Effect of Structured Couple Communication Training With and Without Emotion Regulation Skills on Marital Conflict and Psychological Distress Couple Communication Training and Emotion Regulation

Abstract

Background
Couple communication training addresses interaction patterns associated with marital distress. The additional effect of emotion regulation skills on marital adjustment and psychological symptoms warrants evaluation.
Methods
This prospective quasi-experimental study with three parallel intervention groups at Pacific Institute of Medical Sciences, Udaipur, India included 150 married couples assigned sequentially in a repeated A-B-C cyclic sequence to usual counselling, structured couple communication training or communication training with emotion regulation skills, with 50 couples in each group. Each spouse was assessed independently at baseline, week 12 and week 24 by assessors kept unaware of intervention group. The primary comparison was the baseline adjusted week 12 Revised Dyadic Adjustment Scale (RDAS) difference between the active programmes. Analyses used couple means with multiple imputation of missing spouse scores. Twenty nine secondary comparisons underwent Holm correction.
Results
The adjusted primary difference favoured the combined programme by 3.95 points (95% CI 2.00 to 5.91; p < 0.001). The corresponding week 24 difference was 4.81 points (95% CI 2.81 to 6.81; Holm p < 0.001). Week 24 depressive symptoms, anxiety and emotion regulation difficulties were lower with the combined programme after correction. Demand and withdrawal did not differ significantly between the active programmes after correction. Assessments were available for 274 spouses at week 12 and 245 at week 24. Adverse events were recorded for 15 spouses from 14 couples; one couple discontinued treatment for safety but retained consent for data use.
Conclusion
Couples receiving the combined programme showed greater marital adjustment than those receiving communication training alone. Because group assignment was non-randomised and predictable, residual confounding cannot be excluded; additional treatment contact also limits attribution to emotion regulation content. Study registration: Not registered. Funding: No external funding.