FEATURES

Evidence Base Update on the Efficacy and Effectiveness of Couple and Family Interventions, 2010-2019

 

Based on: Wittenborn, A. K., & Holtrop, K. (2022). Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019. Journal of Marital and Family Therapy, 48(1).  https://doi.org/10.1111/jmft.12576

Since 1995, the Journal of Marital and Family Therapy (JMFT) has published decade reviews to provide clinicians and other stakeholders an update on the evidence base for couple and family interventions for mental and behavioral disorders and health conditions (Pinsof & Wynne, 1995; Sprenkle, 2003; Sprenkle, 2012; Wittenborn & Holtrop, 2022). The most recent JMFT decade review was published in January 2022 (Wittenborn & Holtrop, 2022). This exciting issue reviewed the empirical evidence published from 2010 to 2019 on couple and family interventions for a range of mental and behavioral disorders and health conditions relevant to our work as couple and family therapists.


The JMFT special issue includes 11 articles that review the evidence base on couple and family interventions for common mental and behavioral disorders and one article focused on high mortality health conditions; the final article (Dwanyen, Holtrop, & Parra-Cardona, 2022) describes the past decade of intervention research on racially and ethnically diverse populations. Findings from these reviews add to the cumulative body of evidence that has consistently shown the positive short- and long-term effects of couple and family interventions (e.g., Carr, 2019a; 2019b). The authors of each article in the special issue reviewed the empirical evidence published in the past decade, in combination with the cumulative body of literature, and constructed categories of the interventions they identified. The interventions were grouped into categories based on mechanism of action, underlying theory, or other meaningful characteristics. The authors then used a set of criteria (Southam-Gerow & Prinstein, 2014) to classify the level of evidence that existed for each intervention category into one of five levels of evidence.

Level 1: Well-Established Interventions require two or more rigorous studies, led by two or more independent research teams in independent settings, showing the intervention to be either: (a) statistically superior to another intervention, or (b) equivalent or not significantly different from an already established intervention in a study with adequate statistical power. The studies were required to meet the following methodological criteria: (a) a randomized controlled trial (RCT) design, (b) use of intervention manual or equivalent, (c) clear inclusion criteria applied to the target population, (d) psychometrically sound assessment of outcomes, and (e) appropriate data analyses. Level 2: Probably Efficacious Interventions must show either: (a) two or more rigorous studies demonstrating significantly better outcomes than a waitlist control group, or (b) at least one study meeting Level 1 criteria; they must also meet the same methodological criteria as Level 1. Level 3: Possibly Efficacious Interventions are supported by either: (a) at least one rigorous study showing the intervention to be superior to a waitlist or no treatment control group with the same five methodological criteria as Level 1 and Level 2, or (b) at least two studies showing the intervention to be efficacious but without meeting the RCT method requirement. Level 4: Experimental Interventions have positive findings from at least one study but are not rigorous enough to meet the Level 3 criteria. Finally, Level 5: Treatments of Questionable Efficacy, have been tested against a comparison group and found inferior. 

Brief overview of the JMFT special issue

The special issue articles report evidence-based classifications on interventions for the following conditions: (1) infant and early childhood mental health (Kaminski, Robinson, Hutchins, Newsome, & Barry, 2022), (2) disruptive behavior problems (Sheidow, McCart, & Drazdowski, 2022), (3) attention-deficit/hyperactivity disorder (Babinski & Sibley, 2022), (4) anxiety disorders (Goger & Weersing, 2022), (5) mood disorders (Wittenborn et al., 2022), (6) suicidal ideation and behavior (Frey, Hunt, Russon, & Diamond, 2022), (7) substance use disorders (Hogue, Schumm, MacLean, & Bobek, 2022), (8) traumatic event exposure (McWey, 2022), (9) violence (Stith et al., 2022), (10) couple relationship education (Markman, Hawkins, Stanley, Halford, & Rhoades 2022), (11) couple relationship distress (Doss, Roddy, Wiebe, & Johnson, 2022), and (12) health conditions (Lamson et al., 2022). Table 1 summarizes the classifications of couple and family interventions for each condition. The classification summary is designed to guide clinical decision-making by compiling the most efficacious practices for each condition. Detailed descriptions of the intervention categories listed in Table 1 can be located in the special issue article associated with each condition.


Note. The intervention categories were developed by the authors of each article to best represent the research on that condition and, therefore, the categories are not consistent across conditions. For health interventions, brackets were used to indicate age categories (e.g., [0-24] indicates 0 to 24 years of age).

a Two intervention categories for IECMH could not be classified (i.e., curriculum-based INTs for at-risk parents and families, INTs to promote positive parenting through shared reading and play).   

Source: Wittenborn, A. K., & Holtrop, K. (2022). Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12576


Conclusion

Couple and family interventions are based on the well-established science that close relationships are involved in the development, maintenance, and treatment of mental and behavioral disorders. The evidence base for couple and family interventions has flourished since the first JMFT efficacy and effectiveness special issue was published (Pinsof & Wynne, 1995). When implemented in the community, these efficacious interventions can make a significant difference in the lives of couples and families. We encourage future research on couple and family interventions for diverse racial and ethnic groups, gender and sexual identities, ages, and mental health conditions to strive toward mental health equity for diverse and marginalized populations. Together, we can commit to continued research and clinical practice efforts to ensure that all families can receive the most efficacious and culturally appropriate care.

Listen to AAMFT CEO Tracy Todd discuss the special issue in an interview on Health Professional Radio.

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Andrea K. Wittenborn, PhD, is an AAMFT Professional Member holding the Clinical Fellow and Approved Supervisor designations, a professor in the Department of Human Development and Family Studies at Michigan State University, and the program director of the Couple and Family Therapy doctoral program. She also holds an appointment in the College of Medicine’s Division of Psychiatry and Behavioral Medicine. Her research evaluates the process and outcomes of couple interventions for depression, including methods for personalizing care. Her research has been continuously funded since 2008 by federal agencies such as the National Institute of Mental Health, private foundations, and intramural awards. Wittenborn is a member of the AAMFT Board of Directors and Journal of Marital and Family Therapy Advisory Board. She has also served as a Governor-appointed member of the Michigan Board of Marriage and Family Therapy and mentor for the AAMFT Minority Fellowship Program and AAMFT Leadership Certificate Program. Wittenborn is a licensed marriage and family therapist and has won several awards for excellence in research and mentoring graduate students.

Kendal Holtrop, PhD, is an AAMFT Professional Member holding the Clinical Fellow and Approved Supervisor designations and is an associate professor in the Department of Human Development and Family Studies at Michigan State University. She is also currently serving as the acting program director of the Couple and Family Therapy (CFT) doctoral program. Her program of research focuses on parenting and parenting interventions, with the goal of addressing mental health disparities by expanding the reach of evidence-based parenting interventions among underserved populations. Holtrop has recently completed grants from the National Institutes of Health (NIH) to determine the functional components of the evidence-based GenerationPMTO parenting intervention and from the Michigan Health Endowment Fund to develop and pilot test an online parenting intervention. Holtrop is an editorial board member for the Journal of Marital and Family Therapy, an advisory editor for Family Process, and a mentor for the AAMFT Minority Fellowship Program. She also serves as a Governor-appointed member of the Michigan Board of Marriage and Family Therapy. Holtrop is a licensed marriage and family therapist.


REFERENCES

Babinski, D., & Sibley, M. (2022). Therapy for attention-deficit/hyperactivity disorder in families: A review of randomized controlled trials from 2010 to 2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12572

Carr, A. (2019a). Family therapy and systemic interventions for child-focused problems: The current evidence base. Journal of Family Therapy, 41(2), 153-213. https://doi.org/10.1111/1467-6427.12226

Carr, A. (2019b). Couple therapy, family therapy and systemic interventions for adult-focused problems: The current evidence base. Journal of Family Therapy, 41(4), 492-536. https://doi.org/10.1111/1467-6427.12225

Doss, B., Roddy, M., Wiebe, S., & Johnson, S. (2022). A review of the research (2010-2019) for evidence-based treatments for couple relationship distress. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12552  

Dwanyen, L., Holtrop, K., & Parra-Cardona, R. (2022). Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010-2019). Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12573 

Frey, L., Hunt, Q., Russon, J., & Diamond, G. (2022). Review of family-based treatments from 2010 to 2019 for suicidal ideation and behavior. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12568

Goger, P., & Weersing, V. R. (2022). Family based treatment of anxiety disorders: A review of the literature (2010-2019). Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12548

Hogue, A., Schumm, J., MacLean, A., & Bobek, M. (2022). Couple and family therapy for substance use disorders: Evidence-based update 2010-2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12546

Kaminski, J., Robinson, L., Hutchins, H., Newsome, K., & Barry, C. (2022). Evidence base review of couple and family-based psychosocial interventions to promote infant and early childhood mental health, 2010–2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12570 

Lamson, A., Hodgson, J., Pratt, K., Mendenhall, T., Wong, A., Sesemann, E., Brown, B., Taylor, E., Williams-Reade, J., Blocker, D., Caspari, J. H., Zubatsky, M., & Martin, M. (2022). Couple and family interventions for high mortality health conditions: A strategic review (2010-2019). Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12564

Markman, H., Hawkins, A., Stanley, S., Halford, K., & Rhoades, G. (2022). Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010-2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12565

McWey, L. (2022). Systemic interventions for traumatic event exposure: A 2010-2019 decade review. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12547

Pinsof, W. M., & Wynne, L. C. (1995). The efficacy of marital and family therapy: An empirical overview, conclusions, and recommendations. Journal of Marital and Family Therapy, 21(4), 585-613. https://doi.org/10.1111/j.1752-0606.1995.tb00179.x 

Sheidow, A., McCart, M., & Drazdowski, T. (2022). Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020). Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12567

Southam-Gerow, M. A., & Prinstein, M. J. (2014). Evidence base updates: The evolution of the evaluation of psychological treatments for children and adolescents. Journal of Clinical Child & Adolescent Psychology, 43(1), 1-6. doi: 10.1080/15374416.2013.855128 

Sprenkle, D. H. (2012). Intervention research in couple and family therapy: A methodological and substantive review and an introduction to the special issue. Journal of Marital and Family Therapy, 38(1), 3-29. https://doi.org/10.1111/j.1752-0606.2011.00271x 

Sprenkle, D. H. (2003). Effectiveness research in marriage and family therapy: Introduction. Journal of Marital and Family Therapy, 29, 85-96. https://doi.org/10.1111/j.1752-0606.2003.tb00385.x 

Stith, S., Topham, G., Spencer, C., Jones, B., Coburn, K., Kelly, L., & Langson, Z. (2022). Using systemic interventions to reduce intimate partner violence or child maltreatment: A systematic review of publications between 2010 and 2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12566

Wittenborn, A. K., & Holtrop, K. (2022). Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12576

Wittenborn, A. K., Woods, S., Priest, J., Morgan, P., Tseng, C.-F., Huerta, P., & Edwards, C. (2022). Treating depressive and bipolar disorders with couple and family therapy: Systematic review of the evidence from 2010 to 2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12569

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