One group of depressives shows particularly poor responses to treatment and is at particularly high risk for hospitalization and suicide: depressed patients with concurrent marital difficulties. In addition, this group of depressives constitutes a large percentage of the total population of persons presenting with depression or with marital distress. While cognitive therapy (CT) has been shown to be effective in treating depression, its effectiveness for this population has never been directly tested. Similarly, while Behavioral Marital Therapy (BMT) has been shown to be effective in treating marital problems, and there is evidence that marital therapy may be effective in treating depression, BMT has never been tested directly on this population, nor has its effectiveness been compared to CT in treating this population of depressed patients. Two psychotherapy outcome studies are proposed. In Study I, 60 couples will be randomly assigned to one of three treatment conditions: a) BMT: b) CT; or c) Treatment on Demand (TOD). Treatment will consist of 15 weekly sessions lasting one hour each. Outcome measures will include self-report measures of marital satisfaction, marital communication, perception of the marriage, depressive symptomology, depressive cognitive style, and behavioral observations. Assessments will be made immediately prior to therapy, immediately following therapy, at three month follow-up and at one year follow-up. The study will a) determine the relative effectiveness of CT and BMT in the alleviation of both marital and depressive symptoms in this population; b) establish the effectiveness of both treatments relative to TOD wait list condition; c) determine long-term effectiveness of the treatments by assessing functioning at one year; d) identify predictors of optimal response to each treatment. In Study II, 45 depressed and maritally distressed wives whose husbands will not participate in treatment will be assigned to one of three treatment conditions: a) Individual Marital Therapy; b) Cognitive Therapy; or c) TOD. Treatment used and assessments will parallel those in Study I.
| O'Leary, K D; Beach, S R (1990) Marital therapy: a viable treatment for depression and marital discord. Am J Psychiatry 147:183-6 |
