Table 2.

Summary of RCTs evaluating couple-oriented interventions (K=33)

First author (year)	Sample	Groups and follow-Up	Between-group differences for patients	Between-group differences for partners
Badger, 2007	98 breast cancer patients and partners (77% spouses)	Couple attention control (informational pamphlets and nondirective telephone calls for 6 weeks) Couple education and interpersonal counseling via telephone; 6 sessions for patients and 3 sessions for partners Couple exercise protocol directed via telephone; 6 sessions for patients and 3 sessions for partners	No significant differences between groups	No significant differences between groups
		Patients and partners treated separately
		Follow-up: Post-intervention and 1 month
Baucom, 2009	14 breast cancer patients and spouses	Patient usual medical care Couple relationship enhancement for 6 sessions	Between-group differences not examined. Between-group effect sizes favored Group 2 at post-intervention and 12 months for psychological functioning, marital functioning, and medical symptoms.	Between-group differences not examined. Between-group effect sizes favored Group 2 at post-intervention and 12 months for psychological functioning and marital functioning.
		Follow-up: Post-intervention and 12 months
Campbell, 2007	30 African- American prostate cancer patients and partners	Patient usual medical care Couple coping skills training for 6 sessions via telephone	2> 1 for bowel symptoms	No significant differences between groups
		Follow-up: Post-intervention
Canada, 2005	51 prostate cancer patients and wives	Patient education, counseling, and skills training for 4 sessions Couple education, counseling, and skills training for 4 sessions	No significant differences between groups	No significant differences between groups
		Follow-up: Post-intervention, 3 months, 6 months
Christensen, 1983	20 post-mastectomy patients and husbands	Patient usual medical care Couple counseling for 4 weeks	No significant differences between groups	No significant differences between groups
		Follow-up: Post-intervention
Fife, 2008	87 HIV patients and partners	Patient nondirective support for 4 sessions via telephone Dyad communication, stress appraisal, adaptive coping strategies, and support building within and outside the dyad, for 4 sessions	2> 1 for hostility, guilt, constructed meaning, number of coping strategies, total coping strategies, and active coping at post-intervention	Partner outcomes were assessed but included only as covariates in patient analyses.
			2> 1 for total negative affect, hostility, guilt, joviality, and constructed meaning at 3 months
		Patient and partner treated separately
		Follow-up: Post-intervention and 3 months
Fridlund, 1991	116 post-myocardial in farction (MI) patients and spouses	Patient usual care Couple support and health behavior change, in hospital and weekly sessions after discharge for 6 months. Some sessions conducted in group format.	2> 1 for exercise test, pain, exertion, leisure, exercise, sexual intercourse, breathlessness, fatigue, and fitness at 6 months	No outcomes were reported.
			2> 1 for reinfarction, satisfaction with partner situation, physical exercise, sexual intercourse, breathlessness, chest pain, and fitness at 12 months
		Follow-up: Post-intervention and 6 months
Giesler, 2005	99 prostate cancer patients and partners (96% spouses)	Patient usual medical care Dyad tailored education and problem solving for 6 sessions (4 via telephone)	2> 1 for sexual function at 4 months	No outcomes were reported.
			2> 1 for sexual limitation at 7 months and 12 months
		Follow-up: 4 months, 7 months, and 12 months	2>1 for cancer worry at 12 months
			2> 1 for urinary bother in patients with low depressive symptoms at 4 months and 7 months
			2> 1 for physical role function in patients with high depressive symptoms at 12 months
Gortner, 1988; Gilliss, 1990	67 cardiac surgery patients and spouses	Patient in-hospital education Couple in-hospital education followed by telephone support for 8 weeks	2> 1 for self-efficacy in lifting at 3 months, and 1>2 for tolerating emotional distress at 3 months	No significant differences between groups
		Follow-up: 3 months and 6 months post-discharge
Hartford, 2002	131 coronary artery bypass graft surgery patients and spouses	Patient usual medical care Couple education and support at discharge and 6 telephone calls over 7 weeks	No significant differences between groups	No significant differences between groups
		Follow-up: 3 days, 4 weeks, and 8 weeks post-discharge
Keefe, 2005	56 advanced cancer patients and partners (most were spouses)	Patient usual medical care Dyad pain management training for 3 sessions	No significant differences between groups	2>1 for self-efficacy in helping patient to control pain and other symptoms
		Follow-up: Post-intervention
Keefe, 2004	84 knee osteoarthritis patients and spouses	Patient usual medical care Patient exercise training for 36 sessions. Group format. Couple cognitive-behavioral coping skills training for 12 sessions. Group format. Couple cognitive-behavioral coping skills training (12 sessions) with patient exercise training (36 sessions). Group format.  Follow-up: Post-intervention	4>3 for aerobic fitness; leg extension; and leg flexion	No outcomes were reported.
			4>2 for coping attempts; pain control and rational thinking; and self-efficacy
			4> 1 for aerobic fitness, leg extension, leg flexion, bicep curl, coping attempts, pain control and rational thinking, and self-efficacy
			3>2 for coping attempts
		Follow-up: Post-intervention	2>3 for aerobic fitness, leg extension, leg flexion, and bicep curl
			3>1 for coping attempts and self-efficacy
			2> 1 for leg extension, leg flexion, and bicep curl.
Keefe, 1996, 1999	87 knee osteoarthritis patients and spouses	Patient cognitive-behavioral coping skills training for 10 sessions. Group format. Couple education for 10 sessions. Group format. Couple cognitive-behavioral coping skills training for 10 sessions. Group format.	At post-intervention:	No significant differences between groups.
			3>2 for pain, pain behavior, psychological disability, coping attempts, self-efficacy, and marital adjustment
			1>2 for coping attempts, marital adjustment, and self-efficacy
			At 6 months:
			3>2 for pain control and rational thinking, and pain self-efficacy
		Follow-up: Post-intervention, 6 months, and 12 months	1>3 for marital adjustment
			1>2 for coping attempts
			At 12 months:
			3>2 for self-efficacy
			1>2 for physical disability
Kole-Snijders, 1999	174 chronic low-back pain patients and significant others (most were spouses)	Patient usual care, wait list for patient operant behavioral intervention Patient operant behavioral intervention. Group format. Dyad operant behavioral intervention and patient cognitive coping skills training for 12 sessions. Group format. Dyad operant behavioral intervention and patient group discussion for 12 sessions. Group format.	At post-intervention:	No outcomes were reported.
			4, 3>1 for three composite factors: motoric behavior (pain behavior and activity tolerance); coping control (pain coping, pain control); and negative affect (catastrophizing, pain, depression, fear)
			4>3 for coping control
		Follow-up: Post-intervention, 6 months, 12 months. Group format.
		Experimental groups 1, 3, and 4 compared at post-intervention. All follow-up time points used to compare groups 2, 3, and 4.
Kuijer, 2004	48 mixed cancer patients and spouses	Patient usual care, wait list Couple counseling for 5 sessions	2> 1 for overinvestment/underbenefit, underinvestment/overbenefit, relationship quality, and depressive symptoms at po st-intervention	2>1 for overinvestment/underbenefit, underinvestment/overbenefit, and relationship quality at post-intervention
		Follow-up: Post-intervention and 3 months	Effects were generally maintained at 3 months.	Effects were generally maintained at 3 months
Lenz, 2000	38 coronary artery bypass graft surgery patients and family members (78% spouses)	Patient standard discharge care Dyad counseling, support and problem solving for 12 sessions. Some sessions conducted over the telephone. Some sessions conducted in group format.	No significant differences between groups	No significant differences between groups
		Follow-up: 3–4 days post-surgery; 2, 4, 6, and 12 weeks post-discharge
Manne, 2005, 2007	238 early stage breast cancer patients and husbands	Patient usual medical care Couple stress management, coping, and communication for 6 sessions. Group format	At 6 months: 2> 1 for depressive symptoms	No outcomes were reported.
		Follow-up: post-intervention and 6 months	2> 1 for loss of behavioral and emotional control in women with unsupportive partners and women with more physical impairment
			2> 1 for well-being in women with unsupportive partners
			2> 1 for depressive symptoms in patients with high emotional processing; high emotional expression; and a high level of acceptance
Martire, 2003	24 women with hip or knee osteoarthritis and husbands	Patient education and support enhancement for 6 sessions. Group format. Couple education and support enhancement for 6 sessions. Group format.	2> 1 for arthritis self-efficacy at post intervention	No significant differences between groups
		Follow-up: Post-intervention
Martire, 2007, 2008	193 hip or knee osteoarthritis patients and spouses	Patient usual medical care Patient education and support enhancement for 6 sessions. Group format. Couple education and support enhancement for 6 sessions. Group format.	2>3 for pain and general arthritis severity at 6 months	3>2 for perceived stress at post-intervention
			3>2 for punishing spousal responses at post-intervention, and for supportive spousal responses at 6 months	3>2 for caregiver mastery at post-intervention in spouses with high marital satisfaction
		Follow-up: Post-intervention and 6 months		At 6 months, 3>2 for stress in female spouses and for depressive symptoms in spouses with high marital satisfaction
Mishel, 2002	240 prostate cancer patients and partners (84% spouses)	Patient usual medical care Patient education, cognitive refraining, problem solving, and provider communication training for 8 sessions via telephone Dyad education, cognitive refraining, problem solving, and provider communication training for 8 sessions via telephone	2> 1 for cognitive refraining and problem solving at 4 months	No outcomes were reported.
			3>1 for number of symptoms at 4 months for Caucasian men
			2> 1 for number of symptoms at 7 months for African-American men
		Follow-up: 4 months and 7 months. Analyses focused on baseline to 4 months and 4 months to 7 months
Moore, 1985	43 chronic pain patients and spouses	Patient usual medical care, wait list Patient cognitive-behavioral therapy for 8 sessions. Group format. Dyad cognitive-behavioral therapy for 8 sessions. Group format	3, 2> 1 for pain, somatization, and spouse report of patient psychosocial adjustment at post-intervention.	No outcomes were reported.
		Follow-up: Post-intervention and 3 months. Comparisons with Group 1 conducted only with post-intervention data.
Nezu, 2003	133 mixed cancer patients and family members (95% spouses)	Patient usual care, wait-list Patient problem-solving therapy for 10 sessions Dyad problem-solving therapy for 10 sessions	At post-intervention, 3>1 for negative mood, depression, cancer-related problems, psychiatric symptoms, family reported interpersonal/social behavior, global psychological distress, and problem-solving ability	No outcomes were reported.
		Follow-up: Post-intervention, 6 months, and 12 months	At post-intervention, 2>1 for negative mood, depression, cancer-related problems, psychiatric symptoms, family reported interpersonal/social behavior, global psychological distress, and problem-solving ability
		Only Groups 2 and 3 were compared at 6 and 12 months.
			At 6 and 12 months, 3>2 for negative mood and psychiatric symptoms
Northouse, 2007	235 prostate cancer patients and spouses	Patient usual care Dyad tailored education; enhancement of couples communication and support; coping effectiveness, uncertainty reduction, and symptom management. Three home visits and two telephone sessions.	2> 1 for uncertainty and communication with spouse at 4 months	2>1 for mental health, patients’ cancer specific quality of life, negative appraisal of caregiving, uncertainty, hopelessness, self-efficacy, communication, general distress from patient symptoms, and distress from patient urinary incontinence at 4 months
		Follow-up: 4 months, 8 months, and 12 months		2>1 for physical health, uncertainty communication, and distress from patient urinary incontinence at 8 months
				2>1 for physical health, self-efficacy, communication, and active coping at 12 months
Radojevic, 1992	59 rheumatoid arthritis patients and friends/ family members (81% spouses)	Patient usual medical care Patient behavior therapy for 6 sessions. Group format. Dyad behavior therapy for 6 sessions. Group format. Dyad education and support for 6 sessions. Group format.	2, 3>1, 4 for reduced joint swelling and number of swollen joints at post intervention and 2 months	No outcomes were reported.
			3>2, 1, 4 for reduced joint swelling and number of swollen joints at post-intervention
		Follow-up: Post-intervention and 2 months
Remien, 2005	215 HIV-positive patients and partners	Patient usual medical care Couple education, communication, problem-solving and support for 4 sessions	2> 1 for prescribed medication doses taken at 2 weeks	No outcomes were reported.
			2> 1 for prescribed medication doses taken within time window at 2 weeks, 3 months, and 6 months
		Follow-up: 2 weeks, 3 months, and 6 months
Riemsma, 2003	218 rheumatoid arthritis patients and family members (88% spouses)	Patient usual medical care Patient education for 5 sessions. Group format. Dyad education for 5 sessions. Group format	2>3 for fatigue and self-efficacy re: other symptoms at 12 months	No outcomes were reported.
			1>3 for fatigue and self-efficacy re: other symptoms at 12 months
		Follow-up: Post-intervention, 6 months, and 12 months	2> 1 for self-efficacy re: other symptoms at 12 months
Saarijarvi, 1991a 1991b,1992	59 chronic low back pain patients and spouses	Patient usual medical care Couple therapy for 5 sessions	2> 1 for marital communication at 12 months	No significant differences between groups.
		Follow-up: 12 months and 5 years	2> 1 for depression, anxiety, hostility, and obsessiveness at 5 years
Scott, 2004	90 women with early stage breast or gynecological cancer and husbands	Patient medical information education Patient coping training for 6 sessions. Some sessions conducted by telephone. Couple coping training for 5 sessions. Some sessions conducted by telephone.	3>2, 1 for couple coping, communication at post-intervention and 6 months	3>2, 1 for couple coping, communication at post-intervention and 6 months
			3>2, 1 for personal coping effort at 12 months	3>2, 1 for personal coping effort at 12 months
			3>2, 1 for psychological distress at post-intervention
		Follow-up: Post-intervention, 6 months and 12 months	3>2, 1 and 1>2 for avoidance at post-intervention, 6 months, and 12 months
			3>2, 1 for positive sexual self-schema, sexual intimacy, and partner acceptance at post-intervention, 6 months, and 12 months
Thompson, 1990a & b	60 male post-myocardial infarction patients and wives	Patient usual medical care Couple in-hospital education and counseling for 4 sessions	At 3 days, 2> 1 for anxiety re: health and the future	At 3 days, 2>1 for anxiety re: sexual activity, relations with patient, ability of patient to work, and complications for patient
		Follow-up: 5 days and 1,3, and 6 months since MI. Anxiety subscales also assessed at 1, 2, and 3 days after MI.	At 5 days, 2> 1 for depressive symptoms; general anxiety symptoms; and anxiety re: health, ability to work, complications, leisure activity; and the future	At 5 days, 2>1 for general anxiety symptoms and all specific anxiety scales
			At 1 month, 2>1 for depressive symptoms; general anxiety symptoms; and anxiety re: another MI, complications, leisure activity, and the future	At 1 month, 2> 1 for general anxiety symptoms and all specific anxiety scales except for relations with patient
			At 3 months, 2> 1 for depressive symptoms; general anxiety symptoms; and anxiety re: ability to work, another MI, relations with spouse, and leisure activity	At 3 months, 2>1 for general anxiety symptoms and all specific anxiety scales except for relations with patient
			At 6 months, 2>1 for general anxiety and anxiety re: health, ability to work, another MI, relations with spouse, and leisure activity	At 6 months, 2>1 for general anxiety symptoms and all specific anxiety scales except for complications for patient
Turner, 1990	57 chronic low back pain patients and spouses	Patient usual medical care Patient exercise for 8 sessions. Group format. Patient exercise and couple behavior therapy for 8 sessions (5 sessions for spouses). Group format. Couple behavior therapy for 8 sessions (5 sessions for spouses). Group format.	3>2 for pain, pain behavior, and spouse report of sickness impact at post intervention	No outcomes were reported.
		Follow-up: Post-intervention, 6 months, and 12 months
van Lankveld, 2004	60 rheumatoid arthritis patients and spouses	Patient education and cognitive-behavioral skills training for 8 sessions. Group format. Couple education and cognitive-behavioral skills training for 8 sessions. Group format.	No significant differences between groups	Outcomes not described. Authors reported that spouses did not show improvement in any of the outcomes assessed.
		Follow-up: Post-intervention and 6 months
Wadden, 1983	31 hypertension patients and spouses	Patient education and relaxation therapy for 8 sessions Couple education and relaxation therapy for 8 sessions	2> 1 for number of in-home practice sessions of relaxation therapy and minutes of in-home practice sessions, at 1 month	No outcomes were reported.
		Follow-up: 1 month and 5 months
Wing, 1991	49 obese Type 2 diabetes patients and overweight spouses	Patient behavioral weight-loss program   for 20 sessions. Group format. Couple behavioral weight loss program   for 20 sessions. Group format.	1>2 for decreased calorie intake, and for weight loss in males, at post intervention	2>1 for weight loss at post intervention and 1 year, and for eating behaviors at post intervention
			2> 1 for weight loss in females at post intervention	1>2 for patient support at 1 year
		Follow-up: Post-intervention, 12 months