10.5935/1808-5687.20220005 EMPIRICAL RESEARCH

 

Efeitos de um programa online para resolução de conflitos conjugal functional

 

 

Renata Campos Moreira de Souza Coelho^I; Maycoln Leôni Martins Teodoro^II

^IFunctional Minds, - Belo Horizonte - Minas Gerais - Brazil
^IIFederal University of Minas Gerais, Graduate Program in Psychology: Cognition and Behavior - Belo Horizonte - Minas Gerais - Brazil

Correspondence

 

 

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ABSTRACT

The ability to build and maintain satisfactory marital relationships has been identified in the literature as an essential need for mental and psychosocial health. However, the study of educational programs that help couples improve their relationships is still insipid in Brazil. The present study proposes to evaluate an intervention for couples based on online psychoeducation in conflict resolution and levels of marital satisfaction. An effectiveness study was carried out in 163 adults living together for at least six months. The participants filled the Conflict Resolution Behavior Questionnaire, the Familiogram and the Marital Satisfaction Scale. The intervention consisted of an asynchronous psychoeducational consisting of videos and homework assignments. An increase in the quality of the relationship was found: decreased conflict and increased affection and increased satisfaction of organizational and structural aspects for men and women. The results indicated that asynchronous online programs based on psychoeducation can be an alternative intervention for couples with marital problems, especially those who have difficulties attending face-to-face sessions

Keywords: Cognitive Behavioral Therapy; Marriage.

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INTRODUCTION

Understanding the strategies with which couples solve their conflicts has been the subject of research for more than five decades (Mitchell et al., 1962; Padilha et al., 2019). Currently, the way love relationships are experienced has undergone changes, motivating researchers to investigate new marital arrangements. However, there is little clarity about the scope, definition and theoretical contextualization of the concept of marital quality (Delatorre & Wagner, 2021).

In international literature, themes such as frequency of conflict, content, acknowledgment by spouses of the existence or not of problems and strategies to resolve them are part of most studies (Benetti, 2006; Wagner et al., 2019). This is due to the significant effect on the relationship between marital satisfaction and people's mental health (Yoshany et al., 2017).

As a natural part of the two-way interaction process, the strategies that couples use to resolve conflicts can be decisive for the quality of the love relationship (Juras & Costa, 2017; Neumann et al., 2018). Behaviors such as respectful communication, clarity, self-control, flexibility; recognition and acceptance of one's emotions and behaviors (Bohn & Mosmann, 2021), as well as a joint search for solutions, are included in the range of constructive strategies. Identification of culprits, avoidance behaviors, hostility, negativity, lack of clarity that spouses have about their expectations (Neumann et al., 2019) and complaints are, in turn, part of the range of destructive behaviors (Anderson et al., 2010; Sierau & Herzberg, 2012; Sullivan et al., 2010; Wheeler et al., 2010). In a study by Mohammadi and Soleymani (2017), they found that women with more frequent problem solving are more likely to maintain a long-term supportive relationship. According to Costa et al. (2017), satisfied couples tend to have five positive interactions for each negative interaction compared to dissatisfied or divorced couples, who cannot develop the same equation when interacting.

In a systematic review by Mosmann et al. (2018) focusing on conflicts and resolution strategies, it was demonstrated that there is a growing concern among researchers to develop studies that prove the evidence of efficacy and effectiveness of psychotherapies. The main theoretical approaches found were behavioral, cognitive-behavioral, standing out in relation to systemic and psychodynamic. In this regard, the review suggests that researchers should be concerned with qualifying their research through more sophisticated designs from a methodological point of view (Mosmann et al., 2018).

With the advancement of information technologies, psychotherapies have diversified the forms of intervention, incorporating teleservices and online interventions for different audiences (Martin et al., 2020). This is what happened with the marital education programs, which tend to, through asynchronous interventions focused on prevention and health promotion, produce changes in conflict measures and strategies aimed at modifying the couples' coping style towards them, aiming to favor the improvement of love relationships, fostering more satisfactory and stable relationships (Neumann et al., 2018). A systematic review found in its findings that psychoeducation programs for couples are needed in times of crisis to prevent further problems and to help couples build supportive marital relationships (Wisyaningrum et al., 2021).

Neumann et al. (2018) consider that, although marital education programs are new in Brazil, they can be recommended as effective group interventions, filling gaps that exist in interventions aimed at preventing and promoting the well-being of couples and families. In addition to producing short-term improvements in marital quality (Ditzen et al., 2011), one of the goals of marital education programs is to reduce the decline in marital satisfaction, which is a trend in long-term relationships (Lavner et al., 2014). According to Toniato and Caus (2019), the maintenance of a relationship with "good shape" involves continuous exercise and common purposes, which tend to be modified throughout life as a couple.

Despite the tradition of researching these types of programs, there is still a lack of use of virtual platforms as a facilitator in these interventions. The use of virtual platforms for psychoeducational programs was in its infancy in Brazil compared to other nations like the United States. Data from a 2015 survey already placed 72% of Americans between 18 and 44 years old opting for the online format (Naci & Ioannidis, 2015). The growth was exponential, and people who could not imagine consenting to this virtual experience were forced to test it, and many of them were surprised by the result (Faro et al., 2020). According to the review by Schmidt et al. (2016), it is necessary to consider that Brazil has little culture of collective and preventive interventions aimed at family aspects, using virtual platforms. One of the most important revelations is that virtual platforms have become an effective and accessible option, it appears as a different modality and not a substitute (Martin et al., 2020). In this sense, the only program found using virtual platforms to promote improvements in marital quality, points out that this intervention is effective in increasing relationship satisfaction and the quality of positive interactions. Thus, research is needed to evaluate, especially in the national context, online programs for couples and families. The present study intends to test the effects of a psychoeducational program about marital education, online based on Cognitive-Behavioral Therapy through video sessions regarding the intensity and frequency of conflict, affectivity and marital satisfaction.

 

METHOD

Participants

The initial sample consisted of 307 participants in the pre-test, 25% (n = 77) were male and 75% (n = 230) were female. The couple's participation in the study was not an inclusion criterion. Although suggested, individual marital education interventions already indicate significant effects on outcomes (Neuman et al., 2018). Of these, 163 participants completed the entire study (41 men - 25.15%; and 122 women - 74.85%), with a mean age of 38.10 years (SD = 8.86) for men and 38.48 years (SD = 8.78) for women. Among people who remained until the end of the survey, 50% (n = 82) reported having more than 10 years of relationship, while 11% (n=18) were newly married couples with up to three years of relationship. The vast majority of this sample (78%, n=127) had a high level of education, attending a postgraduate course. Income was up to three minimum wages for 31% (n=52) above 10 wages for 25% (n=41) of the sample.

Table 1 shows data referring to the characteristics of the complete sample in the pre- and post-tests.

Instruments

Sociodemographic Questionnaire

Participants completed an identification data questionnaire in order to investigate sociodemographic issues (gender, age, religion, education level and personal income). In addition to these, it was investigated whether the participants had already undergone individual or couple therapy (for how long), or whether they were doing it at the time the research was taking place. Data such as the participants' e-mail and WhatsApp were asked about the importance of establishing virtual contact during the following online stages.

Conflict Resolution Behavior Questionnaire (CRBQ, Rubenstein & Feldman, 1993)

The CRBQ assesses the frequency with which certain behaviors are used in conflict resolution, consisting of 22 items measured using a five-point Likert scale, ranging from 1 (never) to 5 (always). The scale items are divided into three dimensions: attack (nine items); avoidance (eight items); and agreement (five items). Attack strategies are about physically or verbally attacking your spouse, while avoidance is about moving away from conflict or keeping feelings to yourself. This instrument was developed for adolescents and adapted for use with couples by Shulman et al. (2006). The study by Delatorre and Wagner (2015) found evidence of validity of the adapted version of the Conflict Resolution Behavior Questionnaire (CRBQ) for Brazilian Portuguese, with levels of internal consistency ranging from 0.68 to 0.79.

Familiogram (Teodoro, 2006)

The Familiogram assesses the perception of affectivity and family conflict in family dyads (for example, husband-wife). Affection is defined as a set of positive emotions existing in interpersonal relationships, whereas conflict is characterized as a range of negative feelings, which can be both a source of stress and aggression within the family system. The instrument evaluated the relationship of spouses from 11 positive adjectives (affection) and 11 negatives (conflict), on a scale ranging from 1 (no way) to 5 (completely). Teodoro (2006) demonstrated the existence of a bifactorial structure and Cronbach's Alphas ranging from 0.87 to 0.97 for the Familiogram.

Marital Satisfaction Scale - ESC (Dela Coleta, 1992)

The ESC contains 24 items to be assessed on a three-point Likert scale, with subscales that assess marital interaction, emotional and structural aspects. The study by Hernandez et al. (2017) revised the factor structure of the Marital Satisfaction Scale and presented reliable psychometric properties for both the total scale (α=0.91 and its subscales: marital interaction (α=0.86), emotional aspects (α=0.81) and structural aspects (α=0.79).

Intervention procedures

The psychoeducational videos used during the intervention are part of a marital education program called "Functional Couples". The recordings had already been made prior to the study and were selected, adapted and organized so that they could meet the research objectives. 21 videos were selected, with a minimum time of 2:54 and a maximum of 15:12 grouped into three sessions and released to participants on a weekly basis. The videos were released on a specific platform, developed for this purpose by the researcher, accessed by the participants through a login and password during the stipulated time for each study session. The first session lasted 30 minutes and was called "Cultivate and find", with a focus on investing in relationships and positive interactions. The videos in the first block worked on myths and beliefs about a satisfying marital relationship, helping couples understand why it is so important to learn to invest and take care of their relationship and how to do it assertively and intelligently, learning to speak "love language" of your partner. The second session, "Validation and recognition", lasted around 40 minutes and dealt with marital communication and partner validation. Couples had access to videos that discussed the importance and care of the relationship, as well as self-care. The quality of marital communication enters here as an indicator for the quality of the love relationship. In this module, couples learned to communicate clearly and assertively to the point of realizing which interaction models they should avoid to maintain the health of a relationship.

Finally, the last session, called "Conflict Management", lasted about 60 minutes with the theme of emotion regulation, flexibility and conflict resolution. conflicts were treated as the biggest challenges of a life together. Here, couples will learn how to manage conflicts well, helping them to transform problem situations into opportunities for growth, commitment and intimacy.

The videos were made with themes taken from the book "The 7 Principles for Making Mariage Work" (Gottman & Silver, 2015). Between each session, participants received homework assignments that consolidated the theme addressed in each session. Thus, the intervention was delineated as being asynchronous (Almondes & Teodoro, 2021).

Throughout the intervention, it was emphasized that the program was not about therapy. In all messages sent via WhatsApp, the educational proposal was described, making it clear that, if any participant perceived the need for couple therapy, they should inform the researcher. It is important to mention that in each session, participants could watch the videos separately or together, although marital activities were suggested to be done by two.

Ethical and Research Procedures

Contact with the selected sample was carried out exclusively through WhatsApp and by email, with no face-to-face meeting with the researcher at any time. Weekly messages were sent to the participants, instructing them about the sequence and procedures in each of the steps. The researcher's cell phone was made available if any participant felt the need to contact her in specific situations. Only one contact was made throughout the entire process, aiming at face-to-face service.

The initial messages were sent with the purpose of forwarding the online application form to verify the sociodemographic and qualitative data of the marital relationship. The Informed Consent Form (FICF) was sent after the initial registration, guaranteeing, with its completion, the definitive inclusion of the participant in the research. The project was approved by the COEP of the researchers' university. The pre-test inventories were sent with an interval of one week between each. At the end of the seven-day period, after each inventory sent, a confirmation message was issued in order to verify possible doubts regarding the completion.

The next step consisted of video intervention, divided into three batteries. It was explained that access to the videos would be via exclusive login and password, sent by email, and that all content could be watched free of charge, with a maximum period of one week between each of the video sessions. Conjugal homework assignments were elaborated at the end of each block, aiming to promote engagement with the contents learned through the practice of what was taught in theory. At the end of submitting the post-test forms, participants who completed all the steps received a bonus lecture on "The Five Languages of Love".

Data analysis

Comparisons between groups that completed and dropped out of the intervention were made using the t-test for independent samples. Analyzes with pre- and post-intervention scores were performed using the t-test for paired samples. The magnitude of the pre- and post-test change was analyzed with Cohen's d.

 

RESULTS

The analysis of the effect of the psychoeducational program was carried out separately for the male and female groups. Table 2 indicates the differences in means and effect size between the pre- and post-test for the conflict and affectivity dimensions.

A comparison between the dependent variables used in this study (conflict, affection and marital satisfaction) between the sample that completed the entire survey and the one that dropped out showed two significant differences among the eight surveyed. The evading group has fewer agreement strategies (t=2.09, p<0.05) and more attack strategies (t=2.49, p<0.05) than the one that completed the entire study. Participants who were undergoing individual or couple therapy during the research period and those who did not meet the inclusion criteria, namely being married or living together for at least six months, were excluded from the sample.

Considering the pre- and post-test comparisons for the male and female groups, fifteen significant differences were found out of twenty-four possible ones. All differences point to an improvement in the quality of the marital relationship after the intervention. The male group decreased attacking and avoidance behavior, increasing affectivity and satisfaction aspects with organizational aspects. The female group, on the other hand, improved the agreement and satisfaction strategies with organizational aspects and decreased attack, avoidance and conflict behavior. The magnitudes of change ranged from low to moderate.

Table 3 presents the results regarding quality of life. There was a significant difference for the male and female groups regarding the organizational and structural aspects dimension.

 

DISCUSSION

The aim of this study was to evaluate the effects of a psychoeducational program, based on Cognitive-Behavioral Therapy, promoted through virtual platforms, to reduce conflicts and increase marital satisfaction. Interest in participating in the program was high, but there was a high percentage of people who applied but did not complete or drop out of the intervention. The sample that evaded showed higher levels of attack, and lower accordingly, which may indicate that the sample that remained has lower levels in the indicated indicators, thus revealing a less conflicting profile among the couples that remained.

This dropout pattern can be explained by a study that compared outcomes between two groups of twenty couples (Babcock et al., 2013). One of the groups received, in addition to the psychoeducational sessions, nine additional couple therapy sessions. The group that received additional couple therapy evaded much less than the group that received psychoeducation alone. According to Rodrigues (2013), the two groups were composed of afflicted couples, with moderate to severe levels of suffering. Couple therapy is often indicated for this population, as it aims to manage the high levels of negative effects in the relationship, addressing the ambivalence that many afflicted couples feel when they want the relationship to continue (Halford & Snyder, 2012). In this research, the sample that remained in the study is basically.

Women have larger effect sizes on agreement (d=0.38) and on conflicts (d=0.32), although they do not show significant changes in marital satisfaction items. Men, on the other hand, show more significant improvements in the attack items, with a moderate effect (d=0.52) and avoidance (d=0.45), with significant results in the Satisfaction item with organizational and structural aspects, with a moderate effect (d= 0.51).

Babcock et al. (2013) pointed out that gender influenced the effects of treatment over time. In this study, it was found that women seek greater agreement during conflicts and often talk more with their husbands about the problems, demonstrating that constructive discussions are more important to them than to men.

Although the results of this research have not shown a significant effect on the increase in overall marital satisfaction, it can be seen in the literature that individuals who are satisfied in their relationship presume to use more constructive conflict resolution strategies (Naldoni et al., 2011). On the other hand, it is inferred that the dissatisfied use destructive strategies such as avoidance, manipulation, threat, coercion and retaliation (Greeff & Bruyne, 2000).

Thus, it can be thought that there is a tendency in the literature that indicates that marital satisfaction depends, to a great extent, on the spouses' ability to face and deal with conflicts. It is, therefore, consensual that, if they are viewed constructively, the relationship is enriched; from another perspective, if viewed in a destructive way, the relationship is harmed, with the feeling of dissatisfaction prevailing (Greeff & Bruyne, 2000).

The more couples are able to demonstrate understanding in relation to the other's position, avoiding moving away from the conflict, suppressing hostile feelings, the more viable chances they obtain of resolution and reduction in the increase in the future escalation of conflicts (Rubenstein & Feldman, 1993). It is also worth noting that the proposed intervention has shown to cause more significant improvements in the male sample, thus differing from the results found by the online OR (Our Relationship) program, which points out the effects of satisfaction, not significantly differing by gender (Finkel et al., 2016). Indeed, the contrast between the gains in the items Attack, Avoidance and Affection for men, and Agreement and Conflict for women, suggests that psychoeducational programs differ in their effects, not only by gender.

Although women showed improvements in conflict management styles, this was not enough to point out significant gains in overall relationship satisfaction (d = 0.07). Several possibilities have been put forward to reconcile these inconsistencies, including the possibility that benefits are driven by couples with the poorest baseline skills (Halford & Snyder, 2012) and the possibility that struggling couples may not have deficient skills but simply do not they employ them at home (Snyder & Schneider, 2002).

One might think that studies of associations between changes in skills and marital satisfaction have so far been inconclusive (Finkel et al., 2016). It should be noted that the pattern of conflicts presented by the sample that remained in the study was one of less attack, greater agreement, thus indicating a more satisfactory overall marital quality level. Christensen et al. (2010) (Benson et al., 2012) have argued that changes in specific behaviors such as agreement style and communication towards conflict management are useful predictors of long-term changes in satisfaction marital relationship, as they aim to change risk factors between couples. Programs that transmit this knowledge are essential for brief, preventive and relationship interventions (Halford et al., 2016).

Some limitations were found in this study. First, the characteristics of the enrolled sample may differ from those possibly found in the general population, that is, higher levels of education, higher income and motivation to change (Neumann et al., 2018). The lack of interest in the intervention by the low-income population can be explained by the selection and recruitment bias. This is because the only access was through the researcher's social networks. Furthermore, the study was developed in the center of the south of the country and cannot be generalized to other regions, due to the importance of cultural variation. It is believed that broader forms of dissemination, such as radio and other media, are likely to be explored in future research. On the other hand, the results show that online psychoeducation programs can be a promising tool for interventions in couples. This trend is also present in studies with other populations. A study carried out with cisgender women, with female sexual interest/arousal disorder, demonstrated through semi-structured interviews, online questionnaires, video interventions and self-performing exercises that, in addition to democratic access, virtual platforms suggest greater adherence to the stages of the process (Zippan et al., 2020). It is known that, in our country, there is a lack of preventive interventions that could promote well-being, reducing the risk of marital suffering arising from crises and conflicts between couples (Schmidt et al., 2016). This trend is also present in studies with other populations. A study carried out with cisgender women, with female sexual interest/arousal disorder, demonstrated through semi-structured interviews, online questionnaires, video interventions and self-performing exercises that, in addition to democratic access, virtual platforms suggest greater adherence to the stages of the process (Zippan et al., 2020). It is known that, in our country, there is a lack of preventive interventions that could promote well-being, reducing the risk of marital suffering arising from crises and conflicts between couples (Schmidt et al., 2016). This trend is also present in studies with other populations. A study carried out with cisgender women, with female sexual interest/arousal disorder, demonstrated through semi-structured interviews, online questionnaires, video interventions and self-performing exercises that, in addition to democratic access, virtual platforms suggest greater adherence to the stages of the process (Zippan et al., 2020). It is known that, in our country, there is a lack of preventive interventions that could promote well-being, reducing the risk of marital suffering arising from crises and conflicts between couples (Schmidt et al., 2016). online questionnaires, video interventions and self-performing exercises that, in addition to democratic access, virtual platforms suggest greater adherence to the stages of the process (Zippan et al., 2020). It is known that, in our country, there is a lack of preventive interventions that could promote well-being, reducing the risk of marital suffering arising from crises and conflicts between couples (Schmidt et al., 2016). online questionnaires, video interventions and self-performing exercises that, in addition to democratic access, virtual platforms suggest greater adherence to the stages of the process (Zippan et al., 2020). It is known that, in our country, there is a lack of preventive interventions that could promote well-being, reducing the risk of marital suffering arising from crises and conflicts between couples (Schmidt et al., 2016).It is noteworthy that this was the first study in a Brazilian population that proposed to assess the effectiveness of a psychoeducational program developed on virtual platforms for couples. Through this new possibility, it is possible to overcome cultural, financial and geographic barriers, providing access to mental health treatment. At the same time, they need specific training and care to attend to this population (Martin et al., 2020).

In view of the above, with the evidence that is accumulating supporting the effectiveness of web-based interventions (eg, Ashford et al., 2016; Cuijpers & Cristea, 2016), it is incumbent to establish that there is a growing need for guidance for both that develop as for the consumers of this form of intervention.

For the professionals who develop them, it is necessary to improve advertising (division by sex and conflict profiles between couples) and, similarly, the segmentation of the themes that make up the intervention, also dividing them by sex and severity of conflicts. So far and, according to what was found by the researcher, all existing interventions are not segmented by sex.

For consumers, in turn, it is essential to step up to help identify and select empirically validated online interventions. With the increase in the information offered via the internet, the population's criteria regarding which types of information are safe and validated from a scientific point of view becomes considerable.

It is urgent to conclude, therefore, that future research should be encouraged to explore and offer to fill the existing gaps in the prevention of the population of couples. This is necessary, mainly, because it is still an area little known by the evaluated, but, satisfactorily, useful among men and women that make up this population and, consequently, seek improvement and frequency in the aspects of marital satisfaction and development.

 

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LEITURAS RECOMENDADAS

Andrade, A. L. D., Cassepp-Borges, V., Ferrer, E., & Sanchez-Aragón, R. (2017). Análises de dados diádicos: Um exemplo a partir da pesquisa com casais. Trends in Psychology, 25(4),1571-1588. http://dx.doi.org/10.9788/TP2017.4-05        [ Links ]

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Correspondence:
Renata Campos Moreira de Souza Coelho
E-mail: renata@mentesfuncionais.com.br

Este artigo foi submetido no SGP (Sistema de Gestão de Publicações) da RBTC em 23 de Agosto de 2021. cod. 251
Artigo aceito em 13 de Outubro de 2021