experimental study of three interventions. J Consult Clin Psychol, 81(6): 949–61.
18. Markman HJ, Rhoades GK (2012). Relationship education research: Current status and future directions. J Marital Fam Ther, 38(1): 169–200.
19. Markman HJ, Hawkins AJ, Stanley SM, et al (2022). Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010–2019. J Marital Fam Ther, 48(1): 251–82.
20. Halford WK, Pepping CA, Petch J (2016). The gap between couple therapy research efficacy and practice effectiveness. J Marital Fam Ther, 42(1): 32–44.
21. Doss BD, Cicila LN, Georgia EJ, et al. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. J Consult Clin Psychol, 84(4): 285–96.
22. Nowlan KM, Roddy MK, Doss BD (2017). The online OurRelationship program for relationally distressed individuals : A pilot randomized controlled trial. Couple Family Psychol, 6(3): 189–204.
23. Fincham FD (2003). Marital conflict: Correlates, structure, and context. Curr Dir Psychol Sci, 12(1): 23–7.
24. Davis SD, Piercy FP (2007). What clients of couple therapy model developers and their former students say about change, part II: Model-independent common factors and an integrative framework. J Marital Fam Ther, 33(3): 344–63.
25. Rasoul H, Ali K, Esa J, Maryam M (2016). Effectiveness of self-regulation couple therapy intervention on marital satisfaction and partner abuse (Non-physical). Mediterr J Clin Psychol, 4(1): 1–12.
26. Ryan C, Epstein NB, Keitner GI, et al (2005). Evaluating and treating families: The McMaster approach. Now York: Routledge: Taylor & Francis Group.
27. Wood ND, Crane DR, Schaalje GB, et al (2005). What works for whom: A meta-analytic review of marital and couples therapy in reference to marital distress. Am J Fam Ther, 33(4): 273–87.
28. Liberati A, Altman DG, Tetzlaff J, et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol, 62(10): e1–34.
29. Snyder H (2019). Literature review as a research methodology: An overview and guidelines. J Bus Res, 104(3): 333–9.
30. Russo MW (2007). How to review a meta-analysis. Gastroenterol Hepatol (N Y), 3(8): 637–42.
31. Sutton AJ, Higgins JPT (2008). Recent developments in meta-analysis. Stat Med, 27(5): 625–50.
32. Shadish WR, Baldwin SA (2005). Effects of behavioral marital therapy: A meta-analysis of randomized controlled trials. J Consult Clin Psychol, 73(1): 6–14.
33. Amiri E, Jomehri F, Bagheri F (2017). The effectiveness of family therapy in hope therapy method on reducing marital conflict and couple marital disturbance. Iran J Educ Sociol, 1(6): 28–36.
34. Babakhani V, Navabinejad S, Shafiabady A, et al (2016). Effectiveness of training the McMaster model on mindfulness and marital conflicts of couples. Int J Behav Sci, 10(1): 18–23.
35. Fallahchai R, Fallahi M, Ritchie LL (2017). The impact of PREP Training on marital conflicts reduction : A randomized controlled trial with Iranian distressed couples. J Couple Relatsh Ther, 16(1):61–76.
36. Namagardi HD, Farzad V, Nooranipoor R (2022). Comparing the effectiveness of integrative behavioral couple therapy (IBCT) and affective reconstructive couple therapy (ARCT) on couples’ marital conventionalization and global distress. Journal of Fundamentals of Mental Health, 24(1): 39–46.
37. Rajani AA, Azizi DLS, Naeemi S, et al. (2016). The effect of cognitive behavioral couple therapy on reduction of marital conflicts and burnout of couples. The Turkish Online Journal of Design, Art and Communication, 6: 1649–55.
38. Sharif F, Soleimani S, Mani A, Keshavarzi S (2013). The effect of conflict resolution training on marital satisfaction in couples referring to counseling centers in Shiraz, southern Iran. , International Journal of Community Based Nursing & Midwifery, 1(1): 26–34.
39. McGuinness LA, Higgins JPT (2021). Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods, 12(1):55-61.
40. Snyder DK, Halford WK (2012). Evidence-based couple therapy: Current status and future directions. J Fam Ther, 34(3): 229–49.
41. Blow AJ, Karam EA (2017). The therapist’s role in effective marriage and family therapy practice: The case for evidence based therapists. Adm Policy Ment Health, 44(5): 716–23.
| Files | ||
| Issue | Vol 54 No 1 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Marital conflict resolution Couple therapy Hope therapy Marital therapy Conflict intervention effect | ||
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How to Cite
1.
Joseph B, Joseph V, Rajan S. Effectiveness of Couple Interventions in Marital Distress: A Systematic Review and Meta-Analysis. Iran J Public Health. 2025;54(1):112-123.
