Abstract
Despite the high prevalence of distress in romantic relationships and the significant negative impact of relationship distress on individuals’ mental and physical health, a large majority of distressed couples do not seek treatment due to treatment inaccessibility and stigma. Further, there is a high treatment dropout rate for couples who do seek therapy. Hence, there is a need to develop interventions that are accessible and appealing to those experiencing, or at risk for, relationship distress. Cost-effective, internet-based interventions, such as Cognitive Bias Modification (CBM) programs, that target specific cognitive mechanisms to promote flexible thinking, are ideal ways to overcome the barriers to treatment seeking in couples. However, although CBM paradigms have been shown to be effective in diverse domains (e.g., anxiety and depression), these programs have not been applied to distressed couples. In the current project, we developed and pilot-tested a new adaptation of CBM to target psychological flexibility tied to relational problems (i.e., relational flexibility). Specifically, we will: (1) develop a new Aggregated Relational Flexibility measure (ARF); (2) design training materials for a novel CBM program (CBM-FlexC) that targets relational flexibility; and (3) conduct a pilot feasibility and efficacy study of the CBM-FlexC program.
The ARF was developed and validated using four independent samples. In Study 1A, individuals (N = 208) currently in committed relationships (e.g., married or cohabitating for more than 3 months) were recruited online and answered a set of online questionnaires relating to relational flexibility and various aspects of couples’ and individual’s functioning, to examine the psychometric properties of items shortlisted for the ARF. The new measure was then validated in Study 1B, using a separate online sample (N = 430) of individuals currently in committed relationships, and a subset of this sample (N = 196) was used to establish test-retest reliability. The main results in Studies 1A and IB were replicated in Studies 1C (using an online sample of 260 couples) and 1D (using a laboratory-based sample of 85 couples). The relationship between an individual's relational flexibility and their partner’s relationship satisfaction was also examined in Studies 1C and 1D.
The new CBM-FlexC training materials were developed in Study 2, and expert users (N = 4) and end-point users (N = 7) were recruited to provide feedback (e.g., on clarity and relevance of training materials) via qualitative interviews. Finally, the feasibility and efficacy of the CBM-FlexC program were evaluated in Study 3, using an online sample of currently distressed couples (N = 18). Using a multiple baseline design, participants underwent at least 3 baseline assessment sessions, followed by 6 online sessions of CBM-FlexC training over two weeks, followed by a one-month follow-up. Relational flexibility was assessed after the second, fourth, and sixth training sessions. Additionally, participants completed online questionnaires pre- and post-intervention, and also at the 1-month follow-up. It was hypothesized that couples' relational flexibility would improve from baseline to post-training and at the 1-month follow-up, and that the increase in an individual's relational flexibility would predict an increase in both their own and their partner's relationship satisfaction. Overall, as expected, CBM-FlexC training resulted in higher relational flexibility and relationship satisfaction compared to at baseline, and increases in an individual's relational flexibility significantly predicted increases in their relationship satisfaction. Additionally, these improvements were maintained one-month after training. However, contrary to expectations, increases in an individual's relational flexibility were not significantly associated with changes in their partner's relationship satisfaction.
The current project paves the way for a larger-scale internet-based intervention study that targets distressed couples with limited access to more traditional tools and resources (e.g., couples therapy) due to lack of resources or stigma. This is the first study, to our knowledge, to apply the CBM paradigm to training flexible thinking in couples. Once validated in larger trials, this new intervention has the potential for wide dissemination as an evidence-based tool for distressed couples to help resolve their relationship problems.
