Academic journal article Journal of Marital and Family Therapy

Marital Distress, Co-Occurring Depression, and Marital Therapy: A Review

Academic journal article Journal of Marital and Family Therapy

Marital Distress, Co-Occurring Depression, and Marital Therapy: A Review

Article excerpt

This article reviews several factors that contribute to marital distress and co-occurring depression and also reviews empirically supported therapies. Gender contributes to marital distress and depression but does not appear to be the cause of either. Marital distress and depression appear to have bidirectional influence on each other. The depressed spouse's depression has a marked impact on the marital adjustment of the nondepressed spouse. Both marital distress and depression appear to be chronic. It is recommended that treatment be designed to help couples be supportive of each another, to adapt, and to cope with the depressive symptoms within the framework of their ongoing marital relations.

The co-occurring relationship between marital distress and depression has been well-documented (Fincham, Beach, Harold, & Osborne, 1997) and appears to exist across all marital age groups (Cotton, 1999). Depression has long been recognized as a public health problem (Kaelber, Moul, & Farmer, 1995) and recently Miller (2000) has made a case for marital distress as a public health problem. Both depression and marital dissatisfaction have been shown to have negative effects on clients' physical health (Kiecolt-- Glaser & Newton, 2001) and both appear to cause distressing behaviors, thoughts, and emotions, which disrupt marital, family, work, and other aspects of clients' lives. Burman and Margolin (1992), in a review of marital relationships and health problems, suggest that when a spouse has a chronic illness that the partner may be at risk. This suggests that interventions for co-occurring marital distress and depression should include both partners. The purpose of this article is to explore some of the factors that contribute to marital distress and co-occurring depression and to review treatments that may be efficacious in treating them simultaneously.

DEFINITIONS AND DIAGNOSTIC INDICATORS

Marital Distress

Marital distress has been defined as situations in which partners experience communication and problem-solving difficulties, find it difficult to work together, and have difficulty accepting each other's differences (Jacobson & Christensen, 1996). It has been found that distressed couples exchange fewer rewarding behaviors and more aversive behaviors than do nondistressed couples, and this holds for both verbal communications and for the exchange of other forms of reinforcers (Holtzworth-Munroe & Jacobson, 1991). It has also been found that distressed spouses are more likely than nondistressed spouses to reciprocate each other's use of aversive stimuli (Gottman, 1994) and to be more sensitive to their partner's use of aversive stimuli (Jacobson, Waldron, & Moore, 1980). It has been suggested that few marital problems remit spontaneously (Johnson, Makinen, & Millikin, 2001).

Treatment for marital distress for mild to moderate cases has been shown to be efficacious (Alexander, Holtzworth-Monroe, & Jameson, 1994). However, in study after study, treatment effects have been found to drop off after 1 or 2 years (Christensen & Heavey, 1999) with the exception of one study of insight-- marital therapy, which reported effects continued at a 4-year follow up (Snyder & Wills, 1989). Numerous reasons for marital therapy not having more lasting effects have been suggested, including life-long difficulties in attachment (Johnson et al., 2001) and intractable interpersonal differences (Gottman, Ryan, Carrere, & Erley, 2002). From a behavioral learning point of view, relapses may be a function of the return of environmental conditions that are similar to the conditions that initially shaped and maintained the dysfunctional behavior. Whatever the cause, it seems apparent that marital therapy is not like surgery. If the surgeon removes an appendix, she or he can pretty well guarantee that the patient will never again have appendicitis. Nothing comparable occurs in marital therapy. …

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