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There is a strong association between alcohol use disorder (AUD) and intimate partner violence (IPV), both widely prevalent global health issues. However, few interventions target both IPV and AUD, include both partners in the intervention, and are delivered by non-specialist providers in low- and middle-income country (LMIC) settings with scarce mental health resources. This paper describes the protocol for a randomized controlled trial of a combined motivational interviewing (MI) and behavioral couples therapy (BCT) intervention delivered in urban primary care settings in India by nurses with no behavioral health training prior to joining the study. A total of 400 couples will be enrolled and randomized to one of two arms: an intervention arm comprised of 10, hour-long sessions of the MI + BCT intervention, and a control arm receiving enhanced usual care and medical-legal referrals. Data collection will take place at five timepoints: baseline (pre-intervention), three-, six-, nine-, and 12-month follow-ups. Primary quantitative outcomes include the frequency of intimate partner violence over the last 6 months and self-reported quantity and frequency of alcohol use, drinking behaviors, and alcohol-related problems as assessed on the Alcohol Use Disorders Identification Test (AUDIT). Secondary outcomes include number of days with a negative breathalyzer test over a one-week period, communication patterns, and the quality of marital relationship. Qualitative interviews with a sub-sample (n = 40 couples) from the intervention arm will take place immediately post-intervention and at 12 months to explore underlying mechanisms of change. If successful, study results can inform future efforts to develop scalable interventions for IPV and AUD that can be sustained in the Indian public health system through existing PHC staff and infrastructure and be adapted to similar sociocultural settings.

Couples therapy is challenging in many ways because there are two people who are in distress, each wanting more from their partner, to be understood, and to be responded to emotionally. A common denominator in a variety of approaches to treating couples is verbal communication. This relies on what is available cognitively to the couple. However, sources of tension and disconnection are often outside of their awareness, limiting the effectiveness of the treatment. Somatic-based approaches have strategies that both enable clients to access emotional experience that is held in their implicit memory and is outside of awareness; and regulate nervous system response, which is necessary to fully avail oneself of the growth process of therapy. These somatic-based approaches have been designed for individual therapy. I have adapted some of these somatic interventions to the couple dyad and have found this to be a crucial addition to couple’s therapy. Key components are providing and maintaining structure in session, tracking the body for signs of nervous system activation, employing strategies for nervous system regulation and implementing directed interventions. This somatic-based approach enables couples to communicate more effectively, respond to each other emotionally, solve problems between them and sets the conditions for memory reconsolidation to take place.

Over the past three decades, the theory and practice of couple therapy has moved towards integrative approaches. Typically, two or more couple therapy theories and their associated practices are blended into a more comprehensive, flexible approach to conceptualizing and intervening with couples’ problems. Emerging findings from social and affective neuroscience are also increasingly incorporated. This article argues for broadening integrative efforts to include the perspectives and products of the arts and humanities into couple therapy, with a focus on music. The article presents the rationale for this broadened scope of integration by discussing E. O. Wilson’s consilience theory and its bearing on the distinctions and convergence among the science, craft, and art of therapy. The research on the neuroscience of music and the role of music in affective experience, expression, and intimate relationships strongly supports use of music in transformative work with couples. Music theory and arts provide a useful framework for creating novel theories about couple relationships, for observing and understanding distressed couples’ problematic patterns, and for formulating interventions. Sensitivity to the musical aspects of therapists’ communicative behavior can increase the impact of interventions. The article provides a practical framework for utilizing music in couple therapy, and includes several illustrative case examples.

A multi-site pilot randomized controlled trial of Congruence Couple Therapy (CCT) for problem gambling was conducted in Ontario and Alberta, Canada from 2009 to 2011. The purpose was to assess the feasibility of a full trial and to identify methodological modifications to enhance future trials. The sample (N = 30; 15 couples) consisted of 66 % male gamblers and 34 % female. Mean age of sample was 49.1 years. Baseline mean DSM-IV gambling score was 8.7/10. Retention of the treatment couples was 89 % at 2-month follow-up. Retention of control couples was 78 %. A randomized controlled design compared the status of couples in treatment condition to control condition. Treatment couples received 12-week CCT while control couples received three brief check-ins over 12 weeks. No significant difference was found between treatment and control group at baseline on all measures. At (1) week 12 post-treatment, and (2) week 20 follow-up, significant treatment effects were found for gambling symptoms (p = 0.008; p = 0.041), mental distress (p = 0.001; p = 0.035), and family systems function (p = 0.023; p = 0.054) between treatment and control group. Within group changes for treatment couples over time were significant for mental distress (p = 0.000), dyadic adjustment (p = 0.002), and family systems function (p = 0.000). On similar measures, control group showed non-significant improvement. Future methodological changes, advantages and disadvantages of multi-site partnerships with community treatment agencies are discussed. Of interest is that control participants showed unintended improvement. CCT as a treatment was favourably accepted by counselors, problem gamblers and their spouses. Positive outcome trends ranging from small to large effect size on key measures indicate that a full-scaled trial will require approximately 140 couples and is an investment worth pursuing.

\"Cognitive Behavioural Couple Therapy (CBCT) is an enhanced and contextually grounded approach that provides evidence based strategies for working with couple distress, as well as individual psychopathology in the context of a distressed relationship. Cognitive Behavioural Couple Therapy: Distinctive Features explores this truly integrative and experiential way of working. This model has significantly widened the traditional CBT focus on cognition and behaviour to include an equal emphasis on emotion, stable individual differences and vulnerabilities, as well as an awareness of the importance of the environment and the wider context for couple relationships. Comprising 30 key points, and divided into two parts--Theory and Practice--this concise book includes numerous clinical examples that illustrate the key features of Cognitive Behavioural Couple Therapy. It will offer essential guidance for students, practitioners experienced in individual CBT, as well as practitioners of couple therapy from other theoretical orientations who require an accessible guide to the distinctive theoretical and practical features of this contemporary approach. \"-- Provided by publisher.

Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients' percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=-17.4, 95% CI -36.1 to 1.4; P=.07; Hedges g=-0.53), while the percentage of drinking days was relatively equal between patient groups (β=-2.1, 95% CI -24.8 to 20.7; P=.85; Hedges g=-0.12). Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549.