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Program Profile: Couples Coping Enhancement Training (Switzerland)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on December 03, 2019

Program Summary

This is a marital distress-prevention program designed to encourage positive parenting by teaching couples how to cope with stress. This program is rated Promising. Participating couples reported statistically significant improvements in their perception of the quality of the relationship, coping with stress as a couple, and communication, compared with control group couples, at the 1-year follow up. However, there were no significant differences between groups in improving parenting.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Target Population
The Couples Coping Enhancement Training (CCET) is a marital distress-prevention program in Switzerland, which is designed to improve relationships and encourage positive parenting by teaching couples how to cope with stress. Research suggests that a positive interparental relationship in which couples solve conflicts constructively may enhance their children’s well-being, reduce child problem behaviors, and improve parent-child relations (Ledermann, Bodenmann, and Cina 2007). In CCET, couples learn individual-level coping skills, as well as how to cope with stress together, which is known as dyadic coping. Couples are taught how to recognize and understand their partners’ stress and how to communicate their own stress to their partners so that they can respond appropriately.

Program Components/Key Personnel
The program consists of six modules implemented over 18 hours. The first module includes discussions related to the origins of stress, different forms of stress, and the relationship between cognitive appraisal and stress-related emotions. The second module teaches couples how to cope effectively with stress as individuals, through cognitive techniques and relaxation. The third module teaches couples how to cope with stress together, known as dyadic coping. The fourth module emphasizes the importance of mutual fairness, clear boundaries, and equity in giving and receiving supportive dyadic coping. The fifth and sixth modules teach communication and problem-solving skills (Ledermann, Bodenmann, and Cina 2007).

CCET is typically offered as a weekend course, which is conducted in a group setting with four to eight couples. There is one trainer for every two couples. Couples learn through didactic instruction, which includes short video lectures, personal diagnostics (e.g., evaluation of perceived stress level, individual coping, dyadic coping, communication), quizzes that determine the couple’s mastery of the training material, and video and real-life demonstrations of effective and ineffective problem-solving styles (Zemp et al. 2016). Couples also engage in exercises under the supervision of the trainer. The exercises allow the couples to practice newly learned skills related to stress communication and dyadic coping, fairness and boundaries, communication, and problem solving.

Program Theory
CCET is grounded in stress and coping theories, as related to couples. These theories suggest that the risk of marital decline increases due to stress-related factors, such as deterioration in the quality of marital communication, which leads to more negative interactions and an increase in health problems because of chronic stress exposure, which places a burden on the relationship (Bodemann 2004). Thus, healthy individual-level and dyadic coping techniques can help couples manage the negative impact of stress on their relationship. Coping theories suggest that the more effective that partners are in together handling stress, the more likely they are to effectively reduce stress and create greater cohesion in the relationship (Bodemann and Shantinath 2004).

Additionally, interparental conflict has been associated with maladaptive behaviors in children (Cummings and Davies 2010). Therefore, programs designed to improve coping, communication, and stress management can reduce interparental conflict, which in turn enhances family functioning and children’s wellbeing (Zemp et al. 2016).

Evaluation Outcomes

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Study 1
Dyadic Adjustment
Ledermann, Bodenmann, and Cina (2007) found that couples who participated in Couples Coping Enhancement Training (CCET) showed statistically significant improvements on measures of dyadic adjustment, compared with control group couples, at the 1-year follow up. This means that CCET couples reported a higher quality of relationship than did control group couples.

Parent Problem Checklist
There were no significant differences between groups on the parent problem checklist at the 1-year follow up.

Communication
CCET couples showed statistically significant improvements on measures of communication, compared with control group couples, at the 1-year follow up.

Dyadic Coping
CCET couples showed statistically significant improvements on measures of dyadic coping, compared with control group couples, at the 1-year follow up. This means that couples who participated in CCET were better able to cope with stress together, compared with couples in the control group.
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Evaluation Methodology

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Study 1
Ledermann, Bodenmann, and Cina (2007) conducted a randomized controlled trial in Switzerland to evaluate the effectiveness of Couples Coping Enhancement Training (CCET) on improving marital communication, dyadic coping, and marital quality in parents of children ages 2 to 12 years.

Ninety-one couples were randomly assigned to either receive CCET (n = 46) or to a control group (n = 45) that received no training. Approximately 94 percent of the couples in the intervention group were married, and the average length of the relationship was 12.7 years. The couples had an average of 2.2 children. Of this group, 12 percent had a family income of between $0 and $39,000, 80 percent had an income between $40,000 and $79,999, and 8 percent earned $80,000 or more, annually. In the intervention group, the average age of women was 36.5 years, and the average age of men was 39.6 years. In the control group, 98 percent of the couples were married, and the average length of the relationship was 14.2 years. The couples had an average of 2.4 children. Of this group, 14 percent had a family income of between $0 and $39,000, 68 percent had an income between $40,000 and $79,000, and 18 percent earned $80,000 or more, annually. There were no significant differences between groups on baseline demographics. Information on the race/ethnicity of the study sample was not provided.

Outcomes were measured using the following four scales: 1) Dyadic Adjustment Scale (Spanier 1976), which assesses the quality of the relationship as perceived by both partners; 2) Marital Communication Questionnaire (Bodenmann, 2000), which evaluates communication behaviors such as criticism, defensiveness, contempt, belligerence, being domineering, positive affect, and level of care; 3) Dyadic Coping Inventory (Bodenmann 2007), which measured stress communication, supportive dyadic coping, and negative dyadic coping both individually and jointly; and 4) Parent Problem Checklist (Dadds and Powell 1991),which assesses interparental conflict with regard to child rearing such as the parents’ ability to cooperate and work together when facing educational concerns. At baseline, there was a statistically significant difference in marital cohesion. Women in the CCET group reported higher scores than did women in the control group. No other significant differences were reported.

The researchers used a multivariate analysis of variance to estimate effects of CCET on participants at the 1-year follow up. The authors conducted subgroup analyses on gender.
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Cost

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There is no cost information available for this program.
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Other Information (Including Subgroup Findings)

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Ledermann, Bodenmann, and Cinda (2007) conducted subgroup analyses on the effect of gender and found statistically significant differences between men and women. In terms of marital cohesion, men had higher scores, compared with women across all groups. In terms of positive communication, women had higher scores, compared with men across all groups.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Ledermann, Thomas, Guy Bodenmann, and Annette Cina. 2007. “The Ef?cacy of the Couples Coping Enhancement Training (CCET) in Improving Relationship Quality.” Journal of Social and Clinical Psychology 26(8):940–59.
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Additional References

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These sources were used in the development of the program profile:

Bodenmann, Guy. 2000. Stress und Coping bei Paaren [Stress and Coping in Couples]. Gottingen: Hogrefe.

Bodenmann, Guy. 2007. Dyadisches Coping Inventar (DCI) Testmanual [Dyadic Coping Inventory (DCI) Test Manual] Bern, Gottengen: Huber & Hogrefe.

Bodenmann, Guy, Annette Cina, Thomas Ledermann, T., and Matthew R. Sanders. 2008. “The Ef?cacy of the Triple P-Positive Parenting Program in Improving Parenting and Child Behavior: A Comparison with Two Other Treatment Conditions.” Behaviour Research and Therapy 46(4): 411–27. (This study was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall program rating.)

Bodenmann, Guy, and S.D. Shantinath. 2004. “The Couples Coping Enhancement Training (CCET): A New Approach to Prevention of Marital Distress Based Upon Stress and Coping.” Family Relations 53(5):477–84.

Cummings, E. Mark, and Patrick T. Davies. 2010. Marital Conflict and Children: An Emotional Security Perspective. New York: The Guilford Press.

Dadds, Mark R., and Martine B. Powell. 1991. “The Relationship of Interparental Conflict and Global Marital Adjustment to Aggression, Anxiety, and Immaturity in Aggressive and Nonclinic Children.” Journal of Abnormal Child Psychology 19:553–67.

Spanier, G.B. 1976. “The Measurement of Marital Quality.” Journal of Sex and Marital Therapy 5:288–300.

Zemp, Martina, Anne Milek, E. Mark Cummings, Annette Cina, and Guy Bodenmann. 2016. “How Couple- and Parenting-Focused Programs Affect Child Behavioral Problems: A Randomized Controlled Trial.” Journal of Child and Family Studies 25(3):798–810.
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Program Snapshot

Age: 32 - 46, 2 - 12

Gender: Both

Setting (Delivery): Other Community Setting

Program Type: Conflict Resolution/Interpersonal Skills, Group Therapy, Parent Training

Targeted Population: Families

Current Program Status: Active