The new thrust of this continuation grant is an outcome study examining the effects of behavioral marital therapy on couples where the wife is depressed. BMT will be compared to cognitive behavior therapy (CBT) with the depressed spouse, a treatment including both BMT and CBT, and a minimal contact control. The relative effects of these treatments on both depression and the quality of the marital relationship will be examined, both immediately after treatment and up to one year later. These groups will also be compared to distressed couples with no depressed spouse treated with BMT; and nonmarried depressed women treated with CBT. The additional comparison populations will allow us to explore a variety of issues, including the impact of individual psychopathology on the effectiveness of BMT, the impact of marical distress on the effectiveness of CBT, and differential effects of CBT as a function of marical status. It is believed that the combination of these two treatments can be beneficial for both types of problems, since marical distress often causes or exacerbates depression, and depression can interfere with the success of marital therapy. Since depression is a profound public health problem, and marital disruption precipitates a variety of medical and behavioral problems, the investigation has important implications for two health-related areas. A second major goal of this research is to analyze the communication styles of couples where one spouse is depressed, comparing such couples to a variety of dyadic combinations. This analysis is designed to shed light on the interpersonal factors associated with depression. The third and final goal of this research is to complete the analysis and collection of follow-up data for a study currently in progress. This is the study currently being funded, and it attempts to identify the active change-in-inducing mechanisms of BMT by comparing the long-term effectiveness of a complete BMT treatment package with that of its two major components: behavior exchange procedures and problem solving training.
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