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1 Florida State University Libraries Electronic Theses, Treatises and Dissertations The Graduate School 2010 eprep for Couples: A Randomized Clinical Trial of A Computer Based Preventive Intervention Scott R. Braithwaite Follow this and additional works at the FSU Digital Library. For more information, please contact lib-ir@fsu.edu

2 FLORIDA STATE UNIVERSITY COLLEGE OF ARTS AND SCIENCES eprep FOR COUPLES: A RANDOMIZED CLINICAL TRIAL OF A COMPUTER BASED PREVENTIVE INTERVENTION By SCOTT R. BRAITHWAITE A Dissertation submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy Degree Awarded: Summer Semester, 2010 Copyright 2010 Scott R. Braithwaite All Rights Reserved

3 The members of the committee approve the dissertation of Scott R. Braithwaite defended on July 17, Thomas E. Joiner Professor Co-Directing Dissertation Frank D. Fincham. Professor Co-Directing Dissertation Ming Cui, Outside Committee Member Rick Wagner Committee Member N. Brad Schmidt Committee Member Approved: Janet Kistner, Chair, Department of Psychology Joseph Travis, Dean, College of Arts and Sciences The Graduate School has verified and approved the above-named committee members. ii

4 This work is dedicated to Kim, Taylor and Elle. iii

5 ACKNOWLEDGEMENTS I have been very fortunate to have Frank Fincham and Thomas Joiner as my academic mentors. Without their training and support, this work would not have been possible. Thank you. iv

6 TABLE OF CONTENTS List of Tables... vi List of Figures... vii Abstract... viiii 1. Introduction... 1 Hypotheses Methods... 5 Participants and Procedure... 5 Interventions... 6 Assessment... 8 Assessment of Moderators Results Dedication Alternatives Monitoring Relationship Satisfaction Constructive Communication Intimate Partner Violence Depression Anxiety Examination of Mediators Discussion REFERENCES BIOGRAPHICAL SKETCH v

7 LIST OF TABLES Table 1. Descriptive Statistics and Effect Sizes Table 2. Results for Omnibus Tests of Distinguishability Table 3. Summary of Data from the APIM with Treatment Effects Model.. 29 Table 4. Actor and Partner Moderated Effects and Synergistic Couple Effects Table 5. Intimate Partner Violence Data Recoded to Reflect 6-week Prevalence vi

8 LIST OF FIGURES Figure 1: The actor-partner independence model with treatment effects 32 Figure 2: The Actor-partner Interdependence Model with Treatment Effects and Interaction Effects Figure 3: Flowchart of Randomized Clinical Trial Design Figure 4: The Actor-partner Interdependence Model with Treatment Effects and Moderator Main Effects And Interactions Figure 5: The Actor-partner Interdependence Model with Mediators vii

9 ABSTRACT Although designed to improve relationships, the efficacy of eprep has been documented using individuals rather than couples as participants. This randomized clinical trial uses the Actor Partner Interdependence Model to evaluate the efficacy of the eprep relative to a placebo intervention in a sample of seventy-seven couples. Compared to those who received a placebo intervention, eprep participants demonstrated better mental health and relationship functioning at a six week follow up. Those who engaged more fully in the intervention and mastered the communication techniques tended to experienced superior outcomes; further, there was some evidence that greater risk for relationship dysfunction predicted enhanced treatment response. Finally, mediational analyses showed that, for men, relationship functioning mediated changes in mental health and vice versa. viii

10 CHAPTER 1 INTRODUCTION Between 40-50% of couples that marry today will eventually divorce (Cherlin, 1992; U.S. Bureau of the Census, 1992). This is an important statistic because relationship distress and divorce predict a number of negative outcomes including greater rates of unhappiness, psychopathology, suicide, morbidity, violence, and hastened mortality (for reviews see Amato, 2000 and Waite & Gallagher, 2000). In addition, children of divorce have higher levels of conduct problems and lower levels of school achievement, psychological adjustment, selfconcept, social-adjustment, and positive mother-child and father-child relations (see Grych & Fincham, 1990; Amato & Keith, 1991; Amato, 2000); they are more likely to drop out of school, smoke, drink, and be sexually active as teenagers (Wolfinger, 2005). Finally, parental divorce is predictive of offspring divorce (Wolfinger, 2000), thus the influence of divorce can perpetuate through generations. The most common approach for preventing marital dysfunction and its sequelae has been the use of psychotherapy after the situation has become problematic. Although this approach is effective and well established, this wait to fail model is clearly limited (e.g. Jacobson & Addis, 1993). Thus attention has turned to primary prevention in an attempt to prevent relationship dysfunction before it starts. To effectively prevent a negative outcome it is crucial to understand the risk and protective factors associated with it; risk factors are variables that put an individual at greater risk for dysfunction, while protective factors are variables that buffer against dysfunction (Coie et al., 1993). Researchers have already made a strong start in identifying risk and protective factors for relationship distress and dissolution and have developed and established the efficacy of at least eight preventive interventions (Jakubowski et al., 2004; Braithwaite & Fincham, 2009). Thus, the present challenge facing prevention researchers is not to develop more efficacious interventions, but to refine them and find methods of dissemination that increase the likelihood that existing empirically supported treatments will be used. At present, two key problems face prevention focused relationship education. First, those who have historically received relationship education are at relatively low risk for divorce and other marital problems (Sullivan & Bradbury, 1997). Second, longitudinal studies that have examined the impact of relationship education over longer spans of time suggest that the gains 1

11 achieved through relationship education tend to diminish over time (Markman, Renick, Floyd, & Stanley, 1993). Consequently, a need has arisen to produce evidence based relationship education that addresses these two limitations by increasing flexibility without sacrificing efficacy. A handful of interventions have arisen to meet this need. Halford and colleagues Couple CARE program (2004) which allows participants to complete most of the work associated with the intervention on their own in combination with telephone sessions with a therapist is effective at improving relationship satisfaction at follow up relative to controls. Larson and colleagues examined the impact of an assessment based premarital intervention (RELATE) and found that self-guided use of this intervention produced increased relationship satisfaction at follow up relative to controls (Larson, Galbraith, Holman, & Stahmann, 2007). Research on both of these interventions is limited by the fact that these studies provided only short term follow up data, and neither examined the impact of these interventions on other relevant variables such as psychopathology. However, another intervention, eprep, developed by Braithwaite and Fincham (2007) addresses both of these limitations. eprep is designed to be used as a primary preventive intervention. Arising from Stanley and Markman s Prevention and Relationship Enhancement program (PREP, 2001), eprep is designed for delivery via computer. In an initial randomized clinical trial (RCT; Braithwaite & Fincham, 2007), eprep was compared to two conditions: an empirically supported computerized cognitive behavioral therapy (CBT) treatment and a placebo presentation that taught innocuous information about prevalence rates and forms of treatment for depression, anxiety and relationship distress. Participants who received eprep experienced improvements in problematic communication, intimate partner violence, depression, and anxiety relative to the placebo condition at an eight week follow-up. Interestingly, the eprep intervention was equally effective at improving mental health variables as the empirically supported computer based CBT treatment this despite the fact that eprep makes no mention of depression or anxiety or skills for treating these conditions. As a follow up to this study, Braithwaite and Fincham (2009) conducted another RCT where they examined the efficacy of eprep over a longer span of time using latent growth curve modeling. In this study, eprep was compared to a computer-based placebo intervention and participants were assessed at an eight week follow up and at a ten month follow up. A 2

12 virtually identical pattern of results emerged with the eprep intervention producing mental health and relationship functioning gains that were maintained at ten months post-treatment. Because breaking up premarital relationships is a normative and healthy part of the process of partner selection, this study also sought to examine whether the benefits of eprep were durable to relationship dissolution. The data revealed that neither the mental health nor relationship focused variables were significantly attenuated for those who began romantic relationships with a different partner. Finally, this study examined whether the observed mental health benefits were maintained even if an individual ended their relationship and remained single. This was an important question to answer because research has shown that individuals in committed dating relationships experience health and psychological benefits that singles do not (Braithwaite, Delevi, & Fincham, 2009). Analyses revealed that the positive impact of the eprep intervention on mental health was maintained regardless of relationship status. What is remarkable about both of these RCTs is that only one member of the relationship dyad completed the intervention. This innovation is encouraging when one considers that in many instances, both members of a dyad are not willing to participate in relationship interventions; because eprep has been shown to be efficacious when delivered to only one member of a dyad, it has the power to overcome this obstacle to dissemination. On the other hand it remains to be seen what kind of impact eprep might have when both members of the dyad receive the intervention and work together to implement the principles and skills taught in the eprep intervention to their relationship. The purpose of this study, therefore, is to examine the impact of eprep when it is administered to couples. Administering eprep to couples provides important information in a number of different areas. First, it is logical to suppose that the impact of eprep is greater when it is delivered to a couple rather than to one-half of the couple; especially when one considers that eprep is a skill based program and many of the skills are optimally employed when both partners know and use them. As such, in the present study homework assignments were included as part of the intervention. Research suggests that homework is an important component of psychotherapy interventions (Burns & Spangler, 2000), likely because it provides more of a dose of treatment than interventions where work is not completed out of session. Secondly, because both members of the couple will complete assessments across all time points in the study, this will allow for a clearer view of the interpersonal dynamics of 3

13 relationships over time. Pursuant to this goal, the Actor Partner Independence Model (APIM) will be used when analyzing data. This is a noteworthy analytical approach to use because previous research has shown that the impact of skill based communication programs like eprep may have different effects for men versus women (Baucom et al., 2006) and using the APIM will allow for a glimpse into whether eprep interacts with gender to change outcomes. There are a number of advantages to using the APIM when analyzing couples data. Perhaps the most important advantage is that the APIM deals with the non-independence of couples data. One of the fundamental assumptions of virtually all parametric statistical tests is independence of observations. By their very nature, couples data are not independent (meaning they are inevitably correlated). As an illustration, it is unlikely that one partner is entirely satisfied with the relationship and the other is in abject misery. The violation of the independence assumption presents a major threat to the validity of a given study and can lead to substantially increased risk of Type I or Type II error depending on the pattern of the data being analyzed (Cook & Snyder, 2005). Another key advantage of the APIM is that it allows for an examination of important interpersonal processes that exist within romantic relationships (unlike simple composite scores) by generating actor and partner effects (see Figure 1). This not only allows for a view of the impact of one partners influence on the other s outcomes, but also for a view of important interactions such as whether a partner s initial scores interact with treatment or other moderators to influence the other s outcomes. It also allows for an examination of whether the interactions of both dyad members initial scores can influence outcomes (a couple synergistic effect). Research on skill based relationship education has not yet examined potential mediators of the effect of relationship education (and it has only examined a limited number of moderators). In this study, therefore, we examined a handful of potentially important moderators to determine their impact on couple outcomes. Specifically, it is likely that levels of engagement in and mastery of the intervention will moderate outcomes. Further, previous research has shown that those who benefit most from relationship education tend to be those who are most at risk for relationship dysfunction (Halford, Sanders Beherens, 2001; Schilling et al. 2003), thus we will also examine the influence of relationship dysfunction on treatment outcomes. Finally, we examined relationship functioning and mental health as potential mediators of change in functioning within couples over time. 4

14 Hypotheses The proposed study seeks to test the following hypotheses: Hypothesis 1. Compared to placebo controls, participants who receive eprep will experience better outcomes for relationship relevant variables. Hypothesis 2. Compared to placebo controls, eprep participants will experience better mental health outcomes despite the fact that the eprep intervention does not make any mention of depression or anxiety or specific skills for dealing with their manifestations. Hypothesis 3. Those who engage in the intervention more fully (as evidenced by comprehension of information taught in their respective interventions and completion of weekly homework assignments) will demonstrate greater gains on the outcome variables than those with low engagement. Hypothesis 4. Those who demonstrate greater mastery of the Speaker-Listener technique (as assessed by self-report and follow up interview) will demonstrate greater gains on the outcome variables than those with low mastery. Hypothesis 5. Those who have more risk factors for relationship dysfunction will experience more benefit from treatment than those with low risk. Hypothesis 6. There will be bi-directional mediational effects for relationship functioning and mental health. That is, changes in relationship functioning will mediate changes in mental health and vice versa. In addition, exploratory analyses will be conducted to test the impact of actor effects, partner effects and interactions of these on treatment outcomes as specified in Figure 2. 5

15 CHAPTER 2 METHOD Participants and Procedure Participants were 77 couples recruited from introductory psychology and family sciences courses at a large public university in the southeast. Because the goal for recruitment was couples, only those who had been in a committed romantic relationship for six months or longer were invited to participate. Half of the participants (those enrolled in the classes) received course credit for their participation; their partners received $10. The average age of participants was (1.58) and the average relationship length was between 1-2 years. Twenty percent of participants reported that they were currently cohabiting, and 28% reported that they had cohabited at some point in their life. The ethnic breakdown of participants was as follows: 77% White (non-hispanic), 10% Latino, 8% Black, 3% Mixed Race and 2% Asian. Couples were first asked to independently complete questionnaires that assessed their own levels of depression and anxiety and the current quality of their relationship. After completing these questionnaires participants were randomly assigned to one of two computerbased interventions described below. Upon completion of their respective interventions, participants were given a paper copy of the information covered in their presentation and informed that they would be contacted by each week for the next six weeks. These e- mails directed participants to a survey that assessed their compliance with the previous week s homework assignment and provided instructions for the following week s homework assignment. After six weeks, couples returned to the lab to complete a follow up assessment. A flowchart illustrating these procedures can be seen in Figure 3. Interventions The following interventions are individually administered computer-based presentations that include written text and video. These interventions contain approximately the same amount of content and took approximately the same amount of time to administer; for most participants, the time it took to complete these interventions was approximately one hour. Quizzes were included after each section of both interventions to provide a measure of how engaged couples were in the interventions. In the eprep condition, participants received training in empirically based methods for improving romantic relationships. eprep is an adaptation of Stanley and Markman s 6

16 Prevention and Relationship Enhancement Program (PREP, 2001) that has been modified for computerized administration. PREP has been shown to be an efficacious intervention for improving relationship quality across a number of different indices in at least seven RCTs (Jakubowski et al., 2004). eprep is rooted in basic research on risk and protective factors for marital dysfunction. It teaches communication techniques and problem-solving skills designed to ameliorate destructive relationship patterns. It also teaches couples how to enhance positive aspects of their relationship by fostering fun and friendship. In both of the previous studies on eprep, only one member of the relationship dyad received the intervention. In the present study, eprep was delivered to couples and a homework component was added to the intervention. The first homework assignment was made in the initial session. For this assignment, participants were given a fun deck, which is a tool used for enhancing fun and friendship in the relationship, and were instructed how to use it on their first date night. They also established a specific time each week when they would complete the homework assignments and a specific time each week when they would go on a date. During the second week, participants practiced skills for exiting damaging arguments. During the third week, participants practiced active listening skills. During the fourth week, participants practiced a method of communicating problems (the speaking portion of the Speaker-Listener technique). During the fifth and sixth week, participants practiced the full Speaker-Listener technique. At the end of the sixth week, participants were invited back to the lab to complete a follow up assessment that included videotaped observation of the couples using the Speaker-Listener technique. Participants in the control condition viewed a presentation that taught inert information about anxiety, depression, and relationships such as definitions, prevalence rates, common problems associated with these conditions and available forms of treatment. This presentation was used initially in Cuckrowicz & Joiner (2007) and has since been shown to be effective as a placebo in two previous eprep studies (Braithwaite & Fincham, 2007; Braithwaite & Fincham, 2009). This presentation is identical to eprep in every regard except that it does not provide information about how to improve relationships, depression or anxiety. A placebo intervention was chosen in lieu of other possible comparison interventions in order to establish the absolute effect of eprep for couples when compared to a no treatment control. This decision was also influenced by the fact that there simply is no other computer 7

17 based intervention that is well matched with eprep in terms of length of time for administration and a dyadic rather than individual focus. Pursuant to the goal of creating a placebo that is perceived as an active treatment, thus producing expectancies in the participants involved in the study, participants in the placebo condition were also required to complete weekly homework assignments. These assignments were designed to seem like part of a relationship focused preventive intervention but contained no active ingredients. The first homework assignment was made in the initial session; participants were asked to set aside a specific time each week to review the slides from the presentation (ostensibly to help them gain greater mastery of the material) and complete their homework assignment. During the second week, participants discussed how relationships affect well-being (mental/physical health). During week three, participants taught something from the presentation to friends. During week four, participants discussed celebrity relationships that they judged to be particularly healthy. During week five, participants discussed the strengths of their own relationship. During week six, participants discussed how well-being (mental/physical health) affects relationships. And at the end of week six, participants returned to the lab to complete follow up assessments. Assessment Participants were asked to complete the following measures at baseline and follow up assessments. Inventory of Depression and Anxiety Symptoms (IDAS). The IDAS is a 67 item scale that assesses multiple facets of depression and anxiety with items derived from the diagnostic criteria of these disorders as codified in the DSM-IV-TR. This scale was specifically developed to deal in a more empirically informed way with the considerable overlap between symptoms of depression and anxiety. Research has demonstrated that this scale has good internal consistency and reliability in addition to excellent convergent and discriminant validity especially in relation to more established measures and interview based assessments of depression and anxiety (Watson et al., 2007). Beck Depression Inventory (BDI). The BDI is a validated 21-item self-report measure that assesses the presence of depressive symptoms over the previous two weeks. Scores on symptoms of depression are rated from 0 to 3 and summed with higher scores indicating 8

18 greater depression. The BDI has demonstrated adequate reliability estimates, and has been well validated (Beck, Steer, & Garbin, 1988). Beck Anxiety Inventory (BAI). The BAI is a validated 21-item self-report inventory that assesses the presence of general symptoms of anxiety (Beck, Epstein, Brown, & Steer, 1988). Scores on symptoms of anxiety are rated from 0 to 3 and summed to create a total score. Higher scores on the BAI indicate greater anxiety. The BAI has good psychometric properties (Cronbach s =.92; test-retest reliability =.75). Commitment Measures. To assess commitment attitudes, the dedication (e.g. I want this relationship to stay strong no matter what rough times we may encounter ), and alternatives monitoring (e.g. I know people of the opposite sex whom I desire more than my partner ) scales were used (Stanley and Markman, 1992). We wanted to capture both cognitive and behavioral manifestations of commitment. The psychometrically optimized dedication scale captures a willful cognitive desire to nurture a lasting relationship with one s partner whereas the alternatives monitoring scale assesses the frequency of a key behavior related to commitment (i.e. keeping an eye on other potential partners). These scales have demonstrated good psychometric properties with alphas ranging from.88 to.90. Communication Patterns Questionnaire (CPQ). The CPQ measures important patterns of communication that occur in couple relationships. The CPQ s constructive communications scale is highly correlated with observationally coded problem solving behavior (r =.72, Heavey, Larson, Zumtobel, & Christensen, 1996; see also Hahlweg et al., 2000) and has demonstrated good internal consistency for females and males, =.81 and =.84 respectively (Heavey, Larson, Zumtobel, & Christensen, 1996). Funk-Rogge Couples Satisfaction Index (FR-CSI). Starting with 180 relationship satisfaction items, Funk and Rogge (2007) conducted an Item Response Theory analysis to develop a 4-item measure of relationship satisfaction. Sample items are How rewarding is your relationship with your partner? (Answered on a 6 point scale ranging from not at all to extremely ; higher scores indicate more satisfaction). This measure correlates.87 with the widely used Dyadic Adjustment Scale and -.79 with the Ineffective Arguing Inventory. Coefficients alpha in previous studies using a similar sample range from.90 to.92 (Fincham et al., 2008). 9

19 Revised Conflict Tactics Scale (CTS-2). The CTS-2 assesses the methods couple use to resolve conflict. The psychological aggression and physical assault scales were used to assess how frequently these tactics were employed in the previous 6 weeks. The CTS-2 provides self and partner-reported accounts of intimate partner violence and has demonstrated good construct validity and internal consistency ranges from across scales (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). Assessment of Moderators Three measures of engagement were used. First, we examined participants quiz scores (quizzes were included after each section of the two interventions) which provide an index of how well participants were engaging in the computer presentation. Second, in response to the weekly s, participants rated the degree to which they completed the homework assignment. Scores for weekly homework range from 0 to 2. Third, couples were asked how long they took to complete the homework assignment. This information was scored as the number of minutes it took to complete the assignment ranging from 0 to X, where X is the maximum amount of time in minutes any couple took to complete the assignment. Both self-reported and observationally coded measures of mastery were used. To assess self-reported mastery, those in the eprep condition were asked in the weekly s to rate the degree to which they feel they have mastered the technique being practiced in the homework assignment (1 = I have no idea how to use this technique to 4 = I have perfected this technique ). In addition, at the follow up assessment session, eprep participants were videotaped using the Speaker-Listener technique. These interactions were rated by three experts who had been certified as PREP instructors; the raters reported on three dimensions: speaking skills, active listening skills, and overall performance (from 1 Very Poor to 4 Very Proficient ). Intraclass correlations (using the Shrout & Fleiss, 1979 two-way mixed model analysis) for the three raters were.90 for males and.91 for females suggesting good interrater reliability (i.e. 9-10% of the variance between ratings was a function of the 3 raters). To examine risk, a number of empirically derived predictors of relationship dysfunction were used to create a composite risk variable. To do this a median split was performed on the general depression, communication tactics, relationship satisfaction and neuroticism variables to generate binary indicators where 1 = greater risk and 0 = less risk. These were summed with history of cohabitation (never cohabited = 0, has cohabited = 1) and parent marital status 10

20 (married = 0, separated or divorced = 1) to create an index of risk where higher scores indicate more risk. 11

21 CHAPTER 3 RESULTS The APIM (Kenny, Kashey, & Cook, 2006) was used to test the impact of eprep relative to the placebo intervention. Descriptive statistics including between group effect sizes at follow up can be seen in Table 1.The APIM has two versions: the APIM with distinguishable dyads and the APIM with indistinguishable dyads. According to Kenny et al. (2006), a dyad is considered indistinguishable if there is not a meaningful factor on which its members can be distinguished (e.g. same-sex twins or roommates). In contrast, a dyad is considered theoretically distinguishable if there is some meaningful factor on which its members can be distinguished. In the case of heterosexual couples, the couples can be theoretically distinguished by gender; however, it is possible that a dyad that is theoretically distinguishable is not empirically distinguishable. Thus, prior to conducting the APIM, the omnibus test of distinguishability (I-SAT) was used to test for empirical distinguishability (Olsen & Kenny, 2006). To do this, equality constraints are imposed on the means, variances, and covariances of the manifest variables for both members of the dyad. If χ 2 is significant when these constraints are imposed, one concludes that the couples are empirically distinguishable and proceeds with the distinguishable approach to the APIM. If the constraints hold (χ 2 is not significant), one proceeds with the indistinguishable version of the APIM but adjusts model fit with the results of the I-SAT. Unless otherwise indicated, all analyses were done using distinguishable dyads. The results of all of the I-SATs can be seen in Table 2. While acceptable, the sample size of the present study does not provide optimal power for dyadic analysis. For example, the sample size needed to have power of.80 for the test of not close fit in the case where there is one manifest variable being examined and df = 6 is n = 1,069. This is further complicated when the data are not independent in which case the required sample size doubles because the couple, not the individual, becomes the unit of analysis (thus n = 2,138 would be required). Under these circumstances, achieving statistical significance provides strong evidence of a robust effect (Donnellan, Ackerman & Kashy, 2009). In response to these circumstances, an alpha of.10 was used and standardized effect sizes were reported to provide a clearer picture of the clinical significance of the findings. Unless otherwise indicated, variables were transformed to standardized scores using the sample grand mean and standard deviation; this was done on the recommendation of 12

22 Donnellan and colleagues (2009) who suggest that when using the APIM, standardizing this way provides more reliable estimates than relying on output from statistical software since the metric of standardization is known (i.e., the sample grand mean). Finally, outliers were fenced by reining in extreme values to the median plus or minus 2 interquartile ranges; when this criterion was uninformative (e.g. median = 0, interquartile range = 0), outliers were fenced using the mean plus or minus 2 standard deviations. Before conducting the full SEM analysis, the fit of the measurement models for each of the latent variables was examined and aspects of the model contributing to a poor fit (such as poorly fitting indicators) were adjusted prior to conducting the full analyses; modification indices were used to adjust covariance parameters to ensure optimum fit for the measurement models. Each of the models in the proposed study are known to be identified. In the event of missing data, full information maximum likelihood (FIML) estimation was used to impute missing values. Assessing the role of moderators. In order to assess the influence of engagement, mastery and the influence of preexisting risk for relationship dysfunction, these variables were included in a separate model as main effect and treatment by moderator interaction predictors of the outcome variables. An illustration of the model for moderators can be seen in Figure 4. In an attempt at parsimony, an engagement latent variable comprised of the engagement variables was constructed, but the three indicators comprising the variable did not load well onto a single factor, so the influence of quiz scores, homework completion and time spent on homework were examined as separate moderators in separate models. Regarding mastery, self-reported mastery and observationally coded mastery were examined as separate moderators to capitalize on the multi-informant nature of the data. Dedication The I-SAT suggested that the data for dedication were empirically distinguishable by gender χ 2 = (72), p <.05. Treatment and interaction effects for dedication and all other variables are summarized in Tables 3 and 4. Actor effects for both genders were significant (meaning both men and women s pretreatment scores significantly predicted their outcome scores). No partner effects were significant. Treatment effects were significant only for men (β =.27, p <.05). None of the interactions were significant. There were no significant main effects or interactions for engagement in the computer presentations or the weekly homework assignments. For males, there was a negative main 13

23 effect for the amount of time couples spent on homework (β = -.19, p =.08); this effect was marginally significant for females (β = -.24, p =.14). But the interaction of time spent and condition showed that this effect was mitigated somewhat for those who received eprep (β =.17, p =.19 for males; β =.20, p =.29 for females). Self-reported female mastery predicted increased male commitment (β =.11, p =.10) and self-reported male mastery predicted marginally significant increases in female commitment (β =.17, p =.13). Observationally coded male mastery also predicted increases in female commitment (β =.47, p =.10). There were no significant effects for the risk variable. Alternatives Monitoring The I-SAT for alternatives monitoring suggested that the data were not empirically distinguishable by gender. Analysis of the APIM model revealed that actor effects were significant, but partner effects were not. Treatment effects were significant (β = -.25, p =.07) suggesting that eprep decreased monitoring of other potential romantic partners. No interactions were statistically significant. There was an unexpected main effect for engagement in the computer presentations such that higher quiz scores were associated with increases in alternatives monitoring at follow up (β =.30, p =.03). In contrast, couples in the eprep condition who scored well on the quizzes engaged in significantly less alternatives monitoring at follow up (β = -.33, p =.04). There were no significant main effects or interactions for homework completion or time spent on homework assignments. There were no significant actor or partner effects for self-reported mastery; however there was a marginally significant partner effect for observationally coded mastery (β = -.26, p =.12) such that partner mastery of communication skills predicted decreases in alternatives monitoring. There were no significant effects for the risk variable. Relationship Satisfaction The relationship satisfaction latent variable consisted of the four IRT derived items that comprise the CSI-4. The APIM model fit the data well χ 2 (109) = , p =.02, CFI =.96 TLI =.95 RMSEA =.06. Actor effects for both genders were significant, partner effects were not. Treatment effects were statistically significant for neither gender, but the treatment effect for males was medium in size and trended toward significance (β =.24, p =.16). Regarding interactions, there was a significant female partner-moderated treatment effect, meaning females high in relationship satisfaction who received treatment were more likely to have their 14

24 male partners increase in relationship satisfaction (p =.09). No other interactions were statistically significant. There was a main effect for engagement in the computer presentation such that males with higher scores had less satisfaction at follow up across conditions (β = -.40, p =.02). In contrast, males who received eprep and engaged more fully in the computer presentation experienced significant increases in relationship satisfaction at follow up (β =.48, p =.02). There were no main effects for homework completion, but there was a main effect for time spent on homework such that more time spent doing homework decreased male relationship satisfaction across conditions (β = -.41, p =.03). In contrast, more time spent on homework for males who received eprep led to marginally significant increases in relationship satisfaction (β =.31, p =.14). Self-reported female mastery predicted marginally significant increases in male satisfaction at follow up (β =.19, p =.14). There were no significant effects for observationally coded mastery. Increases in female risk factors were associated with less female (β = -.23, p =.05) and male (β = -.29, p =.04) satisfaction at follow up across both conditions. Constructive Communication The I-SAT for constructive communication indicated that dyad members were not empirically distinguishable, The APIM model fit the data well χ 2 (7) = 7.53, p =.38, CFI = 1.00 TLI = 1.00 RMSEA =.03. Actor effect, partner effect and treatment effects (β =.27, p =.04) were all significant. Regarding interactions, there was a significant actor-moderated treatment effect, meaning that individuals with higher initial levels of constructive communication who received treatment experienced significant reductions in constructive communication over time, perhaps suggesting that couples who communicate well do not benefit from communication skills training. Engagement in the computer presentation for those who received eprep predicted more constructive communication at follow up (β =.29, p =.07). There were no significant effects for homework completion, time spent on homework or self-reported mastery of communication skills. There was a significant actor effect for observationally coded mastery, meaning that those who mastered the skills reported more positive communication at follow up (β =.27, p =.04). There was a significant risk actor effect (β = -.16, p =.08) such that more risk predicted poorer partner communication at follow up across both conditions. 15

25 Intimate Partner Violence For intimate partner violence, we capitalized on the dyadic nature of these data by analyzing separate models for self and informant reports. These data were fenced using the criterion described above, but for the physical assault variable, the data were still very skewed and leptokurtic even after being fenced. To remedy this a log-10 transformation was performed on the data to protect against violations of the normality assumption. Because the data were transformed, standardized output from Mplus was used to generate betas (STDYX). Initially, the data for minor and severe self-reported physical assault were examined separately, but a lack of variance in the data for the severe scale rendered the output uninterpretable. Consequently, the scales were aggregated and examined using the physical assault total score. To provide an additional view of the rates of intimate partner violence in our sample and the clinical significance of the eprep intervention on this variable, scores were recoded to reflect the presence or absence of any form of intimate partner violence (presence =100, absence = 0). Table 5 displays the reported prevalence of intimate partner violence over the past six weeks by condition. Self-Reported Physical Assault The I-SAT for self-reported physical assault indicated that dyads members were not empirically distinguishable, so the APIM for indistinguishable dyads was used. The APIM model fit the data well χ 2 (7) = 9.53, p =.22, CFI =.90 TLI =.90 RMSEA =.07. Actor effects were significant, but partner effects were not. Treatment effects were significant (β = -.16, p =.06). There were no significant interactions. Impact of moderators. There was a positive main effect for engagement in the computer presentation (β =.68, p =.07); however, those in the eprep condition who engaged more in the presentation experienced marginally significant decreases in physical assault (β = -.58, p =.11). There were no significant effects for engagement in weekly homework assignments, but there was a significant positive main effect for time spent on homework assignments (β =.78, p =.04). However, for participants who received eprep, more time spent on homework assignments predicted significant decreases in physical assault (β = -.69, p =.06). There were no significant effects for self-reported mastery. There were significant partner and actor effects for observationally coded mastery that mirrored the findings for depression and anxiety; that is, increased mastery was associated with decreases in actor perpetrated physical assault (β = - 16

26 .35, p =.07) but increases in partner perpetrated physical assault (β =.30, p =.10). Regarding risk, there was a significant main/actor effect (β =.26, p =.02) and marginally significant main/partner effect (β =.19, p =.11) indicating that more risk predicted increases in physical assault at follow up across conditions. Partner-Reported Physical Assault Because the APIM for distinguishable dyad is a saturated model when manifest variables are used (i.e., df = 0), fit indices are not informative and thus not reported. Actor effects were significant for both genders. There was a significant female partner effect suggesting that female physical assault at baseline predicted more male assault at follow-up. The male partner effect operated opposite to the female partner effect, but was not statistically reliable. Treatment was effective at reducing female physical assault (β = -.23, p =.04), but there was not a reliable treatment effect for males (β = -.14, p =.19). There were no significant interactions for partner-reported physical assault. Impact of moderators. There were no significant effects for engagement in the computer presentation or the weekly homework assignments, but there was a significant positive main effect for time spent on homework for males (β = 1.26, p =.01). In contrast, men who received eprep and spent more time on homework experienced significant decreases in physical assault at follow up (β = -1.10, p =.02). There were no significant effects for self-reported or observationally coded mastery. Regarding risk, female risk increased physical assault at follow up for both males (β =.40, p =.02) and females (β =.46, p <.01). There was a significant interaction between female risk and treatment for males (β = -.67, p =.03) such that at risk females who received treatment had males partners who engaged in less physical assault at follow up. Self-Reported Minor Psychological Aggression The APIM showed that actor effects were significant for both genders, and female partner effects were significant, meaning that more female psychological aggression at baseline predicted more male psychological aggression at follow-up. Treatment effects were not significant nor were there any significant interactions. Impact of moderators. There were no significant effects for engagement in the computer presentation or weekly homework assignments. There was a marginally significant treatment interaction for both genders such that eprep participants who spent more time on their 17

27 homework experienced increases in psychological aggression (males β =.40, p =.11; females, β =.43, p =.12). There were no significant effects for completion of weekly homework assignments. There were no significant effects for self-reported or observationally coded mastery. Regarding risk, there was a marginally significant main effect for male risk on female psychological aggression at follow up (β =.27, p =.11) such that having a male partner with more risk factors predicted more minor psychological aggression at follow up for females. Self-Reported Severe Psychological Aggression The saturated APIM showed that actor effects were significant for females, but not males. Partner effects were not significant for either gender. Treatment was effective at reducing severe psychological aggression perpetrated by females (β = -.73, p =.01), but there was not a reliable effect for males (β = -.04, p =.17). None of the interactions were statistically significant, but the female actor-moderated treatment effect was marginally significant (β = -.56, p =.11), suggesting that females who perpetrated more severe psychological aggression at baseline experienced larger decreases in this variable in response to treatment. Impact of moderators. There were no significant effects for engagement in the computer presentation or weekly homework assignments. Time spent on homework had a significant main effect for both genders such that more time spent on homework led to more severe psychological aggression (males β =.96, p <.01; females β =.10, p <.01). There was also a significant interaction for both genders such that receiving eprep and spending more time on homework reduced severe psychological aggression for males (β = -.90, p =.02) and females (β = -.09, p =.01). There was insufficient variability in severe psychological aggression for females in the eprep group at follow up, so mastery could not be examined. Regarding risk, there was a significant male partner effect, meaning having a male partner with more risk factors led to more female perpetrated severe physical assault across both conditions (β =.45, p =.06). There was a marginally significant interaction indicating that women who received eprep and had partners with elevated risk perpetrated less severe psychological aggression over time (β = -.49, p =.13). Partner-reported Minor Psychological Aggression The APIM for partner-reported minor psychological regression showed that actor effects were significant for both genders. Female partner effects were significant, but male partner effects were not. Treatment effects were not significant for males (β = -.15, p =.30) or females 18

28 (β = -.17, p =.44). There was a significant synergistic couple effect for males such that more couple psychological aggression at baseline predicted more male psychological aggression at follow-up. Impact of moderators. There were no significant effects for any of the moderators on partner-reported minor psychological aggression. Partner-reported Severe Psychological Aggression Actor effects were again significant for both genders. Partner effects were not significant for either gender. eprep was effective at reducing female psychological aggression (β = -.45, p =.05), but there was not a reliable treatment effect for males (β = -.16, p =.20). There were significant actor by treatment interactions for males (β = -.90, p <.01) and females (β = -.37, p =.03). There was also a significant synergistic effect on males (β =.23, p =.03) such that more psychological aggression from both partners interacted to increase male psychological aggression at follow up. Impact of moderators. There were no significant effects for engagement in the computer presentation or weekly homework assignments. Time had marginally significant positive main effect for males (β =.40, p =.13). As with self-reported severe psychological aggression, there was insufficient variability in follow up scores of eprep participants so mastery could not be examined. Regarding risk, there was a significant main/actor effect for males (β = -.27, p <.01) suggesting that males who were more at risk were less likely to perpetrate severe psychological aggression regardless of condition. There was also a significant treatment by male risk interaction for males such that males with elevated risk who received treatment were more likely to perpetrate severe psychological aggression at follow up (β =.23, p =.10). Depression The depression latent variables were comprised of the BDI, and the IDAS General Depression, Dysphoria and Well-being (reversed) scales. The latter three scales have been shown to correlate strongly with interview based diagnoses of Major Depressive Disorder (Watson et al., 2008). The APIM model fit the data adequately χ 2 (107) = , p <.01, CFI =.94 TLI =.93 RMSEA =.09. Actor effects for both genders were significant. Male partner effects were significant (meaning male s who were more depressed at baseline predicted increases in female s depression at follow-up). Female partner effects were not significant. Men who received eprep had significantly reduced depression scores at follow-up (β = -.29, p 19

29 =.07), but treatment did not have a significant effect on women s follow-up depression scores. None of the interactions examined were statistically significant. Impact of Moderators. There were no main effects for quiz scores, but the treatment by quiz score interaction predicted significant decreases in depressive symptoms for females who received eprep and engaged more fully in the computer presentation (β = -.37, p =.10). There was a main effect of homework completion on female depressive symptoms (β = -.69, p =.05) indicating that more engagement in weekly homework assignments decreased depressive symptoms for females in both conditions; however, a significant treatment by homework interaction indicated that females who received eprep and completed more of the weekly homework assignments experienced increases in depressive symptoms over time (β =.45, p =.03). The amount of time spent on homework did not reliably predict any main effects or interactions. Female self-reported mastery of eprep skills was marginally associated with decreases in female depression (β = -.29, p =.13). Observationally coded male mastery predicted significant decreases in depression for males (β = -.43, p =.03), but it increased female depressive symptoms (β =.98, p = <.01). In a similar pattern, observationally coded female mastery predicted decreases in depressive symptoms for women (β = -.65, p =.01) and increases in male depressive symptoms, though this effect was not statistically significant (β =.23, p =.16). Finally, there was a significant main effect for the female risk variable such that elevated risk predicted more depressive symptoms for females at follow up across both conditions (β =.40, p =.05). The female treatment by risk interaction predicted decreases in male depression at follow up (β = -.31, p =.10); meaning that having a partner with more risk factors for relationship dysfunction and receiving eprep led to significant decreases in depressive symptoms for males. Anxiety The anxiety latent variable consisted of the BAI, IDAS Panic, Social Anxiety and Trauma scales. The APIM model fit the data well. χ 2 (106) = , p =.03, CFI =.93, TLI =.91 RMSEA =.06. Actor effects for both genders were significant. Female partner effects were significant. Male partner effects were not significant. Treatment effects were not reliably significant for either gender, but there was a non-significant medium treatment effect size for females that suggested increases in anxiety for eprep participants (β =.23, p =.18). Regarding interactions, there was a significant female actor-moderated treatment effect, 20