Gottman Couple Therapy Program in Treatment of Depressed Female Partners

Major Depressive Disorder is the world's leading cause of medical disability , and is associated with costs exceeding $219 billion in the United States each year .

The association between marital discord and depression is well-established, and a large body of work now supports the bi-directional nature of this relationship. That is, marital distress plays a crucial role in the etiology and maintenance of depression. Moreover, the impact of one partner's depression on couple functioning can be profound and prolonged.

About two-thirds of the people seeking individual treatment for depression report significant relationship distress. This holds true for primary care, for psychotherapy practice irrespective of the treatment model, and for couple and family therapy as well . In the caseload of family therapists, depressive disorders are the second most common presenting problem after couple difficulties .

Once MDD is present, supportive interpersonal relationships are highly important for recovery. For instance, relationship functioning is not always improved following individual treatments for depression, even if the disorder itself remits .

Spouses of depressed individuals may be living with the disability for many years and may be unaware or misinformed about how to support the depressed person. Given that depression and relationship distress reciprocally influence each other, researchers have focused on couple-based treatment approaches to change maladaptive relationship patterns as a way to alleviate depression. Although couple therapy most often aims to reduce overall relationship distress, couple-based interventions have also been developed to treat couples in which one or both partners struggle with impairing individual emotional or behavioral disorders .

Couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. It has the twofold aim of modifying negative interaction patterns and increasing mutually supportive aspects of intimate relationships, changing the interpersonal context of depression.

Specific models of couple therapy for depression have been developed, including behavioral therapies, later integrated with cognitive approaches, systemic models and emotion-focused therapy, based on attachment theory. In recent years, a trend toward integration has become evident, as in other fields of psychotherapy . It has been suggested that, despite different theoretical orientations, effective models of couple therapy share a set of common principles: (a) altering the couple's view of the presenting problem to be contextualized and dyadic; (b) decreasing emotion-driven, dysfunctional behavior; (c) eliciting emotion-based, avoided, private behavior; (d) increasing constructive communication patterns; and (e) emphasizing strengths and reinforcing gains .

This study aimed to evaluate the effect of Gottman couple therapy program targeted for discordant couples struggling with the negative impact of depression of the female partner and compare between the outcome in case of usual treatment of depression and the outcome with applying Gottman program added to the usual treatment of depression in the female partner.

Inclusion criteria

• Age of partners: between 20 and 60 years
• Married for at least 1 year.
• Female partners meet the diagnostic criteria for major depressive disorder with a score of Hamilton Depression Rating Scale above 7
• Discordant couples, as indicated by a score of 45 or lower on ENRICH Marital Satisfaction Scale.
• Commitment to participate in the therapy sessions.

Exclusion criteria

• Male partners who meet the diagnostic criteria for a depressive disorder.
• Co-morbid psychiatric illness for any partner
• Couples if one or both disclosed an act of infidelity or more than two acts of physical aggression in the preceding 3 months.
• Couples on the verge of divorce
• Co-morbid serious medical or neurological disorder (stroke, epilepsy, traumatic brain injury, ..etc)