Marital Conflict, Relationship, Marital
Conditions
Brief summary
Although several empirically-supported interventions to prevent and treat relationship distress have been developed, the majority of couples - especially high-risk couples - do not seek these face-to-face interventions. However, our pilot data indicate that large numbers of couples will seek self-administered assistance for their relationship. Additionally, unlike many in-person interventions, couples seeking self-help resources tend to have higher levels of relationship distress. Thus, to improve the reach of couple interventions, this project will translate a leading empirically-supported intervention targeting early signs of relationship distress into a Web-based format. This intervention will consist of individualized feedback and professionally-filmed video clips tailored to a couple's specific needs. By intervening effectively with a large number of couples, the resulting Web-based intervention has the potential to have a population-level impact on relationship distress, divorce, and resulting child difficulties. In the proposed project, building off our previous pilot studies, effective translation of this in-person intervention into a Web-based format will be ensured by conducting two additional intensive pilot studies. Once final changes have been made to the website and Web-based intervention, 300 couples will be randomly assigned to a wait-list control group or an online intervention. All couples will be assessed for the initial two months; intervention couples will be assessed for one year. This project will: 1) demonstrate that couples randomly assigned to the online intervention will report higher levels of individual, child, and relationship functioning than those in the wait-list control group; 2) document the mechanisms of both active conditions; and 3) show that initial gains in those assigned to the intervention are largely maintained through one-year follow-up.
Interventions
BEHAVIORALOurRelationship
Online intervention with coach support
Sponsors
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
University of California, Los Angeles
University of Washington
University of Miami
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 64 Years
Healthy volunteers
Yes
Inclusion criteria
* Currently in a heterosexual relationship * Currently married, engaged, or cohabiting for at least 6 months * At least one partner scoring in distressed range of relationship satisfaction (or both partners \> 0.5 SD of population mean of distress). * Living in the United States * Both partners ages 21-64 (inclusive)
Exclusion criteria
* Severe Intimate Partner Violence in last 3 months * Moderate to severe suicidal ideation in last 3 months * Concrete plans to divorce * Ongoing affair * Ongoing couple therapy (or refusal to seek couple therapy for 3 months)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Relationship Satisfaction | Pre (0 weeks), Mid (3 weeks), and Post (approximately 6 weeks) | Relationship satisfaction as measured by the total scale on the four-item version of the Couple Satisfaction Index (Funk & Rogge, 2007; doi: 10.1037/0893-3200.21.4.572). Scores on this measure range from 0-21, with higher scores indicating greater satisfaction. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Relationship Confidence | Pre (0 weeks), Mid (3 weeks), and Post (approximately 6 weeks) | Relationship confidence as measured by 2 items from the Confidence Scale (I believe we can handle whatever conflicts will arise in the future and I feel good about our prospects to make this relationship work). Scored ranged from 0 to 12, with higher scores indicate more confidence.Cronbach's alpha = .88. These two items have been used in previous studies of couples to assess change (e.g., http://dx.doi .org/10.1177/0192513X08324388). |
| Depressive Symptoms | Pre (0 weeks) and Post (approximately 6 weeks) | Depressive symptoms as measured by the 10-item Center for Epidemiologic Studies-Depression (CES-D) Scale (Cole, Rabin, Smith, & Kaufman, 2004). The total score was used, with possible scores ranging from 0-30. Higher scores on this measure indicate greater depressive symptoms. |
| Anxiety Symptoms | Pre (0 weeks) and Post (approximately 6 weeks) | Anxiety symptoms as measured by the Generalized Anxiety Disorder 7-item scale (GAD-7; Spitzer, Kroenke, Williams, & Löwe, 2006). The range of the measure is 0 to 49, with higher scores indicating greater anxiety symptoms. Cronbach's alpha in the present sample was .91. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| OurRelationship Online Intervention
OurRelationship: Online intervention with coach support | 302 |
| Waitlist Control 2 month waiting period before couples can receive intervention | 298 |
| Total | 600 |
Baseline characteristics
| Characteristic | OurRelationship | Total | Waitlist Control |
|---|---|---|---|
| Age, Continuous | 36.01 years STANDARD_DEVIATION 9.54 | 36.11 years STANDARD_DEVIATION 9.58 | 36.22 years STANDARD_DEVIATION 9.62 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 30 Participants | 59 Participants | 29 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 272 Participants | 541 Participants | 269 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 7 Participants | 4 Participants |
| Race (NIH/OMB) Asian | 13 Participants | 25 Participants | 12 Participants |
| Race (NIH/OMB) Black or African American | 62 Participants | 119 Participants | 57 Participants |
| Race (NIH/OMB) More than one race | 13 Participants | 22 Participants | 9 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 2 Participants | 6 Participants | 4 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 209 Participants | 421 Participants | 212 Participants |
| Region of Enrollment United States | 302 Participants | 600 Participants | 298 Participants |
| Sex: Female, Male Female | 151 Participants | 300 Participants | 149 Participants |
| Sex: Female, Male Male | 151 Participants | 300 Participants | 149 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 302 | 0 / 298 |
| serious Total, serious adverse events | 0 / 302 | 0 / 298 |
Outcome results
Primary
Relationship Satisfaction
Relationship satisfaction as measured by the total scale on the four-item version of the Couple Satisfaction Index (Funk & Rogge, 2007; doi: 10.1037/0893-3200.21.4.572). Scores on this measure range from 0-21, with higher scores indicating greater satisfaction.
Time frame: Pre (0 weeks), Mid (3 weeks), and Post (approximately 6 weeks)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OurRelationship | Relationship Satisfaction | Pre-intervention | 8.335 units on a scale | Standard Deviation 3.915 |
| OurRelationship | Relationship Satisfaction | Mid-intervention | 10.63 units on a scale | Standard Deviation 4.335 |
| OurRelationship | Relationship Satisfaction | Post-intervention | 12.08 units on a scale | Standard Deviation 4.42 |
| Waitlist Control | Relationship Satisfaction | Pre-intervention | 8.37 units on a scale | Standard Deviation 4.025 |
| Waitlist Control | Relationship Satisfaction | Mid-intervention | 9.555 units on a scale | Standard Deviation 4.53 |
| Waitlist Control | Relationship Satisfaction | Post-intervention | 9.51 units on a scale | Standard Deviation 4.82 |
p-value: <0.00195% CI: [0.279, 0.465]Regression, Linear
Secondary
Anxiety Symptoms
Anxiety symptoms as measured by the Generalized Anxiety Disorder 7-item scale (GAD-7; Spitzer, Kroenke, Williams, & Löwe, 2006). The range of the measure is 0 to 49, with higher scores indicating greater anxiety symptoms. Cronbach's alpha in the present sample was .91.
Time frame: Pre (0 weeks) and Post (approximately 6 weeks)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OurRelationship | Anxiety Symptoms | Pre-intervention | 7.995 units on a scale | Standard Deviation 5.385 |
| OurRelationship | Anxiety Symptoms | Post-intervention | 4.875 units on a scale | Standard Deviation 4.5 |
| Waitlist Control | Anxiety Symptoms | Pre-intervention | 8.24 units on a scale | Standard Deviation 5.645 |
| Waitlist Control | Anxiety Symptoms | Post-intervention | 6.11 units on a scale | Standard Deviation 5.135 |
p-value: 0.00295% CI: [-1.871, -0.417]Regression, Linear
Secondary
Depressive Symptoms
Depressive symptoms as measured by the 10-item Center for Epidemiologic Studies-Depression (CES-D) Scale (Cole, Rabin, Smith, & Kaufman, 2004). The total score was used, with possible scores ranging from 0-30. Higher scores on this measure indicate greater depressive symptoms.
Time frame: Pre (0 weeks) and Post (approximately 6 weeks)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OurRelationship | Depressive Symptoms | Pre-intervention | 10.82 units on a scale | Standard Deviation 4.24 |
| OurRelationship | Depressive Symptoms | Post-intervention | 9.105 units on a scale | Standard Deviation 3.22 |
| Waitlist Control | Depressive Symptoms | Pre-intervention | 10.42 units on a scale | Standard Deviation 4.34 |
| Waitlist Control | Depressive Symptoms | Post-intervention | 9.895 units on a scale | Standard Deviation 4.185 |
p-value: <0.00195% CI: [-2.974, -1.324]Regression, Linear
Secondary
Relationship Confidence
Relationship confidence as measured by 2 items from the Confidence Scale (I believe we can handle whatever conflicts will arise in the future and I feel good about our prospects to make this relationship work). Scored ranged from 0 to 12, with higher scores indicate more confidence.Cronbach's alpha = .88. These two items have been used in previous studies of couples to assess change (e.g., http://dx.doi .org/10.1177/0192513X08324388).
Time frame: Pre (0 weeks), Mid (3 weeks), and Post (approximately 6 weeks)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| OurRelationship | Relationship Confidence | Pre-intervention | 7.94 units on a scale | Standard Deviation 2.565 |
| OurRelationship | Relationship Confidence | Mid-intervention | 8.92 units on a scale | Standard Deviation 2.495 |
| OurRelationship | Relationship Confidence | Post-intervention | 9.635 units on a scale | Standard Deviation 2.325 |
| Waitlist Control | Relationship Confidence | Pre-intervention | 7.58 units on a scale | Standard Deviation 3.185 |
| Waitlist Control | Relationship Confidence | Mid-intervention | 8.045 units on a scale | Standard Deviation 3.215 |
| Waitlist Control | Relationship Confidence | Post-intervention | 8.05 units on a scale | Standard Deviation 3.335 |
p-value: <0.00195% CI: [0.105, 0.235]Regression, Linear