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The American Journal of Family Therapy, 43:103–118, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0192-6187 print / 1521-0383 online DOI: 10.1080/01926187.2014.956614
The Effect of Cognitive-Behavioral Group Marital Therapy on Marital Happiness
and Problem Solving Self-Appraisal
CLAUDE BÉLANGER University of Quebec in Montreal (UQAM), Montreal, Canada,
McGill University, Montreal, Canada, and The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada
LISE LAPORTE McGill University Health Center, Montreal, Canada
STÉPHANE SABOURIN The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada, and Laval University, Quebec City, Canada
JOHN WRIGHT The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada
Problem solving self-appraisal affects problem solving performance and marital adjustment. This study investigated the effects of cognitive-behavioral group marital therapy on couples’ adjustment and their self-appraisal of problem solving activities. Sixty-six cou- ples participated in group couples therapy. Subjects were randomly assigned to an experimental or a waiting list control group. They completed the Problem Solving Inventory and the Marital Happiness Scale. Therapy was effective in improving global couple adjustment and problem solving self-appraisal. The program had a differential effect on the improvement of self-perceived problem solving abili- ties depending on the spouses’ initial self-appraised problem solving ability level.
Address correspondence to Claude Bélanger, Département de Psychologie, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, QC H3C 3P8, Canada. E-mail: [email protected]
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Marital therapy based on social learning principles aims to enhance com- munication and/or to teach problem solving skills, with the expectation that such behavioral changes will lead to an increase in marital satisfaction (Woodin, 2001). However, increased attention has been devoted to the role of individual cognitive variables in mediating the relationship between communication/problem solving behaviors and marital distress (Bélanger, Sabourin & El-Baalbaki, 2012). The importance of cognitive processes in the development and maintenance of marital dysfunction has been confirmed in several investigations of the implications of spouses’ cognitions in outcome research (Dunn & Schwebel, 1995).
Researchers have evaluated problem solving self-appraisal as a deter- minant of individuals’ adaptational outcomes (Godshall and Elliott, 1997; Heppner, Kampa, & Brunning, 1987). Problem solving self-appraisal refers to a relatively stable attitude toward one’s personal problem solving reper- toire as well as toward the self-regulatory processes at work while a problem is being solved (Heppner & Krauskopf, 1987).
Social problem solving abilities are used in social contexts, and they af- fect interpersonal adjustment (Elliott & Grant, 2008). For instance, family care- givers demonstrating effective problem solving styles reported greater rela- tionship satisfaction (Shanmugham, Cano, Elliott & Davis, 2009). Self-efficacy in response to personal problems is related to the way the person appraises his or her problem solving skills. Accordingly, to develop good coping ca- pacities, it is important for a person to be able to appraise his or her problem solving skills and style (Heppner & Dong-Gwi, 2009). Moreover, Bandura’s work strongly supports the notion that people’s perception of self-efficacy af- fects their motivation to face challenges, their decision-making behaviors and their emotional reactions in difficult situations (Bandura, 1986; Carré, 2004). Perceived self-efficacy has also been related to many personal difficulties such as depression (Dreer, Elliott, Fletcher, & Swanson, 2005; Rivera et al., 2007; Nezu, Kalmar, Ronan & Clavijo,1986), psychosocial impairment (Shan- mugham, Elliott & Palmatier, 2004) and alcoholism (Elliott, Grant & Miller, 2004); it has also been associated with psychological adjustment (Heppner & Anderson, 1985), physical health (Heppner, Kampa, & Brunning, 1987) and personality (D’Zurilla, Maydeu-Olivares & Gallardo-Pujol, 2011).
The well-established links between problem solving self-appraisal and relationship satisfaction have led researchers to investigate problem solving capacities and self-appraisal in relation to coping skills and the marital relationship. These studies were based on the basic premise that, for most people, the quality of their marital relationship is an important predictor of their general well-being (Hertzog, 2011). When facing stressful life events, partners use joint efforts in problem solving interactions and other coping strategies to reestablish satisfaction and maintain marital adjustment. A failure in these cognitive and behavioral adaptation mechanisms often leads to marital distress.
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Dyadic coping strategies encompass both the cognitive and behavioral components that influence marital satisfaction. Therefore, it is necessary to understand the relationships between the cognitive strategies and so- cial behaviors that partners adopt during their problem solving interactions. If there is such a link, then what is the exact nature of this interrelation, and in what ways do these cognitive (problem solving self-appraisal) and behavioral (problem solving efficacy) strategies influence marital satisfac- tion? The preoccupation with understanding the cognitive and behavioral problem solving determinants of marital adjustment can be found in a lim- ited number of studies that have addressed these particular issues (Baucom & Kerig, 2004). In line with these questions, an investigation in our lab- oratory showed that problem solving self-appraisal differentiates distressed from non-distressed partners (Sabourin, Laporte, & Wright, 1990). Distressed spouses expressed less problem solving confidence, a stronger tendency to avoid different problem solving activities, and less control over their behav- ior than their non-distressed partners (Sabourin et al., 1990). Another study that was run by the same team (Lussier et al., 1997) examined the rela- tionship between spouses’ attachment styles, coping strategies, and marital satisfaction. These researchers pinpointed many links between attachment strategies, coping skills and marital adjustment. These results are consistent with Bodenmann et al. (2006), who reported several studies showing that positive dyadic coping significantly correlates with a better quality of mari- tal relationship, lower levels of stress and better physical and psychological well-being, and in some studies, these correlations are stronger for women than for men. Kurdek (1991) tried to conceptualize these variables into a model in which he assessed the role of cognitively and behaviorally ori- ented problem solving determinants on the relationship satisfaction of gay and lesbian partners. His results support a problem solving model in which relationship satisfaction is related to strategies used by partners to resolve their conflicts.
In a recent study, Bélanger and his colleagues (2012) investigated the mutual contributions of a self-reported cognitive strategy, coping, observed problem solving behaviors, and marital adjustment. In line with Kurdek (1991), they hypothesized that the specific coping strategies would be re- lated to the quality of the problem solving behaviors and that both these variables would be related to marital satisfaction. Their results propose that, for both men and women, there are significant relationships between cog- nitive and coping strategies, problem solving behaviors displayed during marital interactions, and marital adjustment.
Thus, because empirical studies have demonstrated that problem solving self-appraisal is directly related to problem solving performance (Heppner & Dong-Gwi, 2009), spouses should not only possess the problem solving skills necessary to confront and alleviate their marital difficulties but also believe in their capacity to do so. To be of maximum value, marital therapy
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should therefore not only aim to enhance specific problem solving skills but also should work to alter spouses’ appraisal of their problem solving abilities. To the best of our knowledge, very few outcome studies have investigated such an effect of couples’ cognitive-behavioral therapy on the partners’ self- appraisal of their problem solving abilities and marital satisfaction.
Accordingly, the main purpose of this paper is 1) to evaluate the overall effectiveness of cognitive-behavioral group marital therapy in bringing about positive changes in marital satisfaction and 2) to study the effects of such a program on partners’ self-appraisal of problem solving abilities.
The specific hypotheses were that group marital therapy subjects would report changes in a) their marital satisfaction; b) the overall appraisal of their problem solving abilities; c) their problem solving confidence; d) their approach to problem solving activities; and e) their strategies to control their behavior when they try to solve a problem.
The second purpose of this study is to examine the differential effects of cognitive behavioral group marital therapy on appraisal from spouses as being effective or ineffective problem solvers (Nezu, 1985).
It was hypothesized that, following the program, partners who initially appraised their problem solving as ineffective and who believed that they had problem solving deficits would report more changes in their marital adjustment level (Marital Happiness Scale) and in their problem solving skills (Problem Solving Inventory) than subjects who initially appraised themselves as effective problem solvers.
Sixty-six French-Canadian couples participated in the study. The subjects had been living together an average of 12.8 years (SD = 8.7 years, range 1 to 31 years), and their age ranged from 20 to 76 years (M = 38.2 years, SD = 1.7 years). The mean number of children for the sample was 1.2 (88% of the couples had children). The average education level was 14.5 years (SD = 2.9 years) for women and 15.7 years (SD = 3.7 years) for men.
Subjects were recruited through publicity in various media. Couples who expressed interest were briefly informed of the nature of the program and invited to an assessment interview. To be selected, couples had to be living together, free of any important individual psychopathology, free of drug or alcohol problems, free of primary sexual dysfunctions, not in intense marital crisis (no pending divorce or physical abuse) and not currently following another therapy. During the assessment interview, all couples completed a battery of questionnaires that included a demographic questionnaire, the
Impact of Group CBT on Marital Happiness and Self-Appraisal 107
Problem Solving Inventory (Heppner & Petersen, 1982), and the Marital Happiness Scale (Azrin, Naster, & Jones, 1973). Partners completed the ques- tionnaires independently. A research assistant remained in the same room as the couple during the task and was available to help participants. Subjects were ensured of the confidentiality of their responses.
Couples were randomly assigned to the experimental group (n = 30 cou- ples) or to the control group waiting list (n = 36 couples). After completing the program, all couples were administered the same self-report measures. Couples on the waiting list then received the same assessment and treatment procedures.
The Couples Survival Program is a group marital therapy program based on a cognitive-behavioral approach to solving marital difficulties designed by researchers in our laboratory (Wright, 1986). Couples are taught skills focused on effective communication, problem solving, exchange of positive experiences and anger expression. The cognitive and behavioral compo- nents of problem solving skills were taught for two sessions (6 hours) in which couples learned different problem solving stages through reading, in- structions, modeling rehearsal, dyadic practices, feedback, cognitive restruc- turing, group discussions, and homework assignments (Dattilio & Epstein, 2005)
Each group comprised four couples. They met once a week, for nine consecutive weeks, in three hour sessions. Each group was led by a licensed psychologist with a minimum of two-years experience in marital therapy and group intervention. The co-therapist had at least a master’s degree in clinical or counseling psychology. All group leaders received 30 hours of training and weekly supervision between sessions.
The Problem Solving Inventory (PSI; Heppner & Petersen, 1982) is a 32- item measure that evaluates perceptions of personal problem solving behav- iors and attitudes. It yields an overall score as well as three factor scores: problem solving confidence (11 items), approach-avoidance style (16 items), and personal control (5 items). High scores indicate that the subject per- ceives himself/herself as having ineffective problem solving abilities and thus has little problem solving confidence, tendencies to avoid different problem solving activities, and a lack of personal control. Reliability estimates (alpha ranges from .72 to .85) are adequate, and acceptable validity coefficients have been reported in several investigations (Heppner & Anderson, 1985; Nezu &
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Ronan, 1988; Tracey, Sherry, & Keitel, 1986). Moreover, PSI scores have been found to correlate significantly with observational ratings of problem solving competence (Heppner et al, 1982). The French version of the PSI (Laporte, Sabourin, & Wright, 1989) has demonstrated equally sound psychometric properties (alpha ranges from .65 to .86).
The Marital Happiness Scale (Azrin, Naster, & Jones, 1973) is a self-report questionnaire that allows the subject to rate his satisfaction on nine aspects of his marital life (household responsibilities, money management, etc.) and to give an overall assessment of his happiness within the relationship. The scores range from 1 to 10, with a higher score indicating a higher level of marital happiness. The instrument possesses good reliability and discriminant validity. The Marital Happiness Scale has been found to be highly correlated (.85) with the Locke-Wallace Marital Adjustment Test (Locke & Wallace, 1973), and inter-item correlations (p < .05 for all correlations) suggest the presence of an underlying single dimension (Libman, Takefman, & Brender, 1980). The French version of the questionnaire has been demonstrated to have equally sound psychometric qualities (alpha ranges from .71 to .80) (Bourgeois, Sabourin, & Wright, 1990).
Independent t-tests were conducted to determine if there were any sig- nificant differences between the experimental and control groups in terms of sociodemographic variables. The results indicated that the experimental group participants were significantly younger (t (137) = –2.38, p < .02), had more children (t (130) = 6.02, p < .0001) and had been living together for a shorter period (t (125) = –5.09, p < .0001) than their control group counterparts. There were no significant differences between the two groups in terms of income or educational level.
Data showed that a randomization of couples to groups at the onset of the treatment did not produce optimal matching of sociodemographic variables such as age, children and length of relationship. However, Pear- son product-moment correlation coefficients established that the correlations between those variables and the scores on the dependent variables under investigation were very low. There were no significant correlations between socioeconomic variables and problem solving self-appraisal scores (range from .01 to .20), and there was a small relationship between the Marital Happiness Scale’s scores and the ages of the men (p < .02). A two-way analysis of variance was performed on the pretest scores of the experimen- tal and the control groups to determine if there were any initial differences between the groups in the self-appraisal of problem solving abilities and marital adjustment prior to the program. The results indicated that there were no significant differences between the two groups in problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 109
TABLE 1 Means and Standard Deviations of Pretest and Posttest for the Experimental and the Control Group
Group Experimental Control Experimental Control
Time T1 T2 T1 T2 T1 T2 T1 T2
PSI total M 91.3 77.0 86.9 80.9 94.8 82.1 102.5 97.1 SD 23.8 18.5 28.9 26.8 20.7 17.1 21.7 24.8
PSI M 24.7 23.0 26.0 23.5 27.0 22.9 29.0 28.2 Confidence SD 8.9 7.1 10.3 9.1 7.5 6.6 9.5 10.6 PSI M 49.4 39.1 44.1 42.4 48.5 42.5 52.7 50.4 Approach SD 15.1 9.3 15.5 15.2 13.5 10.2 11.9 13.0 PSI M 17.2 15.0 16.7 14.9 19.4 16.6 21.0 18.5 Control SD 5.6 4.3 6.6 5.2 4.3 3.9 4.3 4.4 Marital M 6.3 7.3 6.3 6.6 6.2 6.9 5.9 6.3 Happiness SD 1.3 1.1 1.1 1.4 1.3 1.2 1.5 1.6
Note. M = mean; SD = standard deviation; PSI = Problem Solving Inventory.
self-appraisal (F(3,60) = 0.8, p <.5) or marital adjustment (F(1, 63) = 2.2, p < 0.14).
Effectiveness of the Program
To determine the effect of treatment and sex on problem solving self- appraisal and marital satisfaction, three series of analysis of variance were performed. The means and standard deviations for the men and women of the experimental and the control groups are presented in Table 1.
MARITAL HAPPINESS SCALE
A 2 (male vs. female) × 2 (pre vs. post) × 2 (experimental vs. control) analysis of variance (ANOVA) was conducted on this scale using sex as a repeated measure because of the interdependence of husbands’ and wives’ scores (Kenny & Cook, 1999). The results indicated a significant main effect for Time (F(1, 63) = 26.2, p <.01), which was qualified by a significant Group × Time interaction effect (F(1,63) = 4.1, p < .05). There was no significant Group × Time × Sex interaction effect. The mean scores revealed that cou- ples from the experimental group had significantly higher marital adjustment following the program than couples on the waiting list (see Table 1).
PROBLEM SOLVING SELF-APPRAISAL
First, an ANOVA was conducted on the overall score of the PSI. The results revealed a significant effect for Time (F(1,64) = 21.8, p < .0001), which
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TABLE 2 Means and Standard Deviations of Pre-Waiting Period, Post-Waiting Period, and Post Program for the Subjects of the Control Group
Moment T1 T2 T3 T1 T2 T3
PSI total score 86.5 81.2 71.4 102.9 96.8 84.3 SD 30.0 27.7 22.4 22.6 24.7 25.5 PSI Confidence 25.8 23.8 21.9 29.2 28.3 25.6 SD 10.4 9.3 9.6 9.7 10.8 8.9 PSI Approach 44.2 42.4 37.1 52.9 50.0 42.4 SD 16.0 15.6 11.8 12.4 12.9 13.5 PSI Control 16.5 15.0 12.4 20.8 18.5 16.3 SD 6.8 5.4 4.9 4.4 4.5 5.0 Marital Happiness 6.3 6.5 7.4 5.9 6.2 7.0 SD 1.3 1.3 1.2 1.6 1.5 1.6
Note. T1 = pre-waiting; T2 = post-waiting; T3 = post-treatment; SD = standard deviation; PSI = Problem Solving Inventory.
was qualified by a significant Group × Time effect (F(1,64) = 3.9, p < .05). The Group × Time × Sex interaction effect was not significant. Couples who participated in the program generally appraised themselves as more effective problem solvers than couples who were on the waiting list.
To further explore the nature of treatment gains, a two-way MANOVA was conducted on the three problem solving subscale scores. The results in- dicated a significant main effect for Time (F(3, 62) = 11.16, p< .0001), which was qualified by a significant Group × Time interaction effect (F(3, 62) = 3.11, p < .03). The Group × Time × Sex interaction effect was not signifi- cant. Subsequent ANOVAs revealed that, compared to subjects on the waiting list, spouses who followed the group marital therapy reported a significantly stronger tendency to approach diverse problem solving activities (F(1, 64) = 7.2, p < .009). However, they did not rate themselves as approaching prob- lem solving activities more readily or as having more personal control than the subjects who did not received treatment (see Table 1).
Quasi Replication Analysis
The effect of the program on couples on the waiting list provided an own- control analysis and represented a partial replication of the study. ANOVAs with repeated measures were performed on the data with pre-waiting scores, post-waiting scores and post-treatment scores as the 3 time points. Table 2 summarizes the means and standard deviations for all measures.
The 3 (pre-waiting vs. post-waiting vs. post-program) × 2 (male vs. fe- male) analysis of variance showed a significant main effect of Time for the Marital Happiness Scale (F(2, 31) = 23, p < .0001), for the overall score of the Problem Solving Inventory (F(2, 31) = 16, p < .0001), and for all
Impact of Group CBT on Marital Happiness and Self-Appraisal 111
PSI subscales (F(6, 26) = 9, p < .0001). The Time × Sex interaction ef- fect was not significant. To determine the source of these differences, two series of analyses of variance were conducted. The first analyses assessed the changes from the pre-waiting to the post-waiting period, whereas the second provided the evaluation of the effect of the program (post-waiting to post-program).
The results of the first series of analyses of variance (pre- to post- waiting) indicated a significant Time effect for marital adjustment (F(1.34) = 7.5, p < .01) and for overall PSI score (F(1, 35) = 8.1, p < .007). At the second evaluation, waiting list subjects reported a slight increase in mari- tal adjustment and in the appraisal of their problem solving abilities. The MANOVA conducted on the PSI subscale scores revealed another significant Time effect (F(4, 31) = 3.6, p < .02). Subsequent analyses revealed that subjects reported a significant increase in their problem solving confidence (F(1, 34) = 11.7, p < .002) following the waiting period (see Table 2).
The second series of analyses, which evaluated the effect of the treat- ment, demonstrated a significant Time effect for marital adjustment (F(1, 32) = 26.2, p < .0001) and for PSI total score (F(1, 32) = 14.5, p < .001). MANOVAs conducted on the PSI subscales revealed another significant Time effect (F(429) = 9.6, p < .001). Univariate analyses demonstrated substantial changes following the program on all subscales: problem solving confidence (F(1.32) = 5.2, p < .03), approach to problem solving activities (F(1, 32) = 15.5, p < .0001) and strategies to control their behaviors (F(1, 32) = 2.62, p < .02). As shown in Table 2, score increments recorded by the group follow- ing the program were consistently superior to those reported by the same group during the control period. The data confirm that participation in the group marital therapy increased marital adjustment and enhanced spouses’ self-perceived problem solving efficacy.
Differential Effectiveness of the Program
To investigate the effects of group marital therapy on spouses who appraise their problem solving as either effective or ineffective, three 2 (PSI: effective vs. ineffective) × 2 (pre vs. post) analyses of variance were conducted on the Marital Happiness Scale and on the Problem Solving Inventory (total score and subscales). Because the analyses require a within-group comparison, experimental and control group data were combined to examine the changes from pre- to post-program. Because men and women’s Problem Solving scores had different distributions (respectively, 33 to 161 and 47 to 154), and because they differed significantly from one another (F(1, 61) = 9.8, p < .003), analyses were conducted separately for the sexes using the split half overall PSI score of both groups (men = 83 and women = 94) to subdivide them into effective and ineffective PSI scorers.
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TABLE 3 Means and Standard Deviations of Pre-Program and Post-Program for Effective and Ineffective Scorers
Group Ineffective Effective Ineffective Effective
Time pre post pre post pre post pre post
PSI total M 104.3 81.5 64.5 65.4 112.6 92.4 77.5 73.1 SD 20.0 21.3 12.6 16.2 16.9 23.7 10.8 13.7
PSI M 28.7 23.9 18.9 20.6 33.6 27.1 21.2 21.4 Confidence SD 9.1 8.8 5.5 7.9 8.6 9.3 4.5 4.7 PSI M 56.7 42.6 32.9 32.7 58.5 47.7 39.2 36.6 Approach SD 12.3 10.4 6.7 8.3 9.4 12.8 8.0 7.5 PSI M 18.9 15.0 12.7 12.0 20.5 17.7 17.1 15.1 Control SD 5.1 5.1 4.1 3.8 12.8 4.4 4.0 4.2 Marital M 6.2 7.3 6.6 7.4 5.9 6.7 6.5 7.1 Happiness SD 1.3 1.3 1.2 1.3 1.4 1.5 1.3 1.2
Note. M = mean; SD = standard deviation; PSI = Problem Solving Inventory.
MARITAL HAPPINESS SCALE
The results indicated an absence of a significant difference between the effective and ineffective scorers on the Marital Happiness scale (respectively, for men and women, F(1, 61) = .66, p < .3); F(1, 61) = .38, p < .5)). The mean scores revealed that both groups of men and women (effective and ineffective scorers) reported similar improvement in their marital satisfaction following the program (see Table 3).
PROBLEM SOLVING INVENTORY
Analyses of the Problem Solving Inventory total scores revealed a significant PSI Group × Time effect for men (F(1, 61) = 18.55, p < .0001) and women (F(1, 61) = 11.05, p < .001). Following the program, women who initially perceived themselves as ineffective problem solvers reported more changes in the overall appraisal of their problem solving abilities than women who, before the program, perceived themselves as effective problem solvers. Sim- ilarly, men who initially appraised themselves as ineffective problem solvers reported more improvements in their overall PSI score following the program than men who initially perceived themselves as effective problem solvers (see Table 3).
The results of the MANOVAs conducted on the Problem Solving Inven- tory subscales revealed a significant PSI Group × Time effect (F(3, 59) = 6.26, p < .001) for women and for men (F(3, 59) = 6.2, p < .001). Univari- ate analyses of variance conducted on the group of women indicated that, following the program, women who initially appraised themselves as inef- fective problem solvers noted more improvement in their problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 113
confidence (F(1, 37) = 9.3, p < .004) and in their approach to problem solv- ing activities (F(1, 37) = 8.03, p < .007) than women who initially appraised themselves as effective problem solvers. The two groups of women (effective and ineffective) did not differ, however, in their perceived personal control following the treatment (see Table 3).
As for the men, subsequent univariate analyses indicated that only the ineffective problem solvers reported improvement in their problem solving confidence (F(1, 61) = 10.5, p < .002), in their approach to problem solving activities (F(1, 61) = 18.4, p < .0001) and in their personal control (F(1, 61) = 9.4, p < .004) following the program (see Table 3).
The results of this study generally support the hypothesis that couples’ marital happiness increases significantly following participation in cognitive- behavioral group marital therapy (Baucom, Epstein, Kirby & LaTaillade, 2010; Butler, Chapman, Forman, & Beck, 2006). Furthermore, the program was shown to significantly alter spouses’ appraisal of their problem solving effi- cacy. More specifically, the results indicated that, following the intervention, partners reported a significant improvement in their capacity to confront dif- ferent problem solving activities. Moreover, in the analyses that measured their perception of control, all measures demonstrated a significant change in the expected direction. After completing the program, spouses appraised themselves as having more confidence in their problem solving capacities, a stronger tendency to face problem solving activities rather than avoid prob- lems, and better personal control of their behaviors while solving problems related to their dyadic interactions. Both the experimental versus control group analyses and the perception of control analyses yielded substantially similar results. Although from the perception of control analyses, there was a significant change in some variables from the pre- to post-waiting period, the impact of the treatment was made clear by the important gains in all measures from post-waiting to post-program. This small initial gain between the pre- and post-waiting period could have been due to habituation to the testing situation and to the instruments and does not challenge the efficacy of the treatment.
The results also suggest that the program helped couples improve their marital adjustment independently of how they initially appraised their prob- lem solving abilities. However, the results indicate that cognitive-behavioral group marital therapy had a differential effect on the improvement of self- perceived problem solving capacities depending on the sex of the partic- ipant and on the initial self-appraisal of his/her problem solving abilities. Generally, the program had a favorable impact on women’s perception of self-efficacy, and women who initially perceived themselves as ineffective
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problem solvers reported even more positive changes following the program than those who initially appraised themselves as effective problem solvers. As for men, only those who initially appraised their problem solving abili- ties as ineffective reported improvement in their problem solving appraisal after completion of the program. However, as was the case for women, the program was less useful in helping men who initially perceived themselves as effective problem solvers to change their cognitions.
These results suggest that cognitive-behavioral marital therapy should include cognitive strategies targeting self-appraisal of problem solving ac- tivities if and only if spouses appraise themselves as ineffective problem solvers before the beginning of the intervention. With partners who appraise themselves as effective problem solvers, this strategy would not be pertinent, and other targets should be identified during the initial assessment. These data are consistent with the results of previous studies that have noted the utility of training for subjects who perceived certain problem solving deficits (Heppner et al., 1988). A possible explanation for the lack of improvement in these spouses could be that they had little room for improvement. For example, the optimal functioning score on the PSI is 32, whereas the highest score, 192, reflects the worst functioning. Men who initially perceived their problem solving abilities as effective had a mean score of 64.5 with a mini- mum approximate score of 51.9, while women had an average score of 77.5 with a minimum approximate score of 66.6. Compared to Heppner’s sample (lowest score of 60; Heppner et al., 1988), it seems that our group of effective problem solvers had particularly strong perceptions of their problem solving abilities. However, both groups reported similar appraisal of their problem solving abilities following treatment.
It is also possible that the program itself might be designed to be a better fit for the needs of subjects who initially perceived themselves as ineffec- tive problem solvers. Group leaders focused on cognitive (beliefs, self-talk, self-monitoring) and behavioral skills (effective concrete steps of problem solving) during instructions, modeling rehearsal, feedback and homework assignments. Yet, because the sessions were conducted in groups of four couples (eight individuals) and two therapists, it was impossible to con- stantly create individualized learning experiences. It is possible that a more individualized focus on participants’ self-appraisal of problem solving abili- ties would have produced higher gains in the spouses who initially perceived themselves to be effective problem solvers.
The findings of the present study are interesting for several reasons. First, the results support the effectiveness of group marital therapy in altering the cognitive process of self-perceived ineffective problem solvers. Even if treatments for couples paradigms recognize the role of cognitive variables, very few outcome studies have paid attention to this particular aspect.
These results dovetail nicely, on one hand, with a study by Heppner and his colleagues (1982), who have demonstrated that problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 115
self-appraisal is directly related to problem solving competence and, on the other hand, with a previous study by Sabourin and his colleagues (1990), who demonstrated that problem solving self-appraisal is also related to mar- ital adjustment and to specific coping efforts. This research showed that distressed spouses showed less problem solving confidence, a tendency to avoid different problem solving activities, and poor strategies to con- trol their behavior. Thus, in the clinical evaluation of the partners before starting couple therapy, it would be important to verify the couple’s ap- praisal of their problem solving abilities. If partners demonstrate a lack of empowerment, learned helplessness or self-perception of a low capacity to solve problems, the proposed therapeutic intervention should have a positive effect on the development and maintenance of effective problem solving behaviors and consequently on the long-term improvement of their relationship.
This study has some limitations. There was no follow-up after the con- clusion of treatment to verify if changes in self-appraisal remained in the ab- sence of therapy. Future research should replicate these findings and assess the long-term effects of cognitive-behavioral group marital therapy on the maintenance of effective problem solving self-appraisal and marital satisfac- tion. Furthermore, given the interaction between the initial levels of problem solving self-appraisal and the amount of perceptual change, it would also be important to study subjects who are initially different in their levels of perceived and observed problem solving efficacy (Baucom & Kerig, 2004; Heyman, 2001). It is also possible that this treatment is not unique in its effect on the person’s sense of self-appraisal and that individual therapy, use of homework in therapy, and even other forms of couple therapy may also have improved these skills.
Another limitation is related to the nature of the measurement used for appraising problem solving abilities. Because this study focused on self- report of problem solving efficacy, inferences regarding related changes in overt problem solving skills are not yet warranted. Future research should examine if problem solving self-appraisal bears a relation to the actual prob- lem solving behaviors of spouses. Therefore, as suggested by Bélanger and his colleagues (2012), behavioral modifications of problem solving inter- actions should be included in future studies. Along these lines, our team recently investigated the relationship between specific coping strategies and problem solving/communication behaviors in close relationships (Bélanger et al., 2012). Observed behaviors were coded using a macroscopic coding system for dyadic interactions (Belanger et al., 1993). For both men and women, results showed significant relationships between coping strategies, problem solving, marital interactions, and marital adjustment (Bélanger et al., 2012). It would be interesting to test how these interactions may change af- ter a cognitive behavioral marital program such as the one we tested in this research.
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It might also be of interest to see if a cognitive behavioral program for couples that incorporated dyadic coping skills would be helpful for predict- ing marital adjustment. Bodenmann and his colleagues (2001) tested such a program, the Couples Coping Enhancement Training for couples. These researchers showed that following the intervention, couples reported a sig- nificant increase in their appraisal of a number of domains and an increase in the quality of their marital relationship (Bodenmann, Charvoz, Cina, & Wid- mer, 2001). It would be interesting for future studies to integrate appraisals of coping skills and problem solving and of the actual behavioral capacities to get involved and solve problems (Bélanger et al., 1993).
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