Original research| Volume 100, ISSUE 2, P195-204.e1, February 2019

Investigation of a New Couples Intervention for Individuals With Brain Injury: A Randomized Controlled Trial

Published:September 06, 2018DOI:



      This study aimed to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention.


      Randomized waitlist-controlled trial.


      Midwestern outpatient brain injury rehabilitation center.


      Participants (N=44; 22 persons with brain injury and their intimate partners) were randomized by couples to the intervention or waitlist-controlled group, with 11 couples in each group.


      The Couples Caring and Relating with Empathy intervention is a 16-week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition, empathy training, cognitive-behavioral and dialectical-behavioral strategies, communication skills training, and Gottman’s theoretical framework for couples adjusted for individuals with brain injury.

      Main Outcome Measures

      The Dyadic Adjustment Scale, Quality of Marriage Index (QMI), and the Four Horsemen of the Apocalypse communication questionnaire were implemented. Measures were completed by the person with brain injury and that person’s partner at 3 time points: baseline, immediate postintervention, 3-month follow-up.


      The experimental group showed significant improvement at posttest and follow-up on the Dyadic Adjustment Scale and the Horsemen questionnaire compared to baseline and to the waitlist-controlled group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable.


      Results suggest this intervention can improve couples’ dyadic adjustment and communication after brain injury. High satisfaction ratings suggest this small group intervention is feasible with couples following brain injury. Future directions for this intervention are discussed.


      List of abbreviations:

      CBT (cognitive-behavioral therapy), CI (confidence interval), DBT (dialectical-behavioral therapy), EFT (emotion-focused therapy), TBI (traumatic brain injury), QMI (Quality of Marriage Index)
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