COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
In a 5- to 10-slide PowerPoint presentation, address the following:
Provide an overview of the article you selected, including answers to the following questions:
What type of group was discussed?
Who were the participants in the group? Why were they selected?
What was the setting of the group?
How often did the group meet?COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
What was the duration of the group therapy?
What curative factors might be important for this group and why?
What “exclusion criteria” did the authors mention?
Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own client groups. If so, how? If not, why?
Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than a half page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your presentation with evidence-based literature.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
The American Journal of Family Therapy, 43:103–118, 2015
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
The Effect of Cognitive-Behavioral Group
Marital Therapy on Marital Happiness
and Problem Solving Self-Appraisal
University of Quebec in Montreal (UQAM), Montreal, Canada,
McGill University, Montreal, Canada, and
The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada
McGill University Health Center, Montreal, Canada
The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada, and Laval University, Quebec City, Canada
The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada
Problem solving self-appraisal affects problem solving performance
and marital adjustment. This study investigated the effects of
cognitive-behavioral group marital therapy on couples’ adjustment
and their self-appraisal of problem solving activities. Sixty-six couples
participated in group couples therapy. Subjects were randomly
assigned to an experimental or a waiting list control group. They
completed the Problem Solving Inventory and the Marital Happiness
Scale. Therapy was effective in improving global couple adjustment
and problem solving self-appraisal. The program had a differential
effect on the improvement of self-perceived problem solving abilities
depending on the spouses’ initial self-appraised problem solving
ability level.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
Address correspondence to Claude B´elanger, D´epartement de Psychologie, Universit´e du
Qu´ebec `a Montr´eal, C.P. 8888 succursale Centre-ville, Montr´eal, QC H3C 3P8, Canada. E-mail:
104 C. B´elanger et al.
Marital therapy based on social learning principles aims to enhance communication
and/or to teach problem solving skills, with the expectation
that such behavioral changes will lead to an increase in marital satisfaction
(Woodin, 2001). However, increased attention has been devoted to the
role of individual cognitive variables in mediating the relationship between
communication/problem solving behaviors and marital distress (B´elanger,
Sabourin & El-Baalbaki, 2012). The importance of cognitive processes in the
development and maintenance of marital dysfunction has been confirmed in
several investigations of the implications of spouses’ cognitions in outcome
research (Dunn & Schwebel, 1995).
Researchers have evaluated problem solving self-appraisal as a determinant
of individuals’ adaptational outcomes (Godshall and Elliott, 1997;
Heppner, Kampa, & Brunning, 1987). Problem solving self-appraisal refers
to a relatively stable attitude toward one’s personal problem solving repertoire
as well as toward the self-regulatory processes at work while a problem
is being solved (Heppner & Krauskopf, 1987).
Social problem solving abilities are used in social contexts, and they affect
interpersonal adjustment (Elliott & Grant, 2008). For instance, family caregivers
demonstrating effective problem solving styles reported greater relationship
satisfaction (Shanmugham, Cano, Elliott & Davis, 2009). Self-efficacy
in response to personal problems is related to the way the person appraises
his or her problem solving skills. Accordingly, to develop good coping capacities,
it is important for a person to be able to appraise his or her problem
solving skills and style (Heppner & Dong-Gwi, 2009). Moreover, Bandura’s
work strongly supports the notion that people’s perception of self-efficacy affects
their motivation to face challenges, their decision-making behaviors and
their emotional reactions in difficult situations (Bandura, 1986; Carr´e, 2004).
Perceived self-efficacy has also been related to many personal difficulties
such as depression (Dreer, Elliott, Fletcher, & Swanson, 2005; Rivera et al.,
2007; Nezu, Kalmar, Ronan & Clavijo,1986), psychosocial impairment (Shanmugham,
Elliott & Palmatier, 2004) and alcoholism (Elliott, Grant & Miller,
2004); it has also been associated with psychological adjustment (Heppner &
Anderson, 1985), physical health (Heppner, Kampa, & Brunning, 1987) and
personality (D’Zurilla, Maydeu-Olivares & Gallardo-Pujol, 2011).
The well-established links between problem solving self-appraisal and
relationship satisfaction have led researchers to investigate problem solving
capacities and self-appraisal in relation to coping skills and the marital
relationship. These studies were based on the basic premise that, for most
people, the quality of their marital relationship is an important predictor of
their general well-being (Hertzog, 2011). When facing stressful life events,
partners use joint efforts in problem solving interactions and other coping
strategies to reestablish satisfaction and maintain marital adjustment. A
failure in these cognitive and behavioral adaptation mechanisms often leads
to marital distress.
Impact of Group CBT on Marital Happiness and Self-Appraisal 105
Dyadic coping strategies encompass both the cognitive and behavioral
components that influence marital satisfaction. Therefore, it is necessary
to understand the relationships between the cognitive strategies and social
behaviors that partners adopt during their problem solving interactions.
If there is such a link, then what is the exact nature of this interrelation,
and in what ways do these cognitive (problem solving self-appraisal) and
behavioral (problem solving efficacy) strategies influence marital satisfaction?
The preoccupation with understanding the cognitive and behavioral
problem solving determinants of marital adjustment can be found in a limited
number of studies that have addressed these particular issues (Baucom
& Kerig, 2004). In line with these questions, an investigation in our laboratory
showed that problem solving self-appraisal differentiates distressed
from non-distressed partners (Sabourin, Laporte, & Wright, 1990). Distressed
spouses expressed less problem solving confidence, a stronger tendency to
avoid different problem solving activities, and less control over their behavior
than their non-distressed partners (Sabourin et al., 1990). Another study
that was run by the same team (Lussier et al., 1997) examined the relationship
between spouses’ attachment styles, coping strategies, and marital
satisfaction. These researchers pinpointed many links between attachment
strategies, coping skills and marital adjustment. These results are consistent
with Bodenmann et al. (2006), who reported several studies showing that
positive dyadic coping significantly correlates with a better quality of marital
relationship, lower levels of stress and better physical and psychological
well-being, and in some studies, these correlations are stronger for women
than for men. Kurdek (1991) tried to conceptualize these variables into a
model in which he assessed the role of cognitively and behaviorally oriented
problem solving determinants on the relationship satisfaction of gay
and lesbian partners. His results support a problem solving model in which
relationship satisfaction is related to strategies used by partners to resolve
their conflicts.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
In a recent study, B´elanger and his colleagues (2012) investigated the
mutual contributions of a self-reported cognitive strategy, coping, observed
problem solving behaviors, and marital adjustment. In line with Kurdek
(1991), they hypothesized that the specific coping strategies would be related
to the quality of the problem solving behaviors and that both these
variables would be related to marital satisfaction. Their results propose that,
for both men and women, there are significant relationships between cognitive
and coping strategies, problem solving behaviors displayed during
marital interactions, and marital adjustment.
Thus, because empirical studies have demonstrated that problem solving
self-appraisal is directly related to problem solving performance (Heppner
& Dong-Gwi, 2009), spouses should not only possess the problem solving
skills necessary to confront and alleviate their marital difficulties but also
believe in their capacity to do so. To be of maximum value, marital therapy
106 C. B´elanger et al.
should therefore not only aim to enhance specific problem solving skills but
also should work to alter spouses’ appraisal of their problem solving abilities.
To the best of our knowledge, very few outcome studies have investigated
such an effect of couples’ cognitive-behavioral therapy on the partners’ selfappraisal
of their problem solving abilities and marital satisfaction.
Accordingly, the main purpose of this paper is 1) to evaluate the overall
effectiveness of cognitive-behavioral group marital therapy in bringing about
positive changes in marital satisfaction and 2) to study the effects of such a
program on partners’ self-appraisal of problem solving abilities.
The specific hypotheses were that group marital therapy subjects would
report changes in a) their marital satisfaction; b) the overall appraisal of
their problem solving abilities; c) their problem solving confidence; d) their
approach to problem solving activities; and e) their strategies to control their
behavior when they try to solve a problem.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
The second purpose of this study is to examine the differential effects
of cognitive behavioral group marital therapy on appraisal from spouses as
being effective or ineffective problem solvers (Nezu, 1985).
It was hypothesized that, following the program, partners who initially
appraised their problem solving as ineffective and who believed that they
had problem solving deficits would report more changes in their marital
adjustment level (Marital Happiness Scale) and in their problem solving skills
(Problem Solving Inventory) than subjects who initially appraised themselves
as effective problem solvers.
Sixty-six French-Canadian couples participated in the study. The subjects had
been living together an average of 12.8 years (SD = 8.7 years, range 1 to
31 years), and their age ranged from 20 to 76 years (M = 38.2 years, SD =
1.7 years). The mean number of children for the sample was 1.2 (88% of the
couples had children). The average education level was 14.5 years (SD =
2.9 years) for women and 15.7 years (SD = 3.7 years) for men.
Subjects were recruited through publicity in various media. Couples who
expressed interest were briefly informed of the nature of the program and
invited to an assessment interview. To be selected, couples had to be living
together, free of any important individual psychopathology, free of drug or
alcohol problems, free of primary sexual dysfunctions, not in intense marital
crisis (no pending divorce or physical abuse) and not currently following
another therapy. During the assessment interview, all couples completed
a battery of questionnaires that included a demographic questionnaire, the
Impact of Group CBT on Marital Happiness and Self-Appraisal 107
Problem Solving Inventory (Heppner & Petersen, 1982), and the Marital
Happiness Scale (Azrin, Naster, & Jones, 1973). Partners completed the questionnaires
independently. A research assistant remained in the same room as
the couple during the task and was available to help participants. Subjects
were ensured of the confidentiality of their responses.
Couples were randomly assigned to the experimental group (n = 30 couples)
or to the control group waiting list (n = 36 couples). After completing
the program, all couples were administered the same self-report measures.
Couples on the waiting list then received the same assessment and treatment
procedures.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
The Couples Survival Program is a group marital therapy program based
on a cognitive-behavioral approach to solving marital difficulties designed
by researchers in our laboratory (Wright, 1986). Couples are taught skills
focused on effective communication, problem solving, exchange of positive
experiences and anger expression. The cognitive and behavioral components
of problem solving skills were taught for two sessions (6 hours) in
which couples learned different problem solving stages through reading, instructions,
modeling rehearsal, dyadic practices, feedback, cognitive restructuring,
group discussions, and homework assignments (Dattilio & Epstein,
Each group comprised four couples. They met once a week, for nine
consecutive weeks, in three hour sessions. Each group was led by a licensed
psychologist with a minimum of two-years experience in marital therapy and
group intervention. The co-therapist had at least a master’s degree in clinical
or counseling psychology. All group leaders received 30 hours of training
and weekly supervision between sessions.
The Problem Solving Inventory (PSI; Heppner & Petersen, 1982) is a 32-
item measure that evaluates perceptions of personal problem solving behaviors
and attitudes. It yields an overall score as well as three factor scores:
problem solving confidence (11 items), approach-avoidance style (16 items),
and personal control (5 items). High scores indicate that the subject perceives
himself/herself as having ineffective problem solving abilities and thus
has little problem solving confidence, tendencies to avoid different problem
solving activities, and a lack of personal control. Reliability estimates (alpha
ranges from .72 to .85) are adequate, and acceptable validity coefficients have
been reported in several investigations (Heppner & Anderson, 1985; Nezu &
108 C. B´elanger et al.
Ronan, 1988; Tracey, Sherry, & Keitel, 1986). Moreover, PSI scores have been
found to correlate significantly with observational ratings of problem solving
competence (Heppner et al, 1982). The French version of the PSI (Laporte,
Sabourin, & Wright, 1989) has demonstrated equally sound psychometric
properties (alpha ranges from .65 to .86).
The Marital Happiness Scale (Azrin, Naster, & Jones, 1973) is a self-report
questionnaire that allows the subject to rate his satisfaction on nine aspects
of his marital life (household responsibilities, money management, etc.) and
to give an overall assessment of his happiness within the relationship. The
scores range from 1 to 10, with a higher score indicating a higher level of
marital happiness. The instrument possesses good reliability and discriminant
validity. The Marital Happiness Scale has been found to be highly correlated
(.85) with the Locke-Wallace Marital Adjustment Test (Locke & Wallace,
1973), and inter-item correlations (p < .05 for all correlations) suggest the
presence of an underlying single dimension (Libman, Takefman, & Brender,
1980). The French version of the questionnaire has been demonstrated to
have equally sound psychometric qualities (alpha ranges from .71 to .80)
(Bourgeois, Sabourin, & Wright, 1990).COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
Independent t-tests were conducted to determine if there were any significant
differences between the experimental and control groups in terms
of sociodemographic variables. The results indicated that the experimental
group participants were significantly younger (t (137) = –2.38, p < .02),
had more children (t (130) = 6.02, p < .0001) and had been living together
for a shorter period (t (125) = –5.09, p < .0001) than their control group
counterparts. There were no significant differences between the two groups
in terms of income or educational level.
Data showed that a randomization of couples to groups at the onset
of the treatment did not produce optimal matching of sociodemographic
variables such as age, children and length of relationship. However, Pearson
product-moment correlation coefficients established that the correlations
between those variables and the scores on the dependent variables under
investigation were very low. There were no significant correlations between
socioeconomic variables and problem solving self-appraisal scores (range
from .01 to .20), and there was a small relationship between the Marital
Happiness Scale’s scores and the ages of the men (p < .02). A two-way
analysis of variance was performed on the pretest scores of the experimental
and the control groups to determine if there were any initial differences
between the groups in the self-appraisal of problem solving abilities and
marital adjustment prior to the program. The results indicated that there
were no significant differences between the two groups in problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 109
TABLE 1 Means and Standard Deviations of Pretest and Posttest for the Experimental and
the Control Group
Group Experimental Control Experimental Control
Time T1 T2 T1 T2 T1 T2 T1 T2
PSI total M 91.3 77.0 86.9 80.9 94.8 82.1 102.5 97.1
SD 23.8 18.5 28.9 26.8 20.7 17.1 21.7 24.8
PSI M 24.7 23.0 26.0 23.5 27.0 22.9 29.0 28.2
Confidence SD 8.9 7.1 10.3 9.1 7.5 6.6 9.5 10.6
PSI M 49.4 39.1 44.1 42.4 48.5 42.5 52.7 50.4
Approach SD 15.1 9.3 15.5 15.2 13.5 10.2 11.9 13.0
PSI M 17.2 15.0 16.7 14.9 19.4 16.6 21.0 18.5
Control SD 5.6 4.3 6.6 5.2 4.3 3.9 4.3 4.4
Marital M 6.3 7.3 6.3 6.6 6.2 6.9 5.9 6.3
Happiness SD 1.3 1.1 1.1 1.4 1.3 1.2 1.5 1.6
Note. M = mean; SD = standard deviation; PSI = Problem Solving Inventory.
self-appraisal (F(3,60) = 0.8, p <.5) or marital adjustment (F(1, 63) = 2.2,
p < 0.14).
Effectiveness of the Program
To determine the effect of treatment and sex on problem solving selfappraisal
and marital satisfaction, three series of analysis of variance were
performed. The means and standard deviations for the men and women of
the experimental and the control groups are presented in Table 1.
MARITAL HAPPINESS SCALE
A 2 (male vs. female) × 2 (pre vs. post) × 2 (experimental vs. control)
analysis of variance (ANOVA) was conducted on this scale using sex as a
repeated measure because of the interdependence of husbands’ and wives’
scores (Kenny & Cook, 1999). The results indicated a significant main effect
for Time (F(1, 63) = 26.2, p <.01), which was qualified by a significant Group
× Time interaction effect (F(1,63) = 4.1, p < .05). There was no significant
Group × Time × Sex interaction effect. The mean scores revealed that couples
from the experimental group had significantly higher marital adjustment
following the program than couples on the waiting list (see Table 1).
PROBLEM SOLVING SELF-APPRAISAL
First, an ANOVA was conducted on the overall score of the PSI. The results
revealed a significant effect for Time (F(1,64) = 21.8, p < .0001), which
110 C. B´elanger et al.
TABLE 2 Means and Standard Deviations of Pre-Waiting Period, Post-Waiting Period, and
Post Program for the Subjects of the Control Group
Moment T1 T2 T3 T1 T2 T3
PSI total score 86.5 81.2 71.4 102.9 96.8 84.3
SD 30.0 27.7 22.4 22.6 24.7 25.5
PSI Confidence 25.8 23.8 21.9 29.2 28.3 25.6
SD 10.4 9.3 9.6 9.7 10.8 8.9
PSI Approach 44.2 42.4 37.1 52.9 50.0 42.4
SD 16.0 15.6 11.8 12.4 12.9 13.5
PSI Control 16.5 15.0 12.4 20.8 18.5 16.3
SD 6.8 5.4 4.9 4.4 4.5 5.0
Marital Happiness 6.3 6.5 7.4 5.9 6.2 7.0
SD 1.3 1.3 1.2 1.6 1.5 1.6
Note. T1 = pre-waiting; T2 = post-waiting; T3 = post-treatment; SD = standard deviation; PSI = Problem
Solving Inventory.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
was qualified by a significant Group × Time effect (F(1,64) = 3.9, p < .05).
The Group × Time × Sex interaction effect was not significant. Couples who
participated in the program generally appraised themselves as more effective
problem solvers than couples who were on the waiting list.
To further explore the nature of treatment gains, a two-way MANOVA
was conducted on the three problem solving subscale scores. The results indicated
a significant main effect for Time (F(3, 62) = 11.16, p< .0001), which
was qualified by a significant Group × Time interaction effect (F(3, 62) =
3.11, p < .03). The Group × Time × Sex interaction effect was not significant.
Subsequent ANOVAs revealed that, compared to subjects on the waiting
list, spouses who followed the group marital therapy reported a significantly
stronger tendency to approach diverse problem solving activities (F(1, 64) =
7.2, p < .009). However, they did not rate themselves as approaching problem
solving activities more readily or as having more personal control than
the subjects who did not received treatment (see Table 1).
Quasi Replication Analysis
The effect of the program on couples on the waiting list provided an owncontrol
analysis and represented a partial replication of the study. ANOVAs
with repeated measures were performed on the data with pre-waiting scores,
post-waiting scores and post-treatment scores as the 3 time points. Table 2
summarizes the means and standard deviations for all measures.
The 3 (pre-waiting vs. post-waiting vs. post-program) × 2 (male vs. female)
analysis of variance showed a significant main effect of Time for the
Marital Happiness Scale (F(2, 31) = 23, p < .0001), for the overall score
of the Problem Solving Inventory (F(2, 31) = 16, p < .0001), and for all
Impact of Group CBT on Marital Happiness and Self-Appraisal 111
PSI subscales (F(6, 26) = 9, p < .0001). The Time × Sex interaction effect
was not significant. To determine the source of these differences, two
series of analyses of variance were conducted. The first analyses assessed
the changes from the pre-waiting to the post-waiting period, whereas the
second provided the evaluation of the effect of the program (post-waiting to
The results of the first series of analyses of variance (pre- to postwaiting)
indicated a significant Time effect for marital adjustment (F(1.34) =
7.5, p < .01) and for overall PSI score (F(1, 35) = 8.1, p < .007). At the
second evaluation, waiting list subjects reported a slight increase in marital
adjustment and in the appraisal of their problem solving abilities. The
MANOVA conducted on the PSI subscale scores revealed another significant
Time effect (F(4, 31) = 3.6, p < .02). Subsequent analyses revealed that
subjects reported a significant increase in their problem solving confidence
(F(1, 34) = 11.7, p < .002) following the waiting period (see Table 2).
The second series of analyses, which evaluated the effect of the treatment,
demonstrated a significant Time effect for marital adjustment (F(1,
32) = 26.2, p < .0001) and for PSI total score (F(1, 32) = 14.5, p < .001).
MANOVAs conducted on the PSI subscales revealed another significant Time
effect (F(429) = 9.6, p < .001). Univariate analyses demonstrated substantial
changes following the program on all subscales: problem solving confidence
(F(1.32) = 5.2, p < .03), approach to problem solving activities (F(1, 32) =
15.5, p < .0001) and strategies to control their behaviors (F(1, 32) = 2.62, p
< .02). As shown in Table 2, score increments recorded by the group following
the program were consistently superior to those reported by the same
group during the control period. The data confirm that participation in the
group marital therapy increased marital adjustment and enhanced spouses’
self-perceived problem solving efficacy.
Differential Effectiveness of the Program
To investigate the effects of group marital therapy on spouses who appraise
their problem solving as either effective or ineffective, three 2 (PSI: effective
vs. ineffective) × 2 (pre vs. post) analyses of variance were conducted on the
Marital Happiness Scale and on the Problem Solving Inventory (total score
and subscales). Because the analyses require a within-group comparison,
experimental and control group data were combined to examine the changes
from pre- to post-program. Because men and women’s Problem Solving
scores had different distributions (respectively, 33 to 161 and 47 to 154), and
because they differed significantly from one another (F(1, 61) = 9.8, p <
.003), analyses were conducted separately for the sexes using the split half
overall PSI score of both groups (men = 83 and women = 94) to subdivide
them into effective and ineffective PSI scorers.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
112 C. B´elanger et al.
TABLE 3 Means and Standard Deviations of Pre-Program and Post-Program for Effective and
Group Ineffective Effective Ineffective Effective
Time pre post pre post pre post pre post
PSI total M 104.3 81.5 64.5 65.4 112.6 92.4 77.5 73.1
SD 20.0 21.3 12.6 16.2 16.9 23.7 10.8 13.7
PSI M 28.7 23.9 18.9 20.6 33.6 27.1 21.2 21.4
Confidence SD 9.1 8.8 5.5 7.9 8.6 9.3 4.5 4.7
PSI M 56.7 42.6 32.9 32.7 58.5 47.7 39.2 36.6
Approach SD 12.3 10.4 6.7 8.3 9.4 12.8 8.0 7.5
PSI M 18.9 15.0 12.7 12.0 20.5 17.7 17.1 15.1
Control SD 5.1 5.1 4.1 3.8 12.8 4.4 4.0 4.2
Marital M 6.2 7.3 6.6 7.4 5.9 6.7 6.5 7.1
Happiness SD 1.3 1.3 1.2 1.3 1.4 1.5 1.3 1.2
Note. M = mean; SD = standard deviation; PSI = Problem Solving Inventory.
MARITAL HAPPINESS SCALE
The results indicated an absence of a significant difference between the
effective and ineffective scorers on the Marital Happiness scale (respectively,
for men and women, F(1, 61) = .66, p < .3); F(1, 61) = .38, p < .5)). The
mean scores revealed that both groups of men and women (effective and
ineffective scorers) reported similar improvement in their marital satisfaction
following the program (see Table 3).
PROBLEM SOLVING INVENTORY
Analyses of the Problem Solving Inventory total scores revealed a significant
PSI Group × Time effect for men (F(1, 61) = 18.55, p < .0001) and women
(F(1, 61) = 11.05, p < .001). Following the program, women who initially
perceived themselves as ineffective problem solvers reported more changes
in the overall appraisal of their problem solving abilities than women who,
before the program, perceived themselves as effective problem solvers. Similarly,
men who initially appraised themselves as ineffective problem solvers
reported more improvements in their overall PSI score following the program
than men who initially perceived themselves as effective problem solvers
(see Table 3).
The results of the MANOVAs conducted on the Problem Solving Inventory
subscales revealed a significant PSI Group × Time effect (F(3, 59) =
6.26, p < .001) for women and for men (F(3, 59) = 6.2, p < .001). Univariate
analyses of variance conducted on the group of women indicated that,
following the program, women who initially appraised themselves as ineffective
problem solvers noted more improvement in their problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 113
confidence (F(1, 37) = 9.3, p < .004) and in their approach to problem solving
activities (F(1, 37) = 8.03, p < .007) than women who initially appraised
themselves as effective problem solvers. The two groups of women (effective
and ineffective) did not differ, however, in their perceived personal control
following the treatment (see Table 3).
As for the men, subsequent univariate analyses indicated that only the
ineffective problem solvers reported improvement in their problem solving
confidence (F(1, 61) = 10.5, p < .002), in their approach to problem solving
activities (F(1, 61) = 18.4, p < .0001) and in their personal control (F(1, 61) =
9.4, p < .004) following the program (see Table 3).COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
The results of this study generally support the hypothesis that couples’
marital happiness increases significantly following participation in cognitivebehavioral
group marital therapy (Baucom, Epstein, Kirby & LaTaillade, 2010;
Butler, Chapman, Forman, & Beck, 2006). Furthermore, the program was
shown to significantly alter spouses’ appraisal of their problem solving efficacy.
More specifically, the results indicated that, following the intervention,
partners reported a significant improvement in their capacity to confront different
problem solving activities. Moreover, in the analyses that measured
their perception of control, all measures demonstrated a significant change
in the expected direction. After completing the program, spouses appraised
themselves as having more confidence in their problem solving capacities, a
stronger tendency to face problem solving activities rather than avoid problems,
and better personal control of their behaviors while solving problems
related to their dyadic interactions. Both the experimental versus control
group analyses and the perception of control analyses yielded substantially
similar results. Although from the perception of control analyses, there was
a significant change in some variables from the pre- to post-waiting period,
the impact of the treatment was made clear by the important gains in all
measures from post-waiting to post-program. This small initial gain between
the pre- and post-waiting period could have been due to habituation to the
testing situation and to the instruments and does not challenge the efficacy
of the treatment.
The results also suggest that the program helped couples improve their
marital adjustment independently of how they initially appraised their problem
solving abilities. However, the results indicate that cognitive-behavioral
group marital therapy had a differential effect on the improvement of selfperceived
problem solving capacities depending on the sex of the participant
and on the initial self-appraisal of his/her problem solving abilities.
Generally, the program had a favorable impact on women’s perception of
self-efficacy, and women who initially perceived themselves as ineffective
114 C. B´elanger et al.
problem solvers reported even more positive changes following the program
than those who initially appraised themselves as effective problem solvers.
As for men, only those who initially appraised their problem solving abilities
as ineffective reported improvement in their problem solving appraisal
after completion of the program. However, as was the case for women, the
program was less useful in helping men who initially perceived themselves
as effective problem solvers to change their cognitions.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
These results suggest that cognitive-behavioral marital therapy should
include cognitive strategies targeting self-appraisal of problem solving activities
if and only if spouses appraise themselves as ineffective problem
solvers before the beginning of the intervention. With partners who appraise
themselves as effective problem solvers, this strategy would not be pertinent,
and other targets should be identified during the initial assessment. These
data are consistent with the results of previous studies that have noted the
utility of training for subjects who perceived certain problem solving deficits
(Heppner et al., 1988). A possible explanation for the lack of improvement
in these spouses could be that they had little room for improvement. For
example, the optimal functioning score on the PSI is 32, whereas the highest
score, 192, reflects the worst functioning. Men who initially perceived their
problem solving abilities as effective had a mean score of 64.5 with a minimum
approximate score of 51.9, while women had an average score of 77.5
with a minimum approximate score of 66.6. Compared to Heppner’s sample
(lowest score of 60; Heppner et al., 1988), it seems that our group of effective
problem solvers had particularly strong perceptions of their problem solving
abilities. However, both groups reported similar appraisal of their problem
solving abilities following treatment.
It is also possible that the program itself might be designed to be a better
fit for the needs of subjects who initially perceived themselves as ineffective
problem solvers. Group leaders focused on cognitive (beliefs, self-talk,
self-monitoring) and behavioral skills (effective concrete steps of problem
solving) during instructions, modeling rehearsal, feedback and homework
assignments. Yet, because the sessions were conducted in groups of four
couples (eight individuals) and two therapists, it was impossible to constantly
create individualized learning experiences. It is possible that a more
individualized focus on participants’ self-appraisal of problem solving abilities
would have produced higher gains in the spouses who initially perceived
themselves to be effective problem solvers.
The findings of the present study are interesting for several reasons.
First, the results support the effectiveness of group marital therapy in altering
the cognitive process of self-perceived ineffective problem solvers. Even if
treatments for couples paradigms recognize the role of cognitive variables,
very few outcome studies have paid attention to this particular aspect.
These results dovetail nicely, on one hand, with a study by Heppner
and his colleagues (1982), who have demonstrated that problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 115
self-appraisal is directly related to problem solving competence and, on the
other hand, with a previous study by Sabourin and his colleagues (1990),
who demonstrated that problem solving self-appraisal is also related to marital
adjustment and to specific coping efforts. This research showed that
distressed spouses showed less problem solving confidence, a tendency
to avoid different problem solving activities, and poor strategies to control
their behavior. Thus, in the clinical evaluation of the partners before
starting couple therapy, it would be important to verify the couple’s appraisal
of their problem solving abilities. If partners demonstrate a lack of
empowerment, learned helplessness or self-perception of a low capacity
to solve problems, the proposed therapeutic intervention should have a
positive effect on the development and maintenance of effective problem
solving behaviors and consequently on the long-term improvement of their
This study has some limitations. There was no follow-up after the conclusion
of treatment to verify if changes in self-appraisal remained in the absence
of therapy. Future research should replicate these findings and assess
the long-term effects of cognitive-behavioral group marital therapy on the
maintenance of effective problem solving self-appraisal and marital satisfaction.
Furthermore, given the interaction between the initial levels of problem
solving self-appraisal and the amount of perceptual change, it would also
be important to study subjects who are initially different in their levels of
perceived and observed problem solving efficacy (Baucom & Kerig, 2004;
Heyman, 2001). It is also possible that this treatment is not unique in its
effect on the person’s sense of self-appraisal and that individual therapy, use
of homework in therapy, and even other forms of couple therapy may also
have improved these skills.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
Another limitation is related to the nature of the measurement used
for appraising problem solving abilities. Because this study focused on selfreport
of problem solving efficacy, inferences regarding related changes in
overt problem solving skills are not yet warranted. Future research should
examine if problem solving self-appraisal bears a relation to the actual problem
solving behaviors of spouses. Therefore, as suggested by B´elanger and
his colleagues (2012), behavioral modifications of problem solving interactions
should be included in future studies. Along these lines, our team
recently investigated the relationship between specific coping strategies and
problem solving/communication behaviors in close relationships (B´elanger
et al., 2012). Observed behaviors were coded using a macroscopic coding
system for dyadic interactions (Belanger et al., 1993). For both men and
women, results showed significant relationships between coping strategies,
problem solving, marital interactions, and marital adjustment (B´elanger et al.,
2012). It would be interesting to test how these interactions may change after
a cognitive behavioral marital program such as the one we tested in this
116 C. B´elanger et al.
It might also be of interest to see if a cognitive behavioral program for
couples that incorporated dyadic coping skills would be helpful for predicting
marital adjustment. Bodenmann and his colleagues (2001) tested such
a program, the Couples Coping Enhancement Training for couples. These
researchers showed that following the intervention, couples reported a significant
increase in their appraisal of a number of domains and an increase in
the quality of their marital relationship (Bodenmann, Charvoz, Cina, & Widmer,
2001). It would be interesting for future studies to integrate appraisals
of coping skills and problem solving and of the actual behavioral capacities
to get involved and solve problems (B´elanger et al., 1993).
Azrin, M. H., Master, B. J., & Jones, P. (1973). Reciprocity counselling: A learning
based procedure for marital couselling. Behavior Research and Therapy, 11,
Bandura, A. (1986). Social foundations of thought and action: A social cognitive
theory. Englewood Cliffs, NJ: Prentice-Hall.
Baucom, D. H., Epstein N., Kirby, J. S., & LaTaillade, J. J. (2010). Cognitive-behavioral
couple therapy. In K. S. Dobson (Ed.), Handbook of cognitive behavior therapy
(pp. 411–444). New York, NY: Guilford Press.
Baucom, D. H., & Kerig, P. K. (2004). Coding couples’ interactions: Introduction and
overview. In P. K. Kerig & D. H. Baucom (Eds.), Couple observational coding
systems (pp. 3–10). Mahway, NJ: Lawrence Erlbaum.
B´elanger, C., Sabourin, S., & El-Baalbaki, G. (2012). Behavioral correlates of coping
strategies in close relationships. Europe’s Journal of Psychology (EJOP), 8(3),
B´elanger, C., Sabourin, S., Laughrea, K., Dulude, D., & Wright, J. (1993). Macroscopic
marital interaction coding systems: Are they interchangeable? Behavior Research
and Therapy, 31(8), 789–795.
Bodenmann, G., Charvoz, L., Cina, A., & Widmer, K. (2001). Prevention of marital
distress by enhancing the coping skills of couples: 1-year follow-up-study. Swiss
Journal of Psychology, 60(1), 3–10.
Bourgeois, L., Sabourin, S., & Wright, J. (1990). Predictive validity of therapeutic
alliance in group marital therapy. Journal of Consulting and Clinical Psychology,
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status
of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology
Review, 26(1), 17–31.
Carr´e, P. (2004). De l’apprentissage social au sentiment d’efficacit´e personnelle :
autour de l’oeuvre d’Albert Bandura [Social learning to self efficacy: Albert
Bandura and his writings]. L’Harmattan Eds.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
Dattilio, F. M., & Epstein, N. B. (2005). The role of cognitive-behavioral interventions
in couple and family therapy [Edited special section]. Journal of Marital and
Family Therapy, 31(1), 7–13.
Impact of Group CBT on Marital Happiness and Self-Appraisal 117
Dunn, R. L., & Schwebel, A. I. (1995). Meta-analytic review of marital therapy outcome
research. Journal of Family Psychology, 9, 58–68.
Dreer, L., Elliott, T., Fletcher, D., & Swanson, M. (2005). Social problem solving
abilities and psychological adjustment of persons in low vision rehabilitation.
Rehabilitation Psychology, 50, 232–238.
D’Zurilla, T. J., Maydeu-Olivares, A., & Gallardo-Pujol, D. (2011) Predicting social
problem solving using personality traits. Personality and Individual Differences,
Elliott, T., & Grant, J. (2008). Social problem solving and health. Biennal Review of
Counseling Psychology, 1, 295–309.
Elliott, T., Grant, J., & Miller, D. (2004). Social problem solving abilities and behavioral
health. In E. Chang, T. J. D’Zurilla, & L. J. Sanna (Eds.), Social problem
solving: Theory, research, and training (pp. 117–133). Washington, DC: American
Godshall, F. J., & Elliott, T. R. (1997). Behavioral correlates of self-appraised problem
solving ability: Problem solving skills and health-compromising behaviors.
Journal of Applied Social Psychology, 27, 929–944.
Heppner, P., & Dong-Gwi, L. (2009). Problem solving appraisal and psychological
adjustment. In C. R. Snyder & S. J. Lopez (Eds.), The Oxford handbook of positive
psychology (2nd ed.). New York, NY: Oxford University Press.
Heppner, P. P. (1986). Manual for the Problem Solving Inventory (PSI). Palo Alto,
CA: Consulting Psychologists Press.
Heppner, P. P., & Anderson, W. P. (1985). The relationship between problem solving
self-appraisal and psychological adjustment. Cognitive Therapy and Research,
Heppner, P. P., Baumgardner, A. H., Larson, L. M., & Petty, R. E. (1988). The utility
of problem solving training that emphasises self-management principles.
Counselling Psychology Quarterly, 1, 129–143.
Heppner, P. P., Kampa, M., & Brunning, L. (1987). The relationship between problem
solving self-appraisal and indices of physical and psychological health.
Cognitive Therapy and Research, 11, 155–168.
Heppner, P. P., & Krauskopf, C. J. (1987). An information-processing approach
to personal problem solving. The Counselling Psychologist, 15, 371–
Heppner, P. P., & Petersen, C. H., (1982). The development and implication of
a personal problem solving inventory. Journal of Counselling Psychology, 29,
Hertzog, S. M. (2011). Is marriage good for your health? The influential role of marital
quality and life events on individual-level health and well-being (Doctoral
dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI
Heyman, R. E. (2001). Observation of couple conflicts: Clinical assessment applications,
stubborn truths, and shaky foundations. Psychological Assessment, 13,
Kenny, D. A., & Cook, W. (1999). Partner effects in relationship research: Conceptual
issues, analytic difficulties, and illustrations. Personal Relationships, 6,
118 C. B´elanger et al.
Kurdek, L. A. (1991). Correlates of relationship satisfaction in cohabiting gay and lesbian
couples: Integration of contextual investment and problem solving models.
Journal of Personality and Social Psychology, 61, 910–922.
Laporte, L., Sabourin, S., & Wright, J. (1989). L’inventaire de r´esolution de probl`emes
personnels: une perspective m´etacognitive [The Problem Solving Inventory: A
metacognitive perspective]. Journal International de Psychologie, 23, 569–581.
Libman, E., Takefman, J., & Brender, W. (1980). A comparaison of sexually dysfunctional,
maritally disturbed and well-adjusted couples. Personality and Individual
Differences, 1, 219–227.COGNITIVE BEHAVIORAL GROUP THERAPY NURSING ASSIGNMENT
Locke, H. J., & Wallace, K. M. (1959). Short marital adjustment and prediction test:
Their reliability and validity. Marriage and Family Living, 21, 251–255.
Lussier, Y., Sabourin, S., & Turgeon, C. (1997). Coping strategies as moderators of
the relationship between attachment and marital adjustment. Journal of Social
and Personal Relationships, 14, 777–791.
Nezu, A. M. (1985). Differences in psychological distress between effective and
ineffective problem solvers. Journal of Counseling Psychologist, 32, 135–138.
Nezu, A. M., Kalmar, K., Ronan, G. F., & Clavijo, A. (1986). Attributional correlates of
depression: An interactional model including problem solving. Behavior Therapy,
Nezu, A. M., & Ronan, G. F. (1988). Social problem solving as a moderator of stressrelated
depressive symptoms: A prospective analysis. Journal of Counseling
Psychology, 35, 134–138.
Rivera, P., Elliott, T., Berry, J., Oswald, K., & Grant, J. (2007). Predictors of caregiver
depression among community-residing families living with traumatic brain
injury. NeuroRehabilitation, 22, 3–8.
Sabourin, S., Laporte, L., & Wright, J. (1990). Problem solving self-appraisal and
coping efforts in distressed and nondistressed couples. Journal of Marital and
Family Therapy, 16(1), 89–97.
Shanmugham, K., Cano, M., Elliott, T., & Davis, M. J. (2009). Social problem solving
abilities, relationship satisfaction, and distress among family caregivers of stroke
survivors. Brain Injury, 23, 92–100.
Shanmugham, K., Elliott, T. R., & Palmatier, A. (2004). Social problem solving abilities
and psychosocial impairment among individuals recuperating from surgical
repair for severe pressure sores. NeuroRehabilitation, 19(3), 259–269.
Tracey, T. J., Sherry, P., & Keitel, M. (1986). Distress and help-seeking as a function
of person-environment fit and self-efficacy: A causal model. American Journal
of Community Psychology, 14, 657–676.
Woodin, E. M. (2011). A two-dimensional approach to relationship conflicts: Metaanalytic
findings. Journal of Family Psychology, 25(3), 325–335.
Wright, J. (1986). Survival strategies for couples. Rochester, NY: Prometheus.
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