חיפוש מאמרים

Behavioral couples therapy (BCT) for alcohol and drug use disorders: A meta-analysis
Powers, M. B., Vedel, E., & Emmelkamp, P. M. Clinical psychology review 28.6 (2008): 952-962.
Narrative reviews conclude that behavioral couples therapy (BCT) produces better outcomes than individual-based treatment for alcoholism and drug abuse problemsRead More...

Narrative reviews conclude that behavioral couples therapy (BCT) produces better outcomes than individual-based treatment for alcoholism and drug abuse problems (e.g., [Epstein, E. E., & McCrady, B. S. (1998). Behavioral couples treatment of alcohol and drug use disorders: Current status and innovations. Clinical Psychology Review, 18(6), 689–711; O'Farrell, T. J., & Fals-Stewart, W. (2003). Alcohol abuse. Journal of Marital and Family Therapy, 29(1), 121–146]). However, the strength and consistency of this effect favoring BCT has not been examined because a meta-analysis of BCT studies has not been reported. This meta-analysis combines multiple well controlled studies to help clarify the overall impact of BCT in the treatment of substance use disorders. A comprehensive literature search produced 12 randomized controlled trials (n = 754) that were included in the final analyses. There was a clear overall advantage of including BCT compared to individual-based treatments (Cohen's = 0.54). This was true across outcome domains (frequency of use d = 0.36, consequences of use d = 0.52, and relationship satisfaction d = 0.57). However the pattern of results varied as a function of time. BCT was superior to control conditions only in relationship satisfaction at posttreatment (d = 0.64). However, at follow-up BCT was superior on all three outcome domains (frequency of use d = 0.45, consequences of use d = 0.50, and relationship satisfaction d = 0.51). In addition to other control conditions, BCT also outperformed individual cognitive behavioral therapy without couples therapy (d = 0.42). Larger sample sizes were associated with higher effect sizes (p = 0.02). However, treatment dose and publication year were not related to effect size. Overall, BCT shows better outcomes than more typical individual-based treatment for married or cohabiting individuals who seek help for alcohol dependence or drug dependence problems. The benefit for BCT with low severity problem drinkers has received little attention and one study suggests its efficacy may not extend to this subgroup.

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Enhancing partner support to improve smoking cessation – Cochrane Systematic Review
Faseru, B., Richter, K. P., Scheuermann, T. S., & Park, E. W. Cochrane Database of Systematic Reviews 8 (2018).‏
Background While many cessation programmes are available to assist smokers in quitting, research suggests that support from individual partners, familyRead More...

Background

While many cessation programmes are available to assist smokers in quitting, research suggests that support from individual partners, family members, or 'buddies' may encourage abstinence.

Objectives

To determine if an intervention to enhance one‐to‐one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner‐support component.

Search methods

We limited the search to the Cochrane Tobacco Addiction Group Specialised Register, which was updated in April 2018. This includes the results of searches of the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (via OVID); Embase (via OVID); and PsycINFO (via OVID). The search terms used were smoking (prevention, control, therapy), smoking cessation and support (family, marriage, spouse, partner, sexual partner, buddy, friend, cohabitant and co‐worker). We also reviewed the bibliographies of all included articles for additional trials.

Selection criteria

We included randomised controlled trials recruiting people who smoked. Trials were eligible if they had at least one treatment arm that included a smoking cessation intervention with a partner‐support component, compared to a control condition providing behavioural support of similar intensity, without a partner‐support component. Trials were also required to report smoking cessation at six months follow‐up or more.

Data collection and analysis

Two review authors independently identified the included studies from the search results, and extracted data using a structured form. A third review author helped resolve discrepancies, in line with standard methodological procedures expected by Cochrane. Smoking abstinence, biochemically verified where possible, was the primary outcome measure and was extracted at two post‐treatment intervals where possible: at six to nine months and at 12 months or longer. We used a random‐effects model to pool risk ratios from each study and estimate a summary effect.

Main results

Our update search identified 465 citations, which we assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n = 3370). The definition of partner varied among the studies. We compared partner support versus control interventions at six‐ to nine‐month follow‐up and at 12 or more months follow‐up. We also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self‐reported smoking cessation rates, with limited biochemical verification of abstinence. The pooled risk ratio (RR) for abstinence was 0.97 (95% confidence interval (CI) 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post‐treatment. Of the 11 studies that measured partner support at follow‐up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. We judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system we rated the overall quality of the evidence for the two primary outcomes as low. We downgraded due to the risk of bias, as we judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. We also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group.

Authors' conclusions

Interventions that aim to enhance partner support appear to have no impact on increasing long‐term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation. Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small‐scale studies, before large trials assessing the impact on smoking cessation can be justified.

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Sexual Addiction and Marriage and Family Therapy: Facilitating Individual and Relationship Healing Through Couple Therapy
Bird, M. H. Journal of Marital and Family Therapy 32.3 (2006): 297-311.
In recent decades there has been an increase in literature regarding sexual addiction as well as a growing number ofRead More...

In recent decades there has been an increase in literature regarding sexual addiction as well as a growing number of clients presenting in therapy with problems related to their sexual behaviors (including internet sexual addiction). This article (a) presents a synthesis of the research on the impact of sexual addiction on the addict, the partner, and the couple; (b) outlines the process of healing for each based on the research synthesis; and (c) discusses the role of marriage and family therapy in facilitating both individual and relationship healing from sexual addiction. Implications for future research in sexual addiction, generally, and in marriage and family therapy, specifically, are presented.

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Family Factors of Internet Addiction and Substance Use Experience in Taiwanese Adolescents
Yen, J. Y., Yen, C. F., Chen, C. C., Chen, S. H., & Ko, C. H. CyberPsychology & Behavior 10.3 (2007): 323-329.
The aim of the study is to examine the differences in the diversity of family factors between adolescents with andRead More...

The aim of the study is to examine the differences in the diversity of family factors between adolescents with and without Internet addiction and substance use experience. A total of 3662 students (2328 boys and 1334 girls) were recruited from seven junior high schools, six senior high schools, and four vocational high schools in southern Taiwan. Internet addiction and substance experience were classified according to the score of Chen Internet Addiction Scale Questionnaires for Experience of Substance use. The family factors assessed included perceived family satisfaction, family economic status, parents' marriage status, care-givers, the frequency of intra-family conflict, families' habitual alcohol use, and perceived parents' or care givers' attitude toward adolescents' substance use. This study demonstrated that the characteristics of higher parent-adolescent conflict, habitual alcohol use of siblings, perceived parents' positive attitude to adolescent substance use, and lower family function could be used develop a predictive model for Internet addiction in the multiple logistic regression analysis. The former three family factors were also sufficient in themselves to develop a predictive model for substance use experience. The results revealed that adolescent Internet addiction and substance use experience shared similar family factors, which indicate that Internet addiction and substance use should be considered in the group of behavioral problem syndromes. A family-based preventive approach for Internet addiction and substance use should be introduced for adolescents with negative family factors.

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Helping the female partners of men abusing alcohol: a comparison of three treatments
Halford, W. K., Price, J., Kelly, A. B., Bouma, R., & Young, R. M. Addiction 96.10 (2001): 1497-1508.
Aim. To evaluate the effectiveness of three approaches to assisting the female partners of male problem drinkers with the stressRead More...

Aim.

To evaluate the effectiveness of three approaches to assisting the female partners of male problem drinkers with the stress imposed by the male's drinking.

Design.

Participants were assigned randomly via random number tables to one of three treatment conditions: supportive counselling, stress management or alcohol‐focused couples therapy.

Setting.

The intervention took place at the Behaviour Research and Therapy Centre (BRTC), The University of Queensland. This research and training centre offers outpatient psychology services to the community.

Participants.

Sixty‐one married women whose husbands drank heavily. Participants reported protracted alcohol problems, severe impact of alcohol on social functioning and severe marital distress.

Measurement.

The women's stress, alcohol consumption by the male, and relationship functioning were assessed at pre‐ and post‐treatment and at 6‐month follow‐up.

Interventions.

All three treatments involved 15 1‐hour sessions with the woman. In the alcohol‐focused couple therapy, attempts were made to engage the man in these sessions.

Results.

Contrary to our predictions, there were few differences between the treatments. All three treatments were associated with reductions in the women's reported stress, with trends for somewhat greater reduction in the women's stress in the stress management and alcohol‐focused couples therapy conditions than for supportive counselling. None of the treatments produced clinically significant reductions in men's drinking or relationship distress.

Conclusion.

The treatments ease stresses and burden but do not improve drinking or relationships. Limited power in the design restricted the capacity to to detect differential treatment effects.

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Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients
Fals-Stewart, W., Birchler, G. R., & Kelley, M. L. Journal of Consulting and Clinical Psychology 74.3 (2006): 579.
Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 ofRead More...

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence.

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Attachment, Addiction, and Recovery: Conjoint Marital Therapy for Recovery from a Sexual Addiction
Zitzman, S. T., & Butler, M. H. Sexual Addiction & Compulsivity 12.4 (2005): 311-337.
This study evaluated processes of conjoint therapy for married couples recovering from husbands' addictive use of pornography. We hypothesized thatRead More...

This study evaluated processes of conjoint therapy for married couples recovering from husbands' addictive use of pornography. We hypothesized that through conjoint couple therapy clinicians are able to help organize the relationship to sponsor recovery while also promoting essential relationship and individual healing for both spouses. Results demonstrated an increase in (a) marital trust and confidence in the future, (b) mutual softening, (c) the ability to discern key points of intervention sponsoring and supporting recovery, and (d) client-perceived marital enhancement. Conjoint marital therapy is recommended as a useful component in treating compulsive pornography consumption.

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Behavioral couples therapy for drug-abusing patients: effects on partner violence
Fals-Stewart, W., Kashdan, T. B., O'Farrell, T. J., & Birchler, G. R. Journal of substance abuse treatment 22.2 (2002): 87-96.
Using data from a previous investigation (Fals-Stewart, Birchler, & O'Farrell, 1996), the purpose of the present study was to examine theRead More...

Using data from a previous investigation (Fals-Stewart, Birchler, & O'Farrell, 1996), the purpose of the present study was to examine the effect of Behavioral Couples Therapy (BCT) on the prevalence of partner violence among married or cohabiting substance-abusing men (N = 80). Participants were randomly assigned to receive either BCT or individual-based treatment (IBT). The proportion of couples who engaged in male-to-female physical aggression was not different during the year before treatment for dyads in BCT (n = 17, 43%) and IBT (n = 19, 48%). However, a smaller proportion of couples in the BCT condition reported male-to-female physical aggression during the year after treatment (n = 7, 18%) than those in the IBT condition (n = 17, 43%). Dyadic adjustment, frequency of heavy drinking, and frequency of drug use during the year after treatment mediated the relationship between type of treatment and the prevalence of male-to-female physical aggression.

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Uncovering and Treating Sex Addiction in Couples Therapy
Turner, M. Journal of Family Psychotherapy 20.2-3 (2009): 283-302.
Sex addiction is elusive and often undetected in couples' therapy. Although not as obvious as other addictions, its effects canRead More...

Sex addiction is elusive and often undetected in couples' therapy. Although not as obvious as other addictions, its effects can be just as damaging. The meaning of sex addiction and its implications for couples therapy are explored. Specifically, the etiology is broken down into several different aspects: intergenerational factors, cultural distortions, and sex addiction and the couple. Assessment of sex addition is disclosed along with the signs of sex addiction. Eleven general categories are listed as well as the treatment options and different stages of addiction. Case histories are given to illustrate the impact of sex addiction on the couple subsystem. Research and future develops are also discussed along with its limitations.

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Individual Cognitive-Behavioral Therapy and Behavioral Couples Therapy in Alcohol Use Disorder: A Comparative Evaluation in Community-Based Addiction Treatment Centers
Vedel, E., Emmelkamp, P. M., & Schippers, G. M. Psychotherapy and psychosomatics 77.5 (2008): 280-288.
Background: Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples TherapyRead More...

Background: Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol consumption and enhancing marital functioning, but no study has directly tested the comparative effectiveness of stand-alone BCT versus an individually focused cognitive-behavioral therapy (CBT) in a clinical community sample. Methods: The present study is a randomized clinical trial evaluating the effectiveness of stand-alone BCT (n = 30) compared to individual CBT (n = 34) in the treatment of alcohol use disorders in community treatment centers in Dutch male and female alcoholics and their partners. Results: Results show both BCT and CBT to be effective in changing drinking behavior after treatment. BCT was not found to be superior to CBT. Marital satisfaction of the spouse increased significantly in the BCT condition but not in the CBT condition, the differences being significant at the post-test. Patients’ self-efficacy to withstand alcohol-related high-risk situations increased significantly in both treatment conditions, but more so in CBT than in BCT after treatment. Treatment involvement of the spouse did not increase retention. Conclusion: Regular practitioners in community treatment centers can effectively deliver both treatments. Stand-alone BCT is as effective as CBT in terms of reduced drinking and to some extent more effective in terms of enhancing relationship satisfaction. However, BCT is a more costly intervention, given that treatment sessions lasted almost twice as long as individual CBT sessions.

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Behavioral couples therapy for female substance-abusing patients: effects on substance use and relationship adjustment
Winters, J., Fals-Stewart, W., O'farrell, T. J., Birchler, G. R., & Kelley, M. L. Journal of Consulting and Clinical Psychology, 70(2), 344.
Married or cohabiting female drug-abusing patients (N = 75) were randomly assigned to either a behavioral couples therapy condition (BCT; n = 37), which consistedRead More...

Married or cohabiting female drug-abusing patients (N = 75) were randomly assigned to either a behavioral couples therapy condition (BCT; n = 37), which consisted of group, individual, and behavioral couples therapy sessions, or to an equally intensive individual-based treatment condition (IBT; n = 38), which consisted of group and individual counseling. During most of the 1-year follow-up, compared with participants who received IBT, those who received BCT reported (a) fewer days of substance use, (b) longer periods of continuous abstinence, (c) lower levels of alcohol, drug, and family problems, and (d) higher relationship satisfaction. However, differences in relationship satisfaction and number of days of substance use dissipated over the course of the posttreatment follow-up period and were not significantly different by the end of 1 year.

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Behavioral Couples Therapy for Alcoholism and Drug Abuse: Where We've Been, Where We Are, and Where We're Going
Fals-Stewart, W., O’Farrell, T. J., Birchler, G. R., Córdova, J., & Kelley, M. L. Journal of Cognitive Psychotherapy 19.3 (2005): 229-246.
Among the various types of couple and family therapies used to treat substance abuse, Behavioral Couples Therapy (BCT) has theRead More...

Among the various types of couple and family therapies used to treat substance abuse, Behavioral Couples Therapy (BCT) has the strongest empirical support for its effectiveness. During the last 3 decades, multiple studies have consistently found participation in BCT by married or cohabiting substance-abusing patients results in significant reductions in substance use, decreased problems related to substance use (e.g., job loss, hospitalization), and improved relationship satisfaction. Recently, investigations exploring other outcomes have found that, compared to traditional individual-based treatments, participation in BCT results in significantly (a) higher reductions in partner violence, (b) greater improvements in psychosocial functioning of children who live with parents who receive the intervention, and (c) better cost-benefit and cost-effectiveness. In addition to providing an overview of the theoretical underpinnings of BCT, methods used with this intervention, and the literature supporting its use, this article also examines the future directions of BCT research for substance abuse.

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Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members
Miller, W. R., Meyers, R. J., & Tonigan, J. S. Journal of consulting and clinical psychology, 67(5), 688.
In a randomized clinical trial, 130 concerned significant others (CSOs) were offered 1 of 3 different counseling approaches: (a) anRead More...

In a randomized clinical trial, 130 concerned significant others (CSOs) were offered 1 of 3 different counseling approaches: (a) an Al-Anon facilitation therapy designed to encourage involvement in the 12-step program, (b) a Johnson Institute intervention to prepare for a confrontational family meeting, or (c) a community reinforcement and family training (CRAFT) approach teaching behavior change skills to use at home. All were manual-guided, with 12 hr of contact. Follow-up interviews continued for 12 months, with 94% completed. The CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment (64%) as compared with the more commonly practiced Al-Anon (13%) and Johnson interventions (30%). Two previously reported aspects of the Johnson intervention were replicated: that most CSOs decide not to go through with the family confrontation (70% in this study) and that among those who do, most (75%) succeed in getting the drinker into treatment. All approaches were associated with similar improvement in CSO functioning and relationship quality. Overall treatment engagement rates were higher for CSOs who were parents than for spouses. On average, treatment engagement occurred after 4 to 6 sessions.

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Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns
Ozechowski, T. J., & Liddle, H. A. Clinical Child and Family Psychology Review 3.4 (2000): 269-298.
Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for theRead More...

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate “knowns and unknowns” regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.

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Family therapy for drug abuse: review and updates 2003-2010
Rowe, C. L. Journal of marital and family therapy 38.1 (2012): 59-81.
Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence,Read More...

Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a “promising, but not definitive” approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent‐focused models based on rigorous methodology, as well as advances with adult‐focused family‐based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross‐cutting issues, recommendations for new research, and practice implications of these findings. Adolescent‐focused family‐based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult‐focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family‐based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.

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