Behavioral Couple Therapy for Depression
Status: Modest Research Support
Behavioral couple therapy (BCT) is designed for couples with relationship distress and one depressed partner. This therapy addresses couple distress that decreases closeness and support, increases conflict, and influences the course of depression. BCT includes behavioral interventions that focus on exchanges between partners, communication, and problem solving. In addition, therapists focus on increasing caring behaviors and reducing conflict between partners. Couple therapy is designed to decrease depression and also improve relationship functioning. BCT typically includes 12 to 20 sessions. Gupta, Coyne, and Beach (2003) note that clinicians should carefully consider the extent to which relationship distress plays a role in the depression and the ability of the depressed partner to participate actively in conjoint sessions, especially when the depression is severe.
The late Neil Jacobsen and Andrew Christensen (1996) extended BCT and developed integrative behavioral couples therapy (IBCT). IBCT brings together the behavioral emphasis on active change with acceptance-based strategies that promote emotional acceptance between partners and decrease their emotional reactivity to each other. Although IBCT is an extension of traditional behavior couples therapy, this more recent version has not been examined specifically as a treatment for depression.
Key References (in reverse chronological order)
Christensen, A., Atkins, D. C., Yi, J., Baucom, D. H., & George, W. H. (2006). Couple and individual adjustment for two years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Journal of Consulting and Clinical Psychology, 74, 1180-1191.
Gupta, M, Coyne, J. C., & Beach, R. H. (2003). Couples treatment for major depression: Critique of the literature and suggestions for some different directions, Journal of Family Therapy, 25, 317-346.
Emanuels-Zuurveen, L., & Emmelkamp, P. M. (1996). Individual behavioral-cognitive therapy vs. marital therapy for depression in martially distressed couples. British Journal of Psychiatry, 169, 181-188.
Jacobson, N. S., Fruzzetti, A. E., Dobson, K., Whisman, M.. & Hops, H. (1993). Couple therapy as a treatment for depression: The effects of relationship quality and therapy on depressive relapse.Journal of Consulting and Clinical Psychology, 59, 547-557
Beach, S. R. H., & O'Leary K. D. (1992). Treating depression in the context of marital discord: Outcome, and predictors of response for marital therapy versus cognitive therapy. Behavior Therapy, 23, 507-528.
Jacobson, N.S., Dobson, K., Fruzzeti, A.E., Schmaling, K.B., & Salusky, S. (1991). Marital therapy as a treatment for depression. Journal of Consulting and Clinical Psychology, 59, 547-557.
Snyder, D. K., & Whisman, M. A. (Eds.). (2003). Treating difficult couples: Helping clients with coexisting mental and relationship disorders. New York: Guilford Press.
Whisman, M. A., & Uebelacker, L. A. (1999). Integrating couple therapy with individual therapies and antidepressant medications in the treatment of depression. Clinical Psychology: Science and Practice, 6, 415-429.
Jacobson, N. S., & Christensen, A. (1996). Integrative couples therapy: Promoting acceptance and change. New York: Norton.
Beach, S. R. H., Sandeen, E. E., & O'Leary, K. D. (1990). Depression in marriage: A model for etiology and treatment. New York: Guilford Press.
For training opportunities see the American Association of Marital and Family Therapy website or contact the authors of the treatment manuals:
Steven Beach, K. Daniel O'Leary, and Andrew Christensen.
Mark A. Whisman. Cognitive therapy for depression. Produced by American Psychological Association's APA Psychotherapy Videos, April 2007.