Research has consistently demonstrated the deleterious effect of poor marital quality on health outcomes [1], and there is evidence to suggest that the impact is even greater for older adults than for younger couples [2]. Surprisingly, despite the preponderance of clinical trials demonstrating the efficacy of couple therapy in ameliorating marital distress [13], there is a dearth of research considering the health impact of couple interventions. The current study seeks to take the first step towards bridging the apparent gap between the marriage and health literature and the couple therapy outcome literature with a specific focus on older couples, who, in addition to being at greater risk, tend to be underrepresented in clinical trials of couple therapy. The effect of distress on physiological and immune functioning is considered to be one important pathway by which marital distress may lead to poorer health [16, 17]. Indeed, measures of cardiovascular and HPA axis reactivity, as well as wound healing, a health outcome related to immune functioning, have been found to differ based on the quality of couples'behaviors during interactions [17,24]. Older couples demonstrating lower marital quality also report poorer subjective health [6]. Importantly, these outcomes can be observed on multiple occasions in a laboratory setting and thus are appropriate health-related outcomes to study over the course of couple therapy. The proposed study will recruit 40 older married couples (age 55+) to participate in a clinical trial of Integrative Behavioral Couple Therapy (IBCT) and three laboratory assessments at pre-, mid-, and post- treatment. During each assessment session, the couple will participate in two problem-solving discussions and will complete self-report measures assessing relationship quality, subjective health, and health behaviors. Throughout each session, saliva samples will be obtained to measure salivary cortisol and a blood pressure cuff will be used to assess cardiovascular reactivity. A minimally invasive procedure that removes dead skin cells on the outer skin surface will be performed for assessment of skin barrier recovery. Therapy will consist of 20 sessions with a supervised graduate student therapist who is trained in IBCT, a type of couple therapy that integrates behavioral change strategies with strategies that promote acceptance, tolerance, and an appreciation of differences. IBCT has been proven effective in increasing couples'marital satisfaction and helping them deal with problems in their marriage [14]. The proposed study will assess the relationship between marital quality and health-related outcomes in a sample of distressed older adults and examine the ways in which biological and health outcomes change over time while the couple participates in couple therapy, including whether successful treatment (i.e., improvement in marital quality) predicts changes in these outcomes from pre- to post-treatment. This pilot research is an important first step in determining the utility of couple therapy as preventative care in older adults.

Public Health Relevance

The data from this pilot study will provide novel information about the relationship between marital quality and physiology, skin healing, and self-rated health in distressed older adult couples and the ways in which these variables change over time during the course of couple therapy. This preliminary research may pave the way for future randomized controlled trials of marital interventions on health outcomes. The knowledge to be gained from such research may ultimately inform healthcare and public policy if couple therapy is shown to be a viable and cost-effective option as preventative care.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-RPHB-A (91))
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Spotts, Erica L
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University of California Los Angeles
Schools of Arts and Sciences
Los Angeles
United States
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Robles, Theodore F; Slatcher, Richard B; Trombello, Joseph M et al. (2014) Marital quality and health: a meta-analytic review. Psychol Bull 140:140-87