Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Themenschwerpunkt

Paarbasierte Psychotherapie: Ein Review über die Wirksamkeit kognitiv-verhaltenstherapeutischer Ansätze mit Paaren bei psychischen Störungen

Published Online:September 21, 2020https://doi.org/10.1024/1661-4747/a000419

Abstract

Zusammenfassung. Dieser Artikel gibt einen Überblick über die Wirksamkeit paarbasierter kognitiv-verhaltenstherapeutischer Psychotherapie bei psychischen Störungen. In den vergangenen zwei Jahrzehnten wurden Ansätze aus der kognitiv-verhaltenstherapeutischen Paartherapie systematisch mit Interventionen der kognitiven Verhaltenstherapie (KVT) integriert und für die Behandlung eines breiten Spektrums individueller psychopathologischer Erkrankungen weiterentwickelt. Diese Ansätze grenzen sich deutlich von einer Paartherapie im klassischen Sinne ab und können als Psychotherapie bei einer psychischen Störung mit Krankheitswert unter Einbezug der Partnerin oder des Partners gewertet werden. Zentrale Konzepte der paarbasierten KVT werden kurz vorgestellt und die Ergebnisse klinischer Studien zusammengefasst. Insgesamt zeigen klinische Studien bei Depressionen, Substanzkonsumstörungen, Angststörungen, Zwangsstörungen, Posttraumatischen Belastungsstörungen und Essstörungen signifikante Verbesserungen der Symptomatik und sind somit mindestens ebenso wirksam, wenn nicht wirksamer, als Einzelbehandlungen. Darüber hinaus zeigen sich in der paarbasierten KVT häufig auch Verbesserungen in der Partnerschaftsqualität sowie zum Teil in Faktoren wie Expressed Emotion oder Symptomakkommodation, welches beides Risikofaktoren für den Therapieverlauf sowie für ein Wiederauftreten der Störung sind. Dringend benötigt werden zusätzliche randomisiert-kontrollierte Studien für einen direkten Vergleich mit individueller KVT, welcher für einige Störungen noch nicht vorliegt, sowie für eine genauere Untersuchung von Faktoren, die eine paarbasierte KVT vs. eine individuelle KVT indizieren würden. Abschließend werden klinische Empfehlungen bezüglich der Indikation und Durchführung einer paarbasierten KVT zusammengefasst.


Couple-based psychotherapy: A review of the efficacy of cognitive-behavioral interventions for couples with mental disorders

Abstract. This article reviews the efficacy of couple-based, cognitive-behavioral interventions for psychopathology. Over the past two decades, cognitive-behavioral couples therapy has been adapted and systematically integrated with individual cognitive-behavioral therapy for the treatment of a range of individual mental disorders. These integrated approaches are distinct from typical couples therapy and serve as psychotherapy interventions with a primary focus on the disorder, while incorporating partners in the treatment. The article introduces core concepts of couples-based interventions and reviews the findings of clinical trials. Overall, clinical trials of couple-based interventions for depression, substance-use disorders, anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, and eating disorders show significant symptom improvements that are always at least as large and often larger than that found in individual treatments where a comparison is available. Additionally, couple-based interventions often have significant positive effects on relationship satisfaction as well as interpersonal risk factors for adverse treatment outcomes and relapse such as expressed emotion and symptom accommodation. Further randomized controlled trials are needed to provide a direct comparison with individual cognitive behavioral therapy for several disorders and to pinpoint factors that support clinical decision making to recommend an individual versus couple-based treatment. Finally, clinical recommendations are summarized briefly.

Literatur

  • Abramowitz, J. S. , Baucom, D. H. , Boeding, S. , Wheaton, M. G. , Pukay-Martin, N. D. , Fabricant, L. E. et al. (2013). Treating obsessive-compulsive disorder in intimate relationships: A pilot study of couple-based cognitive-behavior therapy. Behavior Therapy , 44 , 395–407. First citation in articleCrossref, Google Scholar

  • Barbato, A. & D'Avanzo, B. (2008). Efficacy of couple therapy as a treatment for depression: A meta-analysis. Psychiatric Quarterly , 79 , 121–132. First citation in articleCrossref, Google Scholar

  • Baucom, D. H. , Fischer, M. S. , Corrie, S. , Worrell, M. & Boeding, S. (2020). Treating relationship distress and psychopathology in couples: A cognitive-behavioural approach . London, UK: Routledge. First citation in articleGoogle Scholar

  • Baucom, D. H. , Fischer, M. S. , Worrell, M. , Corrie, S. , Belus, J. M. , Molyva, E. et al. (2018). Couple-based intervention for depression: An effectiveness study in the National Health Service in England. Family Process , 57 , 275–292. First citation in articleCrossref, Google Scholar

  • Baucom, D. H. , Kirby, J. S. , Fischer, M. S. , Baucom, B. R. , Hamer, R. & Bulik, C. M. (2017). Findings from a couple-based open trial for adult anorexia nervosa. Journal of Family Psychology , 31 , 584–591. First citation in articleCrossref, Google Scholar

  • Baucom, D. H. , Shoham, V. , Mueser, K. T. , Daiuto, A. D. & Stickle, T. R. (1998). Empirically supported couple and family interventions for marital distress and adult mental health problems. Journal of Consulting and Clinical Psychology , 66 , 53–88. First citation in articleCrossref, Google Scholar

  • Beach, S. R. H. & Whisman, M. A. (2012). Affective disorders. Journal of Marital and Family Therapy , 38 , 201–219. First citation in articleCrossref, Google Scholar

  • Bodenmann, G. (2012). Verhaltenstherapie mit Paaren: Ein bewältigungsorientierter Ansatz. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Bodenmann, G. , Plancherel, B. , Beach, S. R. , Widmer, K. , Gabriel, B. , Meuwly, N. et al. (2008). Effects of coping-oriented couples therapy on depression: A randomized clinical trial. Journal of Consulting and Clinical Psychology , 76 , 944–954. First citation in articleCrossref, Google Scholar

  • Boeding, S. E. , Paprocki, C. M. , Baucom, D. H. , Abramowitz, J. S. , Wheaton, M. G. , Fabricant, L. E. et al. (2013). Let me check that for you: Symptom accommodation in romantic partners of adults with Obsessive – Compulsive Disorder. Behaviour Research and Therapy , 51 , 316–322. First citation in articleCrossref, Google Scholar

  • Bowers, T. G. & Alredha, M. R. (1990). A comparison of outcome with group/marital and standard individual therapies with alcoholics. Journal of Studies on Alcohol , 51 , 301–309. First citation in articleCrossref, Google Scholar

  • Campbell, S. B. , Renshaw, K. D. , Kashdan, T. B. , Curby, T. W. & Carter, S. P. (2017). A daily diary study of posttraumatic stress symptoms and romantic partner accommodation. Behavior Therapy , 48 , 222–234. First citation in articleCrossref, Google Scholar

  • Cohen, S. , O' Leary, K. D. & Foran, H. (2010). A randomized clinical trial of a brief, problem-focused couple therapy for depression. Behavior Therapy , 41 , 433–446. First citation in articleCrossref, Google Scholar

  • Daiuto, A. D. , Baucom, D. H. , Epstein, N. B. & Dutton, S. S. (1998). The application of cognitive-behavioral marital therapy to the assessment and treatment of agoraphobia: Implications of empirical research. Clinical Psychology Review , 18 , 663–687. First citation in articleCrossref, Google Scholar

  • DGPPN, BÄK, KBV, AWMF (Hrsg.) für die Leitliniengruppe Unipolare Depression. (2015). S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung , 2. Auflage . Version5. Verfügbar unter: www.depression.versorgungsleitlinien.de First citation in articleGoogle Scholar

  • Epstein, E. E. , McCrady, B. S. , Morgan, T. J. & Cook, S. M. (2007). Couples treatment for drug-dependent males: Preliminary efficacy of a stand alone outpatient model. Addictive Disorders and Their Treatment , 6 , 21–37. First citation in articleCrossref, Google Scholar

  • Epstein, N. B. & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy for couples: A contextual approach . Washington, DC: American Psychological Association. First citation in articleCrossref, Google Scholar

  • Fischer, M. S. , Baucom, D. H. & Cohen, M. J. (2016). Cognitive-behavioral couple therapies: Review of the evidence for the treatment of relationship distress, psychopathology, and chronic health conditions. Family Process , 55 , 423–442. First citation in articleCrossref, Google Scholar

  • Fredman, S. J. , Baucom, D. H. , Boeding, S. E. & Miklowitz, D. J. (2015). Relatives' emotional involvement moderates the effects of family therapy for bipolar disorder. Journal of Consulting and Clinical Psychology , 83 , 81–91. First citation in articleCrossref, Google Scholar

  • Fredman, S. J. , Macdonald, A. , Monson, C. M. , Dondanville, K. A. , Blount, T. H. , Hall-Clark, B. N. et al. (2019, in Druck). Intensive, Multi-Couple Group Therapy for PTSD: A nonrandomized pilot study with military and veteran dyads. Behavior Therapy . doi:10.1016/j.beth.2019.10.003 First citation in articleGoogle Scholar

  • Fredman, S. J. , Pukay-Martin, N. D. , Macdonald, A. , Wagner, A. C. , Vorstenbosch, V. & Monson, C. M. (2016). Partner accommodation moderates treatment outcomes for couple therapy for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology , 84 , 79–87. First citation in articleCrossref, Google Scholar

  • Fruzzetti, A. E. & Fruzzetti, A. R. (2003). Borderline personality disorder. In D. K. Snyder M. A. Wishman (Eds.), Treating difficult couples: Helping clients with coexisting mental and relationship disorders. (pp.235–260). New York, NY: Guilford Press. First citation in articleGoogle Scholar

  • Gottman, J. M. (1994). What predicts divorce? The relationship between marital processes and marital outcomes . Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. First citation in articleGoogle Scholar

  • Gray, T. D. , Hawrilenko, M. & Cordova, J. V. (2019). Randomized controlled trial of the marriage checkup: Depression outcomes. Journal of Marital and Family Therapy . doi:10.1111/jmft.12411 First citation in articleGoogle Scholar

  • Hahlweg, K. & Wiedemann, G. (2002). Principles and results of family therapy in schizophrenia. In A. Schaub (Ed.), New family interventions and associated research in psychiatric disorders: Gedenkschrift in honor of Michael J. Goldstein (pp.155–173). Wien: Springer. First citation in articleGoogle Scholar

  • Hahlweg, K. & Wiedemann, G. (2006). Familienbetreuung schizophrener Patienten: Ein verhaltenstherapeutischer Ansatz zur Rückfallprophylaxe ( 2., überarb. und erw. Aufl. ). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Hooley, J. M. (2007). Expressed emotion and relapse of psychopathology. Annual Review of Clinical Psychology , 3 , 329–352. First citation in articleCrossref, Google Scholar

  • Hooley, J. M. & Miklowitz, D. J. (2018). Families and mental disorders. In J. N. Butcher J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders (pp.687–703). Washington, DC: American Psychological Association. First citation in articleGoogle Scholar

  • Jacobson, N. S. & Christensen, A. (1998). Acceptance and change in couple therapy: A therapist’s guide to transforming relationships ( 2nd ed. ). New York, NY: Norton. First citation in articleGoogle Scholar

  • Jacobson, N. S. & Margolin, G. (1979). Marital therapy: Strategies based on social learning and behavior exchange principles . New York, NY: Brunner/Mazel. First citation in articleGoogle Scholar

  • Kirby, J. S. & Baucom, D. H. (2007). Treating emotional dysregulation in a couples context: A pilot study of a couples skills group intervention. Journal of Marital and Family Therapy , 33 , 375–391. First citation in articleCrossref, Google Scholar

  • Lee, B. K. & Awosoga, O. (2015). Congruence couple therapy for pathological gambling: A pilot randomized controlled trial. Journal of Gambling Studies , 31 , 1047–1068. First citation in articleCrossref, Google Scholar

  • Macdonald, A. , Pukay-Martin, N. D. , Wagner, A. C. , Fredman, S. J. & Monson, C. M. (2016). Cognitive-behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. Journal of Family Psychology , 30 , 157–162. First citation in articleCrossref, Google Scholar

  • McCrady, B. S. & Epstein, E. E. (2009). Overcoming alcohol problems: A couples-focused program . New York, NY: Oxford University Press. First citation in articleGoogle Scholar

  • McCrady, B. S. , Epstein, E. E. , Cook, S. , Jensen, N. & Hildebrandt, T. (2009). A randomized trial of individual and couple behavioral alcohol treatment for women. Journal of Consulting and Clinical Psychology , 77 , 243–256. First citation in articleCrossref, Google Scholar

  • McCrady, B. S. , Epstein, E. E. , Hallgren, K. A. , Cook, S. & Jensen, N. K. (2016). Women with alcohol dependence: A randomized trial of couple versus individual plus couple therapy. Psychology of Addictive Behaviors , 30 , 287–299. First citation in articleCrossref, Google Scholar

  • McCrady, B. S. , Noel, N. E. , Abrams, D. B. , Stout, R. L. , Nelson, H. F. & Hay, W. M. (1986). Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment. Journal of Studies on Alcohol , 47 , 459–467. First citation in articleCrossref, Google Scholar

  • McCrady, B. S. , Stout, R. , Noel, N. & Abrams, D. (1991). Effectiveness of three types of spouse-involved behavioral alcoholism treatment. British Journal of Addiction , 86 , 1415–1424. First citation in articleCrossref, Google Scholar

  • Miklowitz, D. J. , George, E. L. , Richards, J. A. , Simoneau, T. L. & Suddath, R. L. (2003). A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry , 60 , 904–912. First citation in articleCrossref, Google Scholar

  • Monson, C. M. & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for PTSD: Harnessing the healing power of relationships . New York, NY: Guilford Press. First citation in articleGoogle Scholar

  • Monson, C. M. , Fredman, S. J. , Macdonald, A. , Pukay-Martin, N. D. , Resick, P. A. & Schnurr, P. P. (2012). Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. Journal of the American Medical Association , 308 , 700–709. First citation in articleCrossref, Google Scholar

  • Ngai, F. W. , Wong, P. C. , Chung, K. F. , Chau, P. H. & Hui, P. W. (2020). Effect of couple-based cognitive behavioural intervention on prevention of postnatal depression: multisite randomised controlled trial. Bjog , 127 , 500–507. First citation in articleCrossref, Google Scholar

  • National Institute for Health and Care Excellence. (2016). Depression in adults: Recognition and management . Verfügbar unter: https://www.nice.org.uk/guidance/cg90. First citation in articleGoogle Scholar

  • Nilsson, A. , Magnusson, K. , Carlbring, P. , Andersson, G. & Gumpert, C. H. (2018). The development of an internet-based treatment for problem gamblers and concerned significant others: A pilot randomized controlled trial. Journal of Gambling Studies , 34 , 539–559. First citation in articleCrossref, Google Scholar

  • O'Farrell, T. J. , Cutter, H. S. G. , Choquette, K. A. , Floyd, F. J. & Bayog, R. D. (1992). Behavioral marital therapy for male alcoholics: Marital and drinking adjustment during the two years after treatment. Behavior Therapy , 23 , 529–549. First citation in articleCrossref, Google Scholar

  • O'Farrell, T. J. , Cutter, H. S. G. & Floyd, F. J. (1985). Evaluating behavioral marital therapy for male alcoholics: Effects on marital adjustment and communication from before to after treatment. Behavior Therapy , 16 , 147–167. First citation in articleCrossref, Google Scholar

  • O'Farrell, T. J. & Fals-Steward, W. (2006). Behavioral couples therapy for alcoholism and drug abuse . Journal of Substance Abuse Treatment , 18, 51–54. First citation in articleGoogle Scholar

  • O’Farrell, T. J. , Schumm, J. A. , Murphy, M. M. & Muchowski, P. M. (2017). A randomized clinical trial of behavioral couples therapy versus individually-based treatment for drug-abusing women. Journal of Consulting and Clinical Psychology , 85 , 309–322. First citation in articleCrossref, Google Scholar

  • Pukay-Martin, N. D. , Torbit, L. , Landy, M. S. , Wanklyn, S. G. , Shnaider, P. , Lane, J. E. et al. (2015). An uncontrolled trial of a present-focused cognitive-behavioral conjoint therapy for posttraumatic stress disorder. Journal of Clinical Psychology , 71 , 302–312. First citation in articleCrossref, Google Scholar

  • Powers, M. B. , Vedel, E. & Emmelkamp, P. M. (2008). Behavioral couples therapy (BCT) for alcohol and drug use disorders: A meta-analysis. Clinical Psychology Review , 28 , 952–962. First citation in articleCrossref, Google Scholar

  • Renshaw, K. D. , Allen, E. S. , Fredman, S. J. , Giff, S. T. & Kern, C. (2020). Partners' motivations for accommodating posttraumatic stress disorder symptoms in service members: The reasons for accommodation of PTSD scale. Journal of Anxiety Disorders , 71 , 102199. First citation in articleCrossref, Google Scholar

  • Robles, T. F. & Kiecolt-Glaser, J. K. (2003). The physiology of marriage: Pathways to health. Physiology & Behavior , 79 , 409–416. First citation in articleCrossref, Google Scholar

  • Runfola, C. D. , Kirby, J. S. , Baucom, D. H. , Fischer, M. S. , Baucom, B. R. W. , Matherne, C. E. et al. (2018). A pilot open trial of UNITE-BED: A couple-based intervention for binge-eating disorder. International Journal of Eating Disorders , 51 , 1107–1112. First citation in articleCrossref, Google Scholar

  • Rusu, P. , Bodenmann, G. & Kayser, K. (2018). Cognitive emotion regulation and positive dyadic outcomes in married couples. Journal of Social and Personal Relationships , 36 , 359–376. First citation in articleCrossref, Google Scholar

  • Schindler, L. , Hahlweg, K. & Revenstorf, D. (2019). Partnerschaftsprobleme: Diagnose und Therapie: Handbuch für den Therapeuten ( 3. Aufl. ). Berlin: Springer. First citation in articleCrossref, Google Scholar

  • Schumm, J. A. , Fredman, S. J. , Monson, C. M. & Chard, K. M. (2013). Cognitive-behavioral conjoint therapy for PTSD: Initial findings for Operations Enduring and Iraqi Freedom male combat Veterans and their partners. American Journal of Family Therapy , 41 , 277–287. First citation in articleCrossref, Google Scholar

  • Schumm, J. A. , Monson, C. , O'Farrell, T. J. , Gustin, N. G. & Chard, K. M. (2015). Couple treatment for alcohol use disorder and posttraumatic stress disorder: Pilot results from U.S. military veterans and their partners. Journal of Traumatic Stress , 28 , 247–252. First citation in articleCrossref, Google Scholar

  • Schumm, J. A. , O'Farrell, T. J. & Andreas, J. B. (2012). Behavioral couples therapy when both partners have a current alcohol use disorder. Alcoholism Treatment Quarterly , 30 , 407–421. First citation in articleCrossref, Google Scholar

  • Schumm, J. A. , O'Farrell, T. J. , Kahler, C. W. , Murphy, M. M. & Muchowski, P. (2014). A randomized clinical trial of behavioral couples therapy versus individually based treatment for women with alcohol dependence. Journal of Consulting and Clinical Psychology , 82 , 993–1004. First citation in articleCrossref, Google Scholar

  • Schumm, J. A. , O'Farrell, T. J. , Murphy, M. M. & Muchowski, P. (2019). Efficacy of behavioral couples therapy versus individual recovery counseling for addressing posttraumatic stress disorder among women with drug use disorders. Journal of Traumatic Stress , 32 , 595–605. First citation in articleCrossref, Google Scholar

  • Sepulveda, A. R. , Kyriacou, O. & Treasure, J. (2009). Development and validation of the accommodation and enabling scale for eating disorders (AESED) for caregivers in eating disorders. BMC Health Services Research , 9 : 171. First citation in articleCrossref, Google Scholar

  • Stuart, R. B. (1969). Operant-interpersonal treatment for marital discord. Journal of Consulting and Clinical Psychology , 33 , 675–682. First citation in articleCrossref, Google Scholar

  • University of North Carolina. (2012). UCAN2: Uniting couples in the treatment of anorexia nervosa . Verfügbar unter: https://clinicaltrials.gov/show/NCT01740752 First citation in articleGoogle Scholar

  • Vedel, E. , Emmelkamp, P. M. G. & Schippers, G. M. (2008). Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: A comparative evaluation in community-based addiction treatment centers. Psychotherapy and Psychosomatics , 77 , 280–288. First citation in articleCrossref, Google Scholar

  • Walitzer, K. S. & Dermen, K. H. (2004). Alcohol-focused spouse involvement and behavioral couples therapy: Evaluation of enhancements to drinking reduction treatment for male problem drinkers. Journal of Consulting and Clinical Psychology , 72 , 944–955. First citation in articleCrossref, Google Scholar

  • Warth, M. , Stoffel, M. , Winter, F. , Jarczok, M. N. , Aguilar-Raab, C. , & Ditzen, B. (2020). Instructed Partnership Appreciation in Depression: Effects on Mood, Momentary Relationship Satisfaction, and Psychobiological Arousal. Frontiers in Psychiatry , 11 (701). https://doi.org/10.3389/fpsyt.2020.00701 First citation in articleCrossref, Google Scholar

  • Whisman, M. A. (2001). Marital adjustment and outcome following treatments for depression. Journal of Consulting and Clinical Psychology , 69 , 125–129. First citation in articleCrossref, Google Scholar

  • Whisman, M. A. (2007). Marital distress and DSM-IV psychiatric disorders in a population-based national survey. Journal of Abnormal Psychology , 116 , 638–643. First citation in articleCrossref, Google Scholar

  • Whisman, M. A. & Baucom, D. H. (2012). Intimate relationships and psychopathology. Clinical Child and Family Psychology Review , 15 , 4–13. First citation in articleCrossref, Google Scholar

  • Zietlow, A.-L. , Eckstein, M. , Hernández, C. , Nonnenmacher, N. , Reck, C. , Schaer, M. et al. (2019). Dyadic coping and its underlying neuroendocrine mechanisms—Implications for stress regulation. Frontiers in Psychology , 9 : 2600. doi:10.3389/fpsyg.2018.02600 First citation in articleCrossref, Google Scholar

  • Zietlow, A.-L. , Heinrichs, M. & Ditzen, B. (2016). Psychobiologie Sozialer Nähe – Zusammenhänge mit Stress und Gesundheit im Entwicklungsverlauf. Psychotherapie im Dialog , 3 , 82–85. First citation in articleGoogle Scholar