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PREP for Strong Bonds: A Review of Outcomes from a Randomized Clinical Trial

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Abstract

To help address the relationship needs of service members, there have been a number of programs offered within active duty and veteran contexts. One program, offered within the Strong Bonds portfolio delivered by Army Chaplains, is PREP for Strong Bonds (PREP = the Prevention and Relationship Education Program). PREP has a number of empirically based and tested variants. This article reviews the disseminated research regarding results from a large randomized clinical trial designed to test the effectiveness of PREP for Strong Bonds. From a sample of 662 Army couples drawn from two sites, outcome papers have focused on different subsamples, marital outcomes, follow up time points, and moderators. Reviewing these disseminated outcomes, we conclude that PREP for Strong Bonds has significant divorce reduction effects at one site; these divorce effects were found at both 1 and 2 years post intervention, and were moderated by factors such as minority status, economic strain, and cohabitation history of the couple. In terms of marital quality outcomes, some modest overall effects were found pre to post intervention, but there were no overall marital quality outcome effects 2 years post intervention. However, marital quality outcomes are significantly moderated by infidelity and cohabitation history, with couples reporting these risk factors showing greater positive marital quality outcomes. These results to date are discussed in terms of clinical and research implications as well as directions for future work, such as examining longer term preventative effects.

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References

  • Adler, A. B., Bliese, P. D., McGurk, D., Hoge, C. W., & Castro, C. A. (2011). Battlemind debriefing and Battlemind training as early interventions with soldiers returning from Iraq. Sport, Exercise, and Performance Psychology, 1, 66–83.

    Article  Google Scholar 

  • Allen, E., Atkins, D., Baucom, D., Snyder, D., Gordon, K., & Glass, S. (2005). Intrapersonal, interpersonal, and contextual factors in engaging in and responding to extramarital involvement. Clinical Psychology: Science and Practice, 12, 101–130.

    Google Scholar 

  • Allen, E. S., Rhoades, G. K., Stanley, S. M., Loew, B., & Markman, H. J. (2012). The effects of marriage education for army couples with a history of infidelity. Journal of Family Psychology, 26, 26–35. doi:10.1037/a0026742.

    Article  PubMed Central  PubMed  Google Scholar 

  • Allen, E. S., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2010). Hitting home: Relationships between recent deployment, post traumatic stress symptoms, and marital functioning for Army couples. Journal of Family Psychology, 24, 280–288. doi:10.1037/a0019405.

    Article  PubMed Central  PubMed  Google Scholar 

  • Allen, E., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2011a). On the home front: Stress for recently deployed Army couples. Family Process, 50, 235–247.

    Article  PubMed Central  PubMed  Google Scholar 

  • Allen, E. S., Stanley, S. M., Rhoades, G. K., Markman, H. J., & Loew, B. A. (2011b). Marriage education in the Army: Results of a randomized clinical trial. Journal of Couple and Relationship Therapy, 10, 309–326. doi:10.1080/15332691.2011.613309.

    Article  PubMed Central  PubMed  Google Scholar 

  • Baddeley, J. L., & Pennebaker, J. W. (2011). A postdeployment expressive writing intervention for military couples: A randomized controlled trial. Journal of Traumatic Stress, 24(5), 581–585.

    Article  PubMed  Google Scholar 

  • Bakhurt, M., Lowe, B., McGuire, A., Halford, K., & Markman, H. (2014). Relationship education in the military: Recommendations for best practices. Manuscript under review

  • Beardslee, W., Lester, P., Klosinski, L., Saltzman, W., Woodward, K., Nash, W., & Leskin, G. (2011). Family-centered preventive intervention for military families: Implications for implementation science. Prevention Science, 12(4), 339–348.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bergmann, J. S., Renshaw, K. D., Allen, E. S., Markman, H. J., & Stanley, S. M. (2014). Meaningfulness of service and marital satisfaction in Army couples. Journal of Family Psychology, 28(5), 701.

    Article  PubMed  Google Scholar 

  • Blanchard, V. L., Hawkins, A. J., Baldwin, S. A., & Fawcett, E. B. (2009). Investigating the effects of marriage and relationship education on couples’ communication skills: A meta-analytic study. Journal of Family Psychology, 23, 203–214. doi:10.1037/a0015211.

    Article  PubMed  Google Scholar 

  • Booth, A., Johnson, D., & Edwards, J. N. (1983). Measuring marital instability. Journal of Marriage and the Family, 45(2), 387–394. doi:10.2307/351516.

    Article  Google Scholar 

  • Braithwaite, S., & Fincham, F. (2009). A randomized clinical trial of a computer based preventive intervention: Replication and extension of ePREP. Journal of Family Psychology, 23(1), 32–38.

    Article  PubMed  Google Scholar 

  • Braithwaite, S. R., & Fincham, F. D. (2011). Computer-based dissemination: A randomized clinical trial of eprep using the actor partner interdependence model. Behavior Research and Therapy, 49, 126–131. doi:10.1016/j.brat.2010.11.002.

    Article  Google Scholar 

  • Braithwaite, S. R., & Fincham, F. D. (2014). Computer-based prevention of intimate partner violence in marriage. Behaviour Research and Therapy, 54, 12–21. doi:10.1016/j.brat.2013.12.006.

    Article  PubMed  Google Scholar 

  • Cowan, C. P., Cowan, P. A., & Barry, J. (2011). Couples’ groups for parents of preschoolers: Ten-year outcomes of a randomized trial. Journal of Family Psychology, 25(2), 240–250.

    Article  PubMed Central  PubMed  Google Scholar 

  • Dimiceli, E. E., Steinhardt, M. A., & Smith, S. E. (2010). Stressful experiences, coping strategies, and predictors of health-related outcomes among wives of deployed military servicemen. Armed Forces & Society, 36(2), 351–373.

    Article  Google Scholar 

  • Fawcett, E., Hawkins, A., Blanchard, V., & Carroll, J. (2010). Do premarital education programs really work? A meta-analytic study. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 59(3), 232–239.

    Article  Google Scholar 

  • Fincham, F. D., & Beach, S. R. H. (2002). Forgiveness in marriage: Implications for psychological aggression and constructive communication. Personal Relationships, 9(3), 239–251.

    Article  Google Scholar 

  • Fincham, F. D., & Bradbury, T. N. (1987). The assessment of marital quality: A reevaluation. Journal of Marriage and the Family, 49, 797–809.

    Article  Google Scholar 

  • Foran, H. M., Wright, K. M., & Wood, M. D. (2013). Do combat exposure and post-deployment mental health influence intent to divorce? Journal of Social and Clinical Psychology, 32(9), 917–938.

    Article  Google Scholar 

  • Gordon, K., Baucom, D., & Snyder, D. (2004). An integrative intervention for promoting recovery from extramarital affairs. Journal of Marital and Family Therapy, 30(2), 213–231. doi:10.1111/j.1752-0606.2004.tb01235.x.

    Article  PubMed  Google Scholar 

  • Halford, W. K., & Bodenmann, G. (2013). Effects of relationship education on maintenance of couple relationship satisfaction. Clinical Psychology Review, 33(4), 512–525.

    Article  PubMed  Google Scholar 

  • Halford, W., Sanders, M. R., & Behrens, B. C. (2001). Can skills training prevent relationship problems in at-risk couples? Four-year effects of a behavioral relationship education program. Journal of Family Psychology, 15, 750–768. doi:10.1037/0893-3200.15.4.750.

    Article  PubMed  Google Scholar 

  • Halford, W. K., & Snyder, D. K. (2012). Universal processes and common factors in couple therapy and relationship education: Guest Editors: W. Kim Halford and Douglas K. Snyder. Behavior Therapy, 43(1), 1–12.

    Article  PubMed  Google Scholar 

  • Hawkins, A. J., Blanchard, V. L., Baldwin, S. A., & Fawcett, E. B. (2008). Does marriage and relationship education work? A meta-analytic study. Journal of Consulting and Clinical Psychology, 76, 723–734.

    Article  PubMed  Google Scholar 

  • Hawkins, A. J., Stanley, S. M., Blanchard, V. L., & Albright, M. (2012). Exploring programmatic moderators of the effectiveness of marriage and relationship education programs: A meta-analytic study. Behavior Therapy, 43, 77–87. doi:10.1016/j.beth.2010.12.006.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hogan, P. F., & Seifert, R. F. (2010). Marriage and the military: Evidence that those who serve marry earlier and divorce earlier. Armed Forces & Society, 36, 420–438.

    Article  Google Scholar 

  • Hollis, S., & Campbell, F. (1999). What is meant by intention to treat analysis? Survey of published randomised controlled trials. British Medical Journal, 319, 670–674.

    Article  PubMed Central  PubMed  Google Scholar 

  • Institute of Medicine. (1994). Reducing risk factors for mental disorders: Frontiers for preventive intervention research. Washington, D.C.: National Academies Press.

    Google Scholar 

  • Jakubowski, S. F., Milne, E. P., Brunner, H., & Miller, R. B. (2004). A review of empirically supported marital enrichment programs. Family Relations, 53(5), 528–536.

    Article  Google Scholar 

  • Johnson, M. D. (2012). Healthy marriage initiatives: On the need for empiricism in policy implementation. American Psychologist, 67, 296–308. doi:10.1037/a0027743.

    Article  PubMed  Google Scholar 

  • Jose, A., O’Leary, K. D., & Moyer, A. (2010). Does premarital cohabitation predict subsequent marital stability and marital quality? A meta-analysis. Journal of Marriage and Family, 72(1), 105–116.

    Article  Google Scholar 

  • Karney, B. R., & Crown, J. S. (2007). Families under stress: An assessment of data, theory, and research on marriage and divorce in the military. Santa Monica, CA: Rand Co.

    Google Scholar 

  • Kline, G. H., Stanley, S. M., Markman, H. J., Olmos-Gallo, P. A., St. Peters, M., Whitton, S. W., & Prado, L. M. (2004). Timing is everything: Pre-engagement cohabitation and increased risk for poor marital outcomes. Journal of Family Psychology, 18(2), 311–318.

    Article  PubMed  Google Scholar 

  • Link, P. E., & Palinkas, L. A. (2013). Long-term trajectories and service needs for military families. Clinical Child and Family Psychology Review, 16(4), 376–393.

    Article  PubMed  Google Scholar 

  • MacDermid Wadsworth, S. M. (2010). Family risk and resilience in the context of war and terrorism. Journal of Marriage and Family, 72, 537–556.

    Article  Google Scholar 

  • MacDermid Wadsworth, S. M., Lester, P., Marini, C., Cozza, S., Sornborger, J., Strouse, T., & Beardslee, W. (2013). Approaching family-focused systems of care for military and veteran families. Military Behavioral Health, 1(1), 31–40. doi:10.1080/21635781.2012.721062.

    Article  Google Scholar 

  • Manning, W. D., & Cohen, J. A. (2012). Premarital cohabitation and marital dissolution: An examination of recent marriages. Journal of Marriage and Family, 74(2), 377–387.

    Article  PubMed Central  PubMed  Google Scholar 

  • Markman, H. (2000). Couple activities scale. Unpublished measure, University of Denver.

  • Markman, H. (2014). Best practices in relationship education: Backwards into the Future. Manuscript in Preparation.

  • Markman, H. J., Floyd, F. J., Stanley, S. M., & Storaasli, R. D. (1988). Prevention of marital distress: A longitudinal investigation. Journal of Consulting and Clinical Psychology, 56, 210–217. doi:10.1037/0022-006X.56.2.210.

    Article  PubMed  Google Scholar 

  • Markman, H. J., & Rhoades, G. K. (2012). Relationship education research: Current status and future directions. Journal of Marital and Family Therapy, 38(1), 169–200.

    Article  PubMed Central  PubMed  Google Scholar 

  • Markman, H., Stanley, S., & Blumberg, S. (2010). Fighting for your marriage: A deluxe revised edition of the classic best-seller for enhancing marriage and preventing divorce. San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • McConnell, S., Stuart, E. A., & Devaney, B. (2008). The Truncation-by-Death Problem: What to do in an experimental evaluation when the outcome is not always defined. Evaluation Review, 37(1), 157–186. doi:10.1177/0193841X07309115.

    Article  Google Scholar 

  • Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for PTSD: Harnessing the healing power of relationships. New York: Guilford.

    Google Scholar 

  • O’Farrell, T. J., & Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism and drug abuse. Journal of Substance Abuse Treatment, 18, 51–54.

    Article  PubMed Central  PubMed  Google Scholar 

  • Owen, J. J., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2011). The revised commitment inventory: Psychometrics and use with unmarried couples. Journal of Family Issues, 32, 820–841.

    Article  PubMed Central  PubMed  Google Scholar 

  • Petch, J. F., Halford, W., Creedy, D. K., & Gamble, J. (2012). A randomized controlled trial of a couple relationship and coparenting program (Couple CARE for Parents) for high- and low-risk new parents. Journal of Consulting and Clinical Psychology, 80, 662–673. doi:10.1037/a0028781.

    Article  PubMed  Google Scholar 

  • Raudenbush, S. W., Bryk, A. S., Fai, C. Y., Congdon, R., & du Toit, M. (2011). HLM 7: Hierarchical linear and nonlinear modeling. Lincolnwood, IL: Scientific Software International Inc.

    Google Scholar 

  • Renshaw, K. D., Allen, E. S., Carter, S., Markman, H. J., & Stanley, S. M. (2014). Partners’ attributions for service members’ symptoms of combat-related posttraumatic stress disorder. Behavior Therapy, 45, 187–198. doi:10.1016/j.beth.2013.10.005.

    Article  PubMed Central  PubMed  Google Scholar 

  • Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2009). The pre-engagement cohabitation effect: A replication and extension of previous findings. Journal of Family Psychology, 23(1), 107–111.

    Article  PubMed  Google Scholar 

  • Rhoades, G. K., Stanley, S. M., Markman, H. J. & Allen, E. S. (2014). Can marriage education mitigate the risks associated with premarital cohabitation? Manuscript under review.

  • Saiz, C. C., & Jenkins, N. (1995). The communication skills test (Unpublished measure). Denver CO: University of Denver.

    Google Scholar 

  • Sayers, S. L., Glynn, S. M., & McCutcheon, S. (2014). Family court and a review of family services in the Department of Veterans Affairs. Family Court Review, 52(3), 371–380.

    Article  Google Scholar 

  • Schilling, E. A., Baucom, D. H., Burnett, C. K., Allen, E., & Ragland, L. (2003). Altering the course of marriage: The effect of PREP communication skills acquisition on couples’ risk of becoming maritally distressed. Journal of Family Psychology, 17, 41–53. doi:10.1037/0893-3200.17.1.41.

    Article  PubMed  Google Scholar 

  • Schulz, M. S., Cowan, C. P., & Cowan, P. A. (2006). Promoting healthy beginnings: A randomized controlled trial of a preventive intervention to preserve marital quality during the transition to parenthood. Journal of Consulting and Clinical Psychology, 74(1), 20–31.

    Article  PubMed  Google Scholar 

  • Schumm, W. R., Paff-Bergen, L. A., Hatch, R. C., Obiorah, F. C., Copeland, J. M., Meens, L. D., & Bugaighis, M. A. (1986). Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage and the Family, 48(2), 381–387. doi:10.2307/352405.

    Article  Google Scholar 

  • Stanley, S. M. (2001). Making a case for premarital education. Family Relations, 50(3), 272–280. doi:10.1111/j.1741-3729.2001.00272.x.

    Article  Google Scholar 

  • Stanley, S. M., Allen, E. S., Markman, H. J., Saiz, C. C., Bloomstrom, G., Thomas, R., & Baily, A. E. (2005). Dissemination and evaluation of marriage education in the Army. Family Process, 44, 187–201.

    Article  PubMed  Google Scholar 

  • Stanley, S. M., Hoyer, L & Trathen, D. W. (1994). Confidence Scale. Unpublished measure, University of Denver

  • Stanley, S. M., & Markman, H. J. (1992). Assessing commitment in personal relationships. Journal of Marriage & the Family, 54(3), 595–608.

    Article  Google Scholar 

  • Stanley, S. M., & Markman, H. J. (1997). Marriage in the 90s: A nationwide random phone survey. Denver, CO: PREP Inc.

    Google Scholar 

  • Stanley, S. M., Markman, H. J., Jenkins, N. H., & Blumberg, S. L. (2006a). PREP for Strong Bonds leader’s manual. Denver: PREP Educational Products Inc.

    Google Scholar 

  • Stanley, S. M., Rhoades, G. K., Amato, P. R., Markman, H. J., & Johnson, C. A. (2010). The timing of cohabitation and engagement: Impact on first and second marriages. Journal of Marriage and Family, 72(4), 906. doi:10.1111/j.1741-3737.2010.00738.x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Stanley, S. M., Rhoades, G. K., Loew, B. A., Allen, E. S., Carter, S., Osborne, L. J., & Markman, H. J. (2014). A randomized controlled trial of relationship education in the US army: 2-year outcomes. Family Relations, 63(4), 482–495.

    Article  Google Scholar 

  • Stanley, S. M., Rhoades, G. K., & Markman, H. J. (2006b). Sliding vs. deciding: Inertia and the premarital cohabitation effect. Family Relations, 55, 499–509. doi:10.1111/j.1741-3729.2006.00418.x.

    Article  Google Scholar 

  • Stanley, S. M., Rhoades, G. K., Olmos-Gallo, P. A., & Markman, H. J. (2007). Mechanisms of change in a cognitive behavioral couples prevention program: Does being naughty or nice matter? Prevention Science, 8, 227–239. doi:10.1007/s11121-007-0071-8.

    Article  PubMed Central  PubMed  Google Scholar 

  • Stanley, S. M., Whitton, S. W, Kline, G. H., & Markman, H. J. (2006). Helping couples go beyond “good enough” in marriage. In M. Whisman (Chair), Interpersonal flourishing: The positive side of close relationship functioning. Paper presented at the meeting of the Association for Behavioral and Cognitive Therapies, Chicago, IL

  • Stanley, S. M., Whitton, S. W., Low, S. M., Clements, M. L., & Markman, H. J. (2006d). Sacrifice as a predictor of marital outcomes. Family Process, 45, 289–303.

    Article  PubMed  Google Scholar 

  • Taft, C. T., Howard, J., Monson, C. M., Walling, S. M., Resick, P. A., & Murphy, C. M. (2014). “Strength at Home” intervention to prevent conflict and violence in military couples: Pilot findings. Partner Abuse, 5(1), 41–57.

    Article  Google Scholar 

  • Teachman, J. D., & Tedrow, L. (2008). Divorce, race, and military service: More than equal pay and equal opportunity. Journal of Marriage and Family, 70(4), 1030–1044.

    Article  Google Scholar 

  • Wadsworth, M. E., & Markman, H. J. (2012). Where’s the action? Understanding what works and why in relationship education. Behavior Therapy, 43, 99–112. doi:10.1016/j.beth.2011.01.006.

    Article  PubMed Central  PubMed  Google Scholar 

  • Whisman, M., Dixon, A., & Johnson, B. (1997). Therapists’ perspectives of couple problems and treatment issues in couple therapy. Journal of Family Psychology, 11(3), 361–366. doi:10.1037/0893-3200.11.3.361.

    Article  Google Scholar 

  • Whitton, S. W., Rhoades, G. K., Stanley, S. M., & Markman, H. J. (2008). Effects of parental divorce on marital commitment and confidence. Journal of Family Psychology, 22(5), 789–793.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

Research reported in this publication was supported by NICHD of the National Institutes of Health under award number RO1HD048780. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Psychology, University of Colorado Denver, Denver, CO, 80217, USA

    Elizabeth S. Allen

  2. Department of Psychology, University of Denver, Denver, CO, USA

    Galena K. Rhoades, Howard J. Markman & Scott M. Stanley

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  1. Elizabeth S. Allen
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  2. Galena K. Rhoades
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  3. Howard J. Markman
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Correspondence to Elizabeth S. Allen.

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Allen, E.S., Rhoades, G.K., Markman, H.J. et al. PREP for Strong Bonds: A Review of Outcomes from a Randomized Clinical Trial. Contemp Fam Ther 37, 232–246 (2015). https://doi.org/10.1007/s10591-014-9325-3

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