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Background New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P Conclusions Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277

Objective: To examine couple and parenting outcomes from an American version of Couple CARE for Parents (CCP) in low-income, unmarried couples. Background: We adapted an evidence-based, flexibly delivered program for use with low-income, unmarried couples, for whom the outcome literature is scarce. Method: Couples (N = 443) were recruited from maternity units and began CCP. They completed measures before, during, and immediately after the intervention and again 6 months later. Results: Experience of moderate psychological intimate partner violence (IPV) declined and perceived parenting efficacy increased over time; there was no change in severe psychological or physical IPV. Individuals with lower levels of relationship commitment than their partners showed improvement in relationship satisfaction, whereas those with similar or higher levels of commitment maintained their baseline levels despite being in a period of expected satisfaction decline. Conclusion: CCP showed some signs of helping low-income couples during a stressful period, and its flexible service delivery model allowed these couples to participate by reducing the impediments of transportation challenges, conflicting work schedules, and overall time poverty. Implications: The results of this study suggest practitioners interested in using CCP with low-income couples would likely maximize the impact by (a) focusing on pregnant, first-time parents; (b) integrating CCP within postnatal health care; and (c) assuming that a considerable minority of couples will avail themselves of only up to two sessions, and thus practitioners should frontload content, making other content optional or just-in-time. In addition, nonpsychoeducational elements (e.g., gamification, easy computerized tasks to reduce angry responses, watching couple-themed movies) could enliven preventative offerings for perinatal couples.

Relative to Westerners, Chinese are alleged to prefer more indirect, subtle, and implicit communication, referred to as high-context communication. We examined whether the use of indirect communication is more common, and more closely related to relationship satisfaction, in Chinese compared with Western couples. Cultural differences in communication might lead to relationship distress in intercultural couples, so we also studied intercultural couples. We coded the observed marital problem-solving of n = 36 Chinese couples, n = 32 Western couples, and n = 51 intercultural Chinese-Western couples, all of whom were living in Brisbane, Australia. There were low rates of most indirect communication behaviors in all groups of couples, with few cultural differences other than avoidance, which was notably higher in couples in which the woman was Chinese. Only a few associations of relationship satisfaction with aspects of indirect communication were moderated by culture. The common view of Chinese communication (as being indirect and implicit) was not reflected in the couple communication of Chinese couples living in Australia.

Rates of international migration and intercultural marriage are rising. Migrants and intercultural partners may experience challenges in defining their ethnic identity relative to their own heritage culture, their partner’s heritage culture, and the majority culture of their country of residence. The current study examined Chinese and Western ethnic identification and relationship satisfaction in four cultural combinations of couples: Western–Western (Western male–Western female), Chinese–Chinese (Chinese male–Chinese female), Western male–Chinese female, and Chinese male–Western female. All couples were residing in Brisbane, Australia, a multicultural city with a majority Western culture. Intracultural couples (Western–Western and Chinese–Chinese) reported the strongest ethnic identification with their heritage culture and weakest ethnic identification with their nonheritage culture, whereas intercultural couples (Western male–Chinese female and Chinese male–Western female) demonstrated intermediate identification. Greater similarity between partners on ethnic identification with the majority Western culture of Australia predicted greater relationship satisfaction, but there was no association of relationship satisfaction with partner similarity on Chinese ethnic identification. We discuss patterns of ethnic identification in terms of acculturation of immigrants, the selection of partners who are similar in ethnic identification, and accommodation of individuals’ ethnic identification toward their partner’s ethnic identification. (APA PsycInfo Database Record (c) 2019 APA, all rights reserved)

Military life can place excess strain on couple relationships. The Couple CARE relationship education program was tailored to address the challenges of military couples. Thirty-two Australian military couples participated in a pilot feasibility study assessing the Couple CARE in Uniform adaptation against an active control. Relationship satisfaction and communication improved in both conditions, with no significant difference between the conditions. Couples' high relationship satisfaction on presentation, paired with modest statistical power, might have contributed to the null results. However, Couple CARE in Uniform had significantly higher consumer satisfaction than the comparison condition, suggesting it is a program worthy of further evaluation.

This chapter reviews the emerging field of couple interventions for same-sex couples. It outlines the evidence base for couple relationship education and couple therapy based on research with heterosexual couples. It reviews data pertaining to relationship stability and relationship satisfaction of same-sex couples and also the similarities and differences in the predictors of relationship outcomes between heterosexual and same-sex couples. The differences suggest modifications are required, including addressing the role of external influences on couple functioning, the role of dyadic coping to buffer effects of minority stress, non-monogamous relationships, and managing disclosure of one’s relationship. Currently, there is modest uptake of couple services among same-sex couples, and this chapter offers suggestions to enhance the relevance and inclusivity of couple interventions. It concludes by proposing a number of future research directions, including examining the efficacy of couple interventions for same-sex couples and evaluating innovations to increase same-sex couples’ access to services.

Effective, accessible prevention programs are needed for adults at heightened risk for intimate partner violence IPV. This parallel groups randomized controlled trial examines whether such couples receiving the American version of Couple CARE for Parents of Newborns (CCP; Halford, Heyman, Slep, Petch, & Creedy, 2009) following the birth of a child, compared with controls, report fewer first occurrences of clinically significant IPV, less frequent physical and psychological IPV, and improved relationship functioning. Further, we test whether intervention effects are moderated by level of risk for IPV. Couples at elevated risk for IPV (N = 368) recruited from maternity units, were randomized to CCP (n=188) or a 24-month waitlist (n=180) and completed measures of IPV and relationship functioning at baseline, post-program (when child was 8-months old), and two follow-ups (at 15- and 24-months). Intervention effects were tested using Intent to Treat (ITT) as well as Complier Average Causal Effect (CACE; Jo & Muthén, 2001) structural equation models. CCP did not significantly prevent clinically significant IPV nor were there significant main effects of CCP on clinically significant IPV, frequency of IPV, or most relationship outcomes in the CACE or ITT analyses. Risk moderated the effect of CCP on male-to-female physical IPV at post-program, with couples with a planned pregnancy declining, but those with unplanned pregnancies increasing. This study adds to previous findings that prevention programs for at-risk couples are not often effective and may even be iatrogenic for some couples.

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.

Meta-analyses of randomized controlled trials of couple therapy find large improvements in couple adjustment, but published evaluations of the effectiveness of couple therapy in routine practice find only small-to-moderate effects. The current study analyzes possible explanations for the research-efficacy to practice-effectiveness gap and offers suggestions for enhancing couple therapy effectiveness. Major recommendations are that therapists should clarify whether couples' therapy goal is to clarify commitment to the relationship or to improve the relationship; use standardized assessment of the individual partners and the relationship; and use systematic monitoring of therapy progress and the therapeutic alliance. It is also possible that the greater use of evidence-based therapies when treating couple relationship distress could enhance couple therapy outcome.

Objective: The diagnosis and treatment of prostate cancer is followed by substantive sexual morbidity. The optimal approach for intervening remains unclear. Methods/design A three-arm randomised control trial was undertaken with 189 heterosexual couples where the man had been diagnosed with prostate cancer and treated surgically. The efficacy of peer-delivered telephone support versus nurse-delivered telephone counselling versus usual care in improving both men's and women's sexual adjustment was investigated. Assessments were undertaken at baseline (pre-test) with follow-up at 3, 6 and 12 months. Results At 12 months, men in the peer (p=0.016) and nurse intervention (p=0.008) were more likely to use medical treatments for erectile dysfunction (ED) than men in the usual care arm. Men in the nurse intervention more frequently used oral medication for ED than men in usual care (p=0.002). No significant effects were found for sexual function, sexuality needs, sexual self-confidence, masculine self-esteem, marital satisfaction or intimacy. Conclusion Although peer and nurse couples-based interventions can increase use of medical treatments for ED, this may not translate into better sexual or relationship outcomes. More research is needed into the optimal timing of interventions to improve sexual outcomes for men with prostate cancer and to identify the subpopulations that will benefit from them.

The experience of the diagnosis of prostate cancer is distressing for both men and their partners. The present study describes the prevalence of psychological distress in men with prostate cancer and their partners, and the predictors of adjustment outcomes. A cross-sectional survey of 189 prostate cancer patients who were scheduled for or had undergone surgery for localised prostate cancer and their partners assessed socio-demographic variables, masculine self-esteem and social intimacy, psychological adjustment and quality of life. Overall, patients and partners reported low distress; however, female partners were more anxious with 36 % reporting mild to severe anxiety. For men, masculine self-esteem and time since diagnosis were most strongly related to mental health status; urinary bother most influenced physical quality of life. For female partners, the man’s psychological distress and his sexual bother were most strongly related to her mental health status; higher social intimacy was most strongly associated with physical quality of life. The correlates of distress after the diagnosis of prostate cancer differ between patients and female partners. For men, masculine self-esteem may be most crucial, whereas for women, her partner’s level of distress may matter most. Research to better understand these interactions is needed.

This chapter describes how the couple relationship can influence the course of common major health problems like heart disease and cancer and provides some guidelines for couple-based assessment and intervention. It presents a model for thinking about the reciprocal relationships between health problems, patient well-being, partner well-being, and the couple relationship. There are three broad approaches to the focus of a couple interventions for health: partner-assisted, disorder-specific, or a general couple therapy. The clinician needs to understand the couple's history, the couple's strengths and resources, and the couple's unique challenges. Dyadic processes like communication training are often a part of the treatment. Couple therapy can play an important role in helping partners to support each other and cope effectively to the stresses of serious health problems. When a couple jointly support and manage the challenges of health adversity, that often brings a sense of renewed closeness and enriched meaning to the couple's shared lives.

Objective: To assess the feasibility of peer support to ameliorate the unmet sexuality needs of couples coping with prostate cancer...

Background Parental well-being can be seriously impacted during the challenging perinatal period. Most research and support services focus on perinatal psychopathology, leaving a need for programs that recognize and enhance the strengths and well-being of parents. Furthermore, fathers have received minimal attention and support relative to mothers, despite experiencing perinatal distress. New parents have limited time and energy to invest in program attendance, and web-based programs provide an ideal platform for delivering perinatal well-being programs. Such programs are globally accessible, available at any time, and can be accessed anywhere with an Internet connection. Objective This paper describes the protocol of a randomized controlled trial investigating the effects on first-time parents’ perinatal well-being, comparing two versions of the online program Baby Steps. Methods The clinical trial will randomize 240 primiparous mother-father couples to either (1) Babycare, an online information-only program providing tips on selected childcare issues, or (2) Well-being, an online interactive program including all content from the Babycare program, plus parental well-being-focused content with tools for goal-setting and problem solving. Both programs will be supported by short message service (SMS) texts at two, four, seven, and ten weeks to encourage continued use of the program. Primary outcomes will be measures of perinatal distress and quality of life. Secondary outcomes will be couple relationship satisfaction, parent self-efficacy, and social support. Cost-effectiveness will also be measured for each Baby Steps program. Results Participant recruitment commenced March, 2015 and continued until October, 2015. Follow-up data collection has commenced and will be completed May, 2016 with results expected in July, 2016. Conclusions Perinatal distress has substantial impacts on parents and their infants, with potential to affect later childhood adjustment, relationships, and development. This study aims to test the impact of a highly accessible online program to support parental coping, and maximize the well-being of both parents. By including fathers in the program, Baby Steps has the potential to engage and support this often neglected group who can make a substantial contribution to familial well-being. ClinicalTrial Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367277 (Archived by WebCite at http://www.webcitation.org/6ibUsjFIL)

Assessment and feedback of relationship strengths and challenges is a widely used brief approach to couple relationship education (CRE). It can be fully automated through the internet, with couples self-interpreting the feedback. This study assessed whether therapist guidance of couples to interpret the report and develop relationship goals enhanced the benefits of the feedback. Thirty-nine couples seeking CRE were randomly assigned to either self-interpretation of an internet-based relationship assessment report (RELATE), or therapist-guided interpretation of the same report (RELATE+). Participants were assessed on relationship satisfaction and psychological distress pre- and post-CRE, and at 6-month follow-up. RELATE and RELATE+ were not reliably different in outcome. Couples in both conditions sustained high relationship satisfaction and showed an overall decline in psychological distress. However, consumer satisfaction was substantially higher for the RELATE+ condition than the RELATE condition.

Several approaches to couple therapy produce large and clinically significant reductions in relationship distress. However, 25 to 30 per cent of couples show no benefit from couple therapy. Adapted forms of couple therapy can effectively treat some psychological disorders and enhance adjustment to physical health problems. The specific mechanisms underlying the effects of couple therapy on relationship distress are unclear. Current attempts to enhance the efficacy of couple therapy have three foci: (1) identifying the common factors that might account for change across approaches, (2) integrating different approaches to address specific needs of particular partners and couples and (3) monitoring the progress of couples during therapy and using that information to modify couple therapy as required. Given the high prevalence of relationship distress and its association with other problems, clinicians should routinely screen for relationship distress in adults. Couple therapy needs to be considered as the focus, or part of the focus, of treatment for a wide range of adult emotional and behavioural problems.

Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.

The current study examined the learning processes involved in professionally supported self-directed couple relationship education (CRE). Fifty-nine couples completed Couple CARE, a systematic, self-directed CRE program designed in flexible delivery mode to be completed at home. Couples watched a DVD introducing key relationship ideas and skills and then completed a structured guidebook. The learning process was supported by telephone-based coaching sessions from a professional relationship educator. Couples completed the learning tasks associated with the programe and successfully implemented a wide range of relationship self-change, and most reported continuing implementation of program learning at 6 months follow-up. These findings suggest that Couple CARE is readily accessible and results in effective skill acquisition for couples.

We assessed the effects of the Controlling Alcohol and Relationship Enhancement (CARE) program, an early intervention combining reduction of hazardous alcohol consumption and enhancement of couple relationships. Thirty-seven hazardous drinking couples were randomly allocated to either the CARE program or to a control condition. CARE couples improved their communication more than controls, but couples in both conditions reduced hazardous drinking to a similar extent. CARE is a potentially useful means of promoting positive relationship communication in hazardous drinking couples.

Relationship education holds much promise for reducing the individual, family, and community costs of relationship distress and breakdown. To realize this, potential educators need to offer evidence-based education that tailors content to the risk and resiliency profiles of the couples. Education needs to be offered at crucial developmental points in couple relationships, in an integrated manner with community development initiatives, to couples at high risk of future relationship problems and in a variety of delivery modes.

Kim Halford has conducted major research on the determinants of relationship satisfaction and stability, and how to promote healthy couple relationships both through relationship education for currently well-functioning couples, and through couple therapy for distressed couples. Kim is Professor of Clinical Psychology at Griffith University, and Director, Queensland Cancer Fund, Griffith University Cancer Support Centre. He is the author of Brief Couple Therapy: Helping Partners Help Themselves; Australian Couples in Millennium Three: A Research and Development Agenda for Marriage and Relationship Education, co-author of Clinical Handbook of Marriage and Couples Interventions; Report to the Australian Psychological Society on the Status and Future Directions of Health Psychology in Australia; Couple CARE: The Couple Commitment and Relationship Enhancement Program, Couple Guidebook (in press). He is also author or co-author of over 90 book chapters, journal articles and audiovisual productions. (author abstract)

This chapter is focused on Unit 5 of the Couple CARE for Parents (CPP) program, which aims to help couples negotiate a mutually acceptable sharing of infant care responsibilities, and to balance individual, couple and family time. Unit 5 is the first unit delivered in flexible delivery mode (in the usual way of delivering CPP). Flexible delivery involves the couple completing activities at home and reviewing these activities with the educator at a later time via telephone or Internet. This chapter reviews some practical issues in making the flexible delivery format effective. The content also describes how to help couples analyze their current patterns of time use, and promote a healthy balance of individual, couple and family activities. The focus is then on helping couples review their parenting roles, and how those roles vary from their pre-birth expectations, with the aim of helping couples negotiate a shared approach to parenthood. This chapter also describes common challenges to completion of the flexible delivery units (e.g., when couples have not completed their self-directed learning activities), and how to manage those challenges.

Feedback to therapists based on systematic monitoring of individual therapy progress reliably enhances therapy outcome. An implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. To explore the possibility of using feedback of therapy progress to enhance couple therapy outcome, the current study tested whether weekly therapy progress could detect off-track clients early in couple therapy. In an effectiveness trial of couple therapy, 136 couples were monitored weekly on relationship satisfaction and an expert derived algorithm was used to attempt to predict eventual therapy outcome. As expected, the algorithm detected a significant proportion of couples who did not benefit from couple therapy at Session 3, but prediction was substantially improved at Session 4 so that eventual outcome was accurately predicted for 70% of couples, with little improvement of prediction thereafter. More sophisticated algorithms might enhance prediction accuracy, and a trial of the effects of therapy progress feedback on couple therapy outcome is needed.

Diet is an important component of the management of Insulin Dependent Diabetes Mellitus (IDDM), yet it has been difficult to obtain effective measures of dietary management. Two studies were conducted assessing the frequency and antecedents of problems in dietary self-care in IDDM. In study one the Diet Problem Setting Inventory (DPSI), a self-report inventor assessing the settings in which poor dietary management occur, was developed. One hundred and thirty-seven individuals with IDDM completed the DPSI, and a factor analysis revealed three internally consistent factors. In study two, 41, IDDM patients self-monitored, and were interviewed daily about their diet, to ascertain the frequency and antecedents of problems in dietary self-care. Subjects also completed the DPSI twice to assess its test-retest reliability. The total score on the DPSI showed high test-retest reliability, and moderate convergent validity with self-monitored dietary management. The more intensive self-monitoring assessment ...

Effective dietary management in Insulin Dependent Diabetes Mellitus (IDDM) is impeded by a variety of transient cognitive, behavioural and environmental events. In the current study forty individual's with IDDM were assigned randomly to either a treatment pup in which they were taught to identify and change eating in high risk situations for poor dietary management. or a wait list control. Dietary management and blood glucose control were assessed at pre- and post-treatment, and at three month follow up for the 32 subjects completing the study. The intervention produced significant improvements in dietary management, which were maintained to follow-up, and short term improvements in blood sugar control.

The health of an individual is determined by the interaction of genetic and individual factors with wider social and environmental elements. Public health approaches to improving the health of disadvantaged populations will be most effective if they optimise influences at each of these levels, particularly in the early part of the life course. In order to better ascertain the relative contribution of these multi-level determinants there is a need for robust studies, longitudinal and prospective in nature, that examine individual, familial, social and environmental exposures. This paper describes the study background and methods, as it has been implemented in an Australian birth cohort study, Environments for Healthy Living (EFHL): The Griffith Study of Population Health. EFHL is a prospective, multi-level, multi-year longitudinal birth cohort study, designed to collect information from before birth through to adulthood across a spectrum of eco-epidemiological factors, including genetic material from cord-blood samples at birth, individual and familial factors, to spatial data on the living environment. EFHL commenced the pilot phase of recruitment in 2006 and open recruitment in 2007, with a target sample size of 4000 mother/infant dyads. Detailed information on each participant is obtained at birth, 12-months, 3-years, 5-years and subsequent three to five yearly intervals. The findings of this research will provide detailed evidence on the relative contribution of multi-level determinants of health, which can be used to inform social policy and intervention strategies that will facilitate healthy behaviours and choices across sub-populations.

A central aspect of self-management of diabetes involves patients regulating the timing and intake of dietary carbohydrates. A 20 year old female diabetic patient was taught to identify deviations from appropriate dietary self-management, and a problem solving intervention was used to train new behavior in settings associated with such deviations. Dietary behavior and blood glucose levels were monitored in a diary and electronically, and treatment effects were evaluated in a multiple baseline across settings design. Treatment resulted in clear improvement in dietary management, and a substantial gain in blood glucose control at the end of intervention. At follow-up dietary change was maintained. Long term effects on blood glucose levels were confounded by a reduction in insulin dosage between treatment and follow-up.

OBJECTIVE: Although women's breast cancer affects both women and their male partners, as well as their relationships, few interventions have been developed to work with couples confronting breast cancer. The current investigation presents the pilot results from a new couple-based intervention program for breast cancer that teaches couples how to minimize negative effects and maximize positive functioning during this difficult time. METHOD: In this pilot study, 14 couples in which the wife had early stage breast cancer were randomly assigned to one of the two treatment conditions: Couple-based relationship enhancement (RE) or treatment-as-usual (TAU). RESULTS: The results from this study suggest that compared with couples receiving treatment-as-usual, both women and men in the RE condition experienced improved functioning on individual psychological variables as well as relationship functioning at posttest and 1-year follow-up. In addition, women in RE show fewer medical symptoms at both time periods. CONCLUSIONS: In this pilot study, the couple-based intervention, RE, has shown promise in improving individual, medical, and relationship functioning for couples in which the woman is facing breast cancer, and therefore merits further investigation on a larger scale.

Background Prostate cancer is the most common male cancer in the Western world. The most substantial long term morbidity from this cancer is sexual dysfunction with consequent adverse changes in couple and intimate relationships. Research to date has not identified an effective way to improve sexual and psychosocial adjustment for both men with prostate cancer and their partners. As well, the efficacy and cost effectiveness of peer counselling as opposed to professional models of service delivery has not yet been empirically tested. This paper presents the design of a three arm randomised controlled trial (peer vs. nurse counselling vs. usual care) that will evaluate the efficacy of two couples-based sexuality interventions (ProsCan for Couples: Peer support vs. nurse counselling) on men's and women's sexual and psychosocial adjustment after surgical treatment for localised prostate cancer; in addition to cost-effectiveness. Methods/design Seventy couples per condition (210 couples in total) will be recruited after diagnosis and before treatment through urology private practices and hospital outpatient clinics and randomised to (1) usual care; (2) eight sessions of peer-delivered telephone support with DVD education; and (3) eight sessions of oncology nurse-delivered telephone counselling with DVD education. Two intervention sessions will be delivered before surgery and six over the six months post-surgery. The intervention will utilise a cognitive behavioural approach along with couple relationship education focussed on relationship enhancement and helping the couple to conjointly manage the stresses of cancer diagnosis and treatment. Participants will be assessed at baseline (before surgery) and 3, 6 and 12 months post-surgery. Outcome measures include: sexual adjustment; unmet sexuality supportive care needs; attitudes to sexual help seeking; psychological adjustment; benefit finding and quality of life. Discussion The study will provide recommendations about the efficacy of peer support vs. nurse counselling to facilitate better sexual and couple adjustment after prostate cancer as well as recommendations on whether the interventions represent efficient health service delivery. Trial Registration ACTRN12608000358347

This paper examines the organisational, interpersonal, and political processes involved in setting up specialised clinical research and training facilities within Australian universities. The Behaviour Research and Therapy Centre (BRTC) at the University of Queensland is discussed as an example to illustrate the tasks involved in setting up and maintaining a clinical research and training facility. We also discuss some of the organisational obstacles to designing clinical facilities and possible strategies for overcoming them. Designing a training environment creates opportunities to apply principles of environmental design, organisational psychology, and behaviour modification.

In Australia, the strengthening of marriage through relationship education has received strong governmental policy support and some modest financial support. Couple relationship education services are offered by a variety of community-based, church-affiliated, and church-based providers. There is a strong emphasis on providing programs that are developed locally in response to perceived couple needs and government policies. Available evaluations show that most couples who attend education value the service, but relationship education providers need to do a better job reaching out to couples at high risk for future relationship problems, and more research is needed on the effects of education on long-term marital outcomes. There is significant scope for building on current initiatives to incorporate evidence-based approaches and to expand the program reach to more couples.

This article introduces the special section on international perspectives on couple relationship education. We first describe the theory and research underlying the increased interest in relationship education, with a strong emphasis on social policy issues. We include a discussion of both the benefits and controversies resulting from governments being involved in promoting healthy relationships. We then provide an overview of the four articles included in the special section and show how they illustrate trends occurring in a diverse set of cultural and national contexts. We conclude by highlighting issues and future directions for the relationship education field.

The Fourth World Congress of Behaviour Therapy, held on the Gold Coast of Queensland, Australia between July 4–8, 1992 was an important event in the professional calendars of many behaviour therapists internationally. It was hosted by the Australian Behaviour Modification Association, in association with the Association for the Advancement of Behavior Therapy, and the European Association of Behavior Therapy. This 3-yearly event provides an important opportunity for behaviour therapists from around the world to meet, socialise, exchange information, perspectives and ideas, and establish or extend colleague networks in a multicultural context. As the first World Congress on Behaviour Therapy to be held in the southern hemisphere, it achieved the same high standard of previous congresses in Israel, Washington, and Edinburgh, producing a balanced and stimulating program addressing most of the major areas of contemporary behaviour therapy research and clinical practice.

Marital breakdown is common, and often associated with depression. A model is outlined in which such depression may be maintained by avoidance of depression eliciting stimuli. A 27-year-old recently-separated male with severe depression was treated with systematic exposures to depression eliciting stimuli, with cognitive coping self statements being used during exposures. The worst self ratings of depression reported by the client and scores on the Beck Depression Inventory improved greatly from baseline to treatment phases. Gains were maintained at 4 week, 3 and 6 month follow-ups. Further research is warranted to evaluate the efficacy of this potentially useful approach to treating marital breakdown, and possibly other adjustment disorders, which are associated with depressed mood.