Online Program For Couples Results In Long-Term Gains In Relationship Functioning And Individual Health

Nearly half of first-time marriages end in divorce (Copen, Daniels, Vespa, & Mosher, 2012) and more than one-third of marriages are relationally distressed at any given time (Whisman, Beach, & Snyder, 2008). Individuals in distressed relationships generally have worse physical (e.g. Whisman & Uebelacker, 2012) and mental health (e.g. Whisman, 2007) than individuals in happy relationships. And despite the large number of couples that are in relationally distressed marriages, only a minority of distressed couples seek treatment (Johnson et al., 2002) with common barriers including finances, the stigma of therapy, or living in rural areas.

More and more frequently, those in distressed relationships are turning to the internet for relationship advice. The online program with the most empirical support is OurRelationship (www.OurRelationship.com). The OurRelationship program is an online adaptation of Integrative Behavioral Couple Therapy (IBCT; Christensen et al., 2004) – an in-person couple therapy with a strong evidence base. Over the course of about 6-8 hours, couples in the OurRelationship program work through a three-step process (Doss, Benson, Georgia, & Christensen, 2013).

In the Observe phase, couples receive feedback comparing their relationships to national norms and identify a relationship problem they would like to work on throughout the remainder of the program. In the Understand phase, couples develop a D.E.E.P. (Differences, Emotions, External Stress, and Patterns) understanding of their relationship problem. In the Respond phase, couples come up with specific changes they can make to improve their relationship based on their DEEP understanding. At the end of the program, couples get feedback on how they have improved since the start of the program and guidance on any further steps they can take to strengthen their relationship. Throughout the program, couples see videos of couples who are experiencing common relationship problems and how they are able to work through those problems.

At the start of the program and after completing each of the three phases, couples have videoconference calls with a telehealth coach. During these calls, coaches assist couples in applying what they have learned in the program into their own relationship, provide technical assistance, and encourage program completion.

Previous Research on OurRelationship

The initial randomized controlled trial of the OurRelationship program compared 300 opposite-sex couple randomized to the intervention or 6-week waitlist control group. Couples were recruited nationally through paid online advertising (e.g. Google Ads) as well as word of mouth and media coverage. From pre to post-treatment, couples in the OurRelationship program, compared to couples in the control group, reported small to medium effects on relationship domains such as relationship satisfaction (Cohen’s d = 0.69), relationship confidence (Cohen’s d = 0.47), relationship positives (Cohen’s d = 0.15), and relationship negatives (Cohen’s d = -0.57; Doss et al., 2016).

In addition to gains in their relationships, couples in the intervention also reported improved individual functioning including decreased depressive (Cohen’s d = -0.50) and anxious (Cohen’s d = -0.21) symptoms as well as increased work functioning (Cohen’s d = 0.19), quality of life (Cohen’s d = 0.18) and perceived health (Cohen’s d = 0.23), with larger effects on individual functioning for participants who initiated the program with distress in those domains. Couples in the OurRelationship group significantly improved on relationship satisfaction, relationship confidence, and relationship negatives (within-group Cohen’s |d| = 0.64 – 0.93); however, they did not report significant improvements in relationship positives (within-group Cohen’s d = -0.01).

A second randomized controlled trial of the OurRelationship program compared the program described above (full program) to identical online content but reduced the number of coach calls from four to one 20-minute call. Intent to treat analyses demonstrated that couples in both the full and reduced condition significantly improved relationship satisfaction and decreased depressive symptoms over the course of the program, and couples in the full condition reported significantly greater reductions in anxiety than the reduced condition (Roddy, Rothman, & Doss, 2018). However, couples in the reduced condition were significantly less likely to complete the program than couples in the full condition.

Maintenance of Effects

To see if couples’ initial gains during the OurRelationship program lasted over time, we contacted the 152 couples that were randomized to the OurRelationship program from the initial research trial three and 12 months after they finished the two-month long program (Doss et al., 2019). Surveys were completed by 75% of participants at three months and by 79% of participants at 12 months. Missing data was significantly higher for couples who did not complete the program; therefore, program non-completion was controlled for in all analyses. Additionally, missing data was imputed using multiple imputations, and all analyses were run using full information maximum likelihood estimation (FIML).

At 12-months following the program, 84% of couples were intact, 6% had broken up, and for the remaining 10% of couples, no relationship status could be determined. Relationship satisfaction, relationship confidence, and relationship negatives, all of which demonstrated a treatment effect (Doss et al., 2016), saw no significant increases or decreases over the 12-month follow-up. Couples maintain gains from the program up to a year later. Positive relationship quality significantly improved over the follow-up period (within-group d = 0.17).

In addition to the maintenance and continued improvement in the relationship domain, couples also reported maintenance of individual gains over the year follow-up. Specifically, participants reported no significant change in depressive symptoms, work functioning, quality of life, and perceived health. Furthermore, anxiety symptoms continued to decrease over the year follow up (within-group d = -0.12). Therefore, across domains of both relationship and individual functioning, couples who participated in the OurRelationship program maintained, and in some instances continued to improve, during the yearlong follow-up.

In addition to the main effects of maintenance, Doss and colleagues sought to understand what predicted better maintenance of relationship and individual functioning (2019). Seven predictors were tested: relationship length, African American race, Hispanic ethnicity, rural status, low-income status, education, and baseline functioning. Across all analyses, couples where one or both members were Hispanic reported a larger increase in relationship confidence and larger decreases in negative relationship quality during the follow-up period. Additionally, individuals who started the program with a higher quality of life and better-perceived health reported significantly smaller gains within those domains over follow-up, likely due to a ceiling effect. Thus, historically underserved groups – such as racial/ethnic minorities, lower-income couples, and rural couples – experienced equal or better maintenance as more advantaged couples.

Implications and Current Program Availability

Results of this study demonstrate that online programs are a viable option for couples who want to improve or strengthen their relationship, with effects lasting for at least a year after the program. Furthermore, the OurRelationship program can help couples overcome common barriers to couple therapy such as scheduling conflicts, lack of childcare, and high costs (often not covered by insurance).

If couples are eligible and interested in completing the OurRelationship program for free, they can participate in part of the research study (and earn up to $500 for completing research assessments). More information about the research study can be found here: https://www.ourrelationship.com/research-and-payment. People who are not interested in being in research study can complete either the couples version (for couples to do together: www.OurRelationship.com/couples) or the individual program (for situations when the partner is unavailable or unwilling to do the program: www.OurRelationship.com/individuals) for a one-time charge of $50.

References:

1. Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H., & Simpson, L. E. (2004). Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Journal of Consulting and Clinical Psychology, 72(2), 176-191. https://my.apa.org/apa/idm/login.seam?ERIGHTS_TARGET=http%3A%2F%2Fdoi.apa.org%2Fgetdoi.cfm%3Fdoi%3D10.1037%2F0022-006X.72.2.176&AUTHENTICATION_REQUIRED=true
2. Copen, C. E., Daniels, K., Vespa, J., & Mosher, W. D. (2012). First marriages in the United States: Data from the 2006–2010 National Survey of Family Growth. National Health Statistics Reports, 49, 1–21.
3. Doss, B. D., Benson, L. A., Georgia, E. J., & Christensen, A. (2013). Translation of integrative behavioral couple therapy to a web-based intervention. Family Process, 52(1), 139–153. https://onlinelibrary.wiley.com/action/cookieAbsent.
4. Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84(4), 285-296. https://my.apa.org/apa/idm/login.seam?ERIGHTS_TARGET=http%3A%2F%2Fdoi.apa.org%2Fgetdoi.cfm%3Fdoi%3D10.1037%2Fccp0000063&AUTHENTICATION_REQUIRED=true
5. Doss, B. D., Roddy, M. K., Nowlan, K. M, Rothman, K, & Christensen, A. (2019). Maintenance of gains in relationship and individual functioning following the online OurRelationship program. Behavior Therapy, 50, 73-86. https://linkinghub.elsevier.com/retrieve/pii/S0005789418300510
6. Johnson, C. A., Stanley, S. M., Glenn, N. D., Amato, P. R., Nock, S. L., Markman, H. J., et al. (2002). Marriage in Oklahoma: 2001 baseline statewide survey on marriage and divorce. Oklahoma: Bureau for Social research, Oklahoma State University.
7. Roddy, M.K., Rothman, K., & Doss, B.D. (2018) A randomized controlled trial of different levels of coach support in an online intervention for relationship distress. Behaviour Research and Therapy, 110, 47-54. https://linkinghub.elsevier.com/retrieve/pii/S0005796718301372
8. Whisman, M. A. (2007). Marital distress and DSM–IV psychiatric disorders in a population-based national survey. Journal of Abnormal Psychology, 116, 638–643. https://my.apa.org/apa/idm/login.seam?ERIGHTS_TARGET=http%3A%2F%2Fdoi.apa.org%2Fgetdoi.cfm%3Fdoi%3D10.1037%2F0021-843X.116.3.638&AUTHENTICATION_REQUIRED=true
9. Whisman, M. A., Beach, S. R., & Snyder, D. K. (2008). Is marital discord taxonic and can taxonic status be assessed reliably? Results from a national, representative sample of married couples. Journal of Consulting and Clinical Psychology, 76, 745–755. https://my.apa.org/apa/idm/login.seam?ERIGHTS_TARGET=http%3A%2F%2Fdoi.apa.org%2Fgetdoi.cfm%3Fdoi%3D10.1037%2F0022-006X.76.5.745&AUTHENTICATION_REQUIRED=true
10. Whisman, M. A., & Uebelacker, L. A. (2012). A longitudinal investigation of marital adjustment as a risk factor for metabolic syndrome. Health Psychology, 31, 80–86. https://my.apa.org/apa/idm/login.seam?ERIGHTS_TARGET=http%3A%2F%2Fdoi.apa.org%2Fgetdoi.cfm%3Fdoi%3D10.1037%2Fa0025671&AUTHENTICATION_REQUIRED=true