The theory and practice of group psychotherapy

The Effect of Cognitive-Behavioral Group Marital Therapy on Marital Happiness

and Problem Solving Self-Appraisal

CLAUDE BÉLANGER University of Quebec in Montreal (UQAM), Montreal, Canada,

McGill University, Montreal, Canada, and The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse

(CRIPCAS), Montreal, Canada

LISE LAPORTE McGill University Health Center, Montreal, Canada

STÉPHANE SABOURIN The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse

(CRIPCAS), Montreal, Canada, and Laval University, Quebec City, Canada

JOHN WRIGHT The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse

(CRIPCAS), Montreal, Canada

Problem solving self-appraisal affects problem solving performance and marital adjustment. This study investigated the effects of cognitive-behavioral group marital therapy on couples’ adjustment and their self-appraisal of problem solving activities. Sixty-six cou- ples participated in group couples therapy. Subjects were randomly assigned to an experimental or a waiting list control group. They completed the Problem Solving Inventory and the Marital Happiness Scale. Therapy was effective in improving global couple adjustment and problem solving self-appraisal. The program had a differential effect on the improvement of self-perceived problem solving abili- ties depending on the spouses’ initial self-appraised problem solving ability level.

Address correspondence to Claude Bélanger, Département de Psychologie, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, QC H3C 3P8, Canada. E-mail: belanger.claude@uqam.ca The theory and practice of group psychotherapy

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Marital therapy based on social learning principles aims to enhance com- munication and/or to teach problem solving skills, with the expectation that such behavioral changes will lead to an increase in marital satisfaction (Woodin, 2001). However, increased attention has been devoted to the role of individual cognitive variables in mediating the relationship between communication/problem solving behaviors and marital distress (Bélanger, Sabourin & El-Baalbaki, 2012). The importance of cognitive processes in the development and maintenance of marital dysfunction has been confirmed in several investigations of the implications of spouses’ cognitions in outcome research (Dunn & Schwebel, 1995).

Researchers have evaluated problem solving self-appraisal as a deter- minant of individuals’ adaptational outcomes (Godshall and Elliott, 1997; Heppner, Kampa, & Brunning, 1987). Problem solving self-appraisal refers to a relatively stable attitude toward one’s personal problem solving reper- toire as well as toward the self-regulatory processes at work while a problem is being solved (Heppner & Krauskopf, 1987).

Social problem solving abilities are used in social contexts, and they af- fect interpersonal adjustment (Elliott & Grant, 2008). For instance, family care- givers demonstrating effective problem solving styles reported greater rela- tionship satisfaction (Shanmugham, Cano, Elliott & Davis, 2009). Self-efficacy in response to personal problems is related to the way the person appraises his or her problem solving skills. Accordingly, to develop good coping ca- pacities, it is important for a person to be able to appraise his or her problem solving skills and style (Heppner & Dong-Gwi, 2009). Moreover, Bandura’s work strongly supports the notion that people’s perception of self-efficacy af- fects their motivation to face challenges, their decision-making behaviors and their emotional reactions in difficult situations (Bandura, 1986; Carré, 2004). Perceived self-efficacy has also been related to many personal difficulties such as depression (Dreer, Elliott, Fletcher, & Swanson, 2005; Rivera et al., 2007; Nezu, Kalmar, Ronan & Clavijo,1986), psychosocial impairment (Shan- mugham, Elliott & Palmatier, 2004) and alcoholism (Elliott, Grant & Miller, 2004); it has also been associated with psychological adjustment (Heppner & Anderson, 1985), physical health (Heppner, Kampa, & Brunning, 1987) and personality (D’Zurilla, Maydeu-Olivares & Gallardo-Pujol, 2011)The theory and practice of group psychotherapy.

The well-established links between problem solving self-appraisal and relationship satisfaction have led researchers to investigate problem solving capacities and self-appraisal in relation to coping skills and the marital relationship. These studies were based on the basic premise that, for most people, the quality of their marital relationship is an important predictor of their general well-being (Hertzog, 2011). When facing stressful life events, partners use joint efforts in problem solving interactions and other coping strategies to reestablish satisfaction and maintain marital adjustment. A failure in these cognitive and behavioral adaptation mechanisms often leads to marital distress.

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Dyadic coping strategies encompass both the cognitive and behavioral components that influence marital satisfaction. Therefore, it is necessary to understand the relationships between the cognitive strategies and so- cial behaviors that partners adopt during their problem solving interactions. If there is such a link, then what is the exact nature of this interrelation, and in what ways do these cognitive (problem solving self-appraisal) and behavioral (problem solving efficacy) strategies influence marital satisfac- tion? The preoccupation with understanding the cognitive and behavioral problem solving determinants of marital adjustment can be found in a lim- ited number of studies that have addressed these particular issues (Baucom & Kerig, 2004). In line with these questions, an investigation in our lab- oratory showed that problem solving self-appraisal differentiates distressed from non-distressed partners (Sabourin, Laporte, & Wright, 1990). Distressed spouses expressed less problem solving confidence, a stronger tendency to avoid different problem solving activities, and less control over their behav- ior than their non-distressed partners (Sabourin et al., 1990). Another study that was run by the same team (Lussier et al., 1997) examined the rela- tionship between spouses’ attachment styles, coping strategies, and marital satisfaction. These researchers pinpointed many links between attachment strategies, coping skills and marital adjustment. These results are consistent with Bodenmann et al. (2006), who reported several studies showing that positive dyadic coping significantly correlates with a better quality of mari- tal relationship, lower levels of stress and better physical and psychological well-being, and in some studies, these correlations are stronger for women than for men. Kurdek (1991) tried to conceptualize these variables into a model in which he assessed the role of cognitively and behaviorally ori- ented problem solving determinants on the relationship satisfaction of gay and lesbian partners. His results support a problem solving model in which relationship satisfaction is related to strategies used by partners to resolve their conflicts.

In a recent study, Bélanger and his colleagues (2012) investigated the mutual contributions of a self-reported cognitive strategy, coping, observed problem solving behaviors, and marital adjustment. In line with Kurdek (1991), they hypothesized that the specific coping strategies would be re- lated to the quality of the problem solving behaviors and that both these variables would be related to marital satisfaction. Their results propose that, for both men and women, there are significant relationships between cog- nitive and coping strategies, problem solving behaviors displayed during marital interactions, and marital adjustment.

Thus, because empirical studies have demonstrated that problem solving self-appraisal is directly related to problem solving performance (Heppner & Dong-Gwi, 2009), spouses should not only possess the problem solving skills necessary to confront and alleviate their marital difficulties but also believe in their capacity to do so. To be of maximum value, marital therapy

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should therefore not only aim to enhance specific problem solving skills but also should work to alter spouses’ appraisal of their problem solving abilities. To the best of our knowledge, very few outcome studies have investigated such an effect of couples’ cognitive-behavioral therapy on the partners’ self- appraisal of their problem solving abilities and marital satisfaction.

Accordingly, the main purpose of this paper is 1) to evaluate the overall effectiveness of cognitive-behavioral group marital therapy in bringing about positive changes in marital satisfaction and 2) to study the effects of such a program on partners’ self-appraisal of problem solving abilities.

The specific hypotheses were that group marital therapy subjects would report changes in a) their marital satisfaction; b) the overall appraisal of their problem solving abilities; c) their problem solving confidence; d) their approach to problem solving activities; and e) their strategies to control their behavior when they try to solve a problem.

The second purpose of this study is to examine the differential effects of cognitive behavioral group marital therapy on appraisal from spouses as being effective or ineffective problem solvers (Nezu, 1985).

It was hypothesized that, following the program, partners who initially appraised their problem solving as ineffective and who believed that they had problem solving deficits would report more changes in their marital adjustment level (Marital Happiness Scale) and in their problem solving skills (Problem Solving Inventory) than subjects who initially appraised themselves as effective problem solvers The theory and practice of group psychotherapy.

METHOD

Subjects

Sixty-six French-Canadian couples participated in the study. The subjects had been living together an average of 12.8 years (SD = 8.7 years, range 1 to 31 years), and their age ranged from 20 to 76 years (M = 38.2 years, SD = 1.7 years). The mean number of children for the sample was 1.2 (88% of the couples had children). The average education level was 14.5 years (SD = 2.9 years) for women and 15.7 years (SD = 3.7 years) for men.

Procedure

Subjects were recruited through publicity in various media. Couples who expressed interest were briefly informed of the nature of the program and invited to an assessment interview. To be selected, couples had to be living together, free of any important individual psychopathology, free of drug or alcohol problems, free of primary sexual dysfunctions, not in intense marital crisis (no pending divorce or physical abuse) and not currently following another therapy. During the assessment interview, all couples completed a battery of questionnaires that included a demographic questionnaire, the

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Problem Solving Inventory (Heppner & Petersen, 1982), and the Marital Happiness Scale (Azrin, Naster, & Jones, 1973). Partners completed the ques- tionnaires independently. A research assistant remained in the same room as the couple during the task and was available to help participants. Subjects were ensured of the confidentiality of their responses.

Couples were randomly assigned to the experimental group (n = 30 cou- ples) or to the control group waiting list (n = 36 couples). After completing the program, all couples were administered the same self-report measures. Couples on the waiting list then received the same assessment and treatment procedures.

Treatment

The Couples Survival Program is a group marital therapy program based on a cognitive-behavioral approach to solving marital difficulties designed by researchers in our laboratory (Wright, 1986). Couples are taught skills focused on effective communication, problem solving, exchange of positive experiences and anger expression. The cognitive and behavioral compo- nents of problem solving skills were taught for two sessions (6 hours) in which couples learned different problem solving stages through reading, in- structions, modeling rehearsal, dyadic practices, feedback, cognitive restruc- turing, group discussions, and homework assignments (Dattilio & Epstein, 2005)

Each group comprised four couples. They met once a week, for nine consecutive weeks, in three hour sessions. Each group was led by a licensed psychologist with a minimum of two-years experience in marital therapy and group intervention. The co-therapist had at least a master’s degree in clinical or counseling psychology. All group leaders received 30 hours of training and weekly supervision between sessions.

Measures

The Problem Solving Inventory (PSI; Heppner & Petersen, 1982) is a 32- item measure that evaluates perceptions of personal problem solving behav- iors and attitudes. It yields an overall score as well as three factor scores: problem solving confidence (11 items), approach-avoidance style (16 items), and personal control (5 items). High scores indicate that the subject per- ceives himself/herself as having ineffective problem solving abilities and thus has little problem solving confidence, tendencies to avoid different problem solving activities, and a lack of personal control. Reliability estimates (alpha ranges from .72 to .85) are adequate, and acceptable validity coefficients have been reported in several investigations (Heppner & Anderson, 1985; Nezu & The theory and practice of group psychotherapy

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Ronan, 1988; Tracey, Sherry, & Keitel, 1986). Moreover, PSI scores have been found to correlate significantly with observational ratings of problem solving competence (Heppner et al, 1982). The French version of the PSI (Laporte, Sabourin, & Wright, 1989) has demonstrated equally sound psychometric properties (alpha ranges from .65 to .86).

The Marital Happiness Scale (Azrin, Naster, & Jones, 1973) is a self-report questionnaire that allows the subject to rate his satisfaction on nine aspects of his marital life (household responsibilities, money management, etc.) and to give an overall assessment of his happiness within the relationship. The scores range from 1 to 10, with a higher score indicating a higher level of marital happiness. The instrument possesses good reliability and discriminant validity. The Marital Happiness Scale has been found to be highly correlated (.85) with the Locke-Wallace Marital Adjustment Test (Locke & Wallace, 1973), and inter-item correlations (p < .05 for all correlations) suggest the presence of an underlying single dimension (Libman, Takefman, & Brender, 1980). The French version of the questionnaire has been demonstrated to have equally sound psychometric qualities (alpha ranges from .71 to .80) (Bourgeois, Sabourin, & Wright, 1990).

Pre-Treatment Equivalence

Independent t-tests were conducted to determine if there were any sig- nificant differences between the experimental and control groups in terms of sociodemographic variables. The results indicated that the experimental group participants were significantly younger (t (137) = –2.38, p < .02), had more children (t (130) = 6.02, p < .0001) and had been living together for a shorter period (t (125) = –5.09, p < .0001) than their control group counterparts. There were no significant differences between the two groups in terms of income or educational level.

Data showed that a randomization of couples to groups at the onset of the treatment did not produce optimal matching of sociodemographic variables such as age, children and length of relationship. However, Pear- son product-moment correlation coefficients established that the correlations between those variables and the scores on the dependent variables under investigation were very low. There were no significant correlations between socioeconomic variables and problem solving self-appraisal scores (range from .01 to .20), and there was a small relationship between the Marital Happiness Scale’s scores and the ages of the men (p < .02). A two-way analysis of variance was performed on the pretest scores of the experimen- tal and the control groups to determine if there were any initial differences between the groups in the self-appraisal of problem solving abilities and marital adjustment prior to the program. The results indicated that there were no significant differences between the two groups in problem solving The theory and practice of group psychotherapy