Objective Within the United States, one-third of married couples are distressed and almost half of first marriages (and more than half of unmarried cohabiting relationships) end in divorce/separation. Additionally, relationship distress has been linked to mental and physical health problems in partners and their children. Although couple therapy is effective in reducing relationship distress, it is utilized by less than one third of divorcing couples. Therefore, more accessible interventions for relationship distress are needed. Method This study tests the efficacy of the OurRelationship (OR) program, an eight-hour online program adapted from an empirically-based, in-person couple therapy. In the program, couples complete online activities and have four, 15-minute calls with project staff. Nationwide, 300 heterosexual couples (N = 600 participants) participated; couples were generally representative of the US in terms of race, ethnicity, and education. Couples were randomly assigned to begin the program immediately or to a two month waitlist control group. Results Compared to the waitlist group, intervention couples reported significant improvements in relationship satisfaction (Cohen’s d=0.69), relationship confidence (d=0.47), and negative relationship quality (d=0.57). Additionally, couples reported significant improvements in multiple domains of individual functioning, especially when individuals began the program with difficulties in that domain: depressive (d=0.71) and anxious symptoms (d=0.94), perceived health (d=0.51), work functioning (d=0.57), and quality of life (d=0.44). Conclusions In a nationally-representative sample of couples, the OR program was effective in significantly improving both relationship and individual functioning, suggesting it can substantially increase the reach of current interventions through its low-cost, web-based format.

Objective: Although low-income couples experience greater relationship challenges, they have limited access to effective relationship interventions. Furthermore, most previous efforts to improve low-income couples' relationships have yielded very small effects (Hawkins & Erickson, 2015). In an effort to overcome these limitations, this study investigated the effectiveness of 2 web-based interventions for low-income couples. Method: In total, 742 low-income couples (N ϭ 1,484 individuals; mean [M] age ϭ 33; 55% White, non-Hispanic; 52% married; median [Mdn] annual household income ϭ $27,000) were recruited nationally and randomized to the OurRelationship program, the ePREP program, or a waitlist control group. Couples were repeatedly assessed for 6 months using self-report measures of relationship satisfaction, communication conflict, intimate partner violence, emotional support, and breakup potential. Relationship status was assessed at 6-month follow-up. Results: Compared to the control group, intervention couples experienced significantly greater improvements in all 5 domains of relationship functioning (Mdn |d| ϭ 0.46) by the end of the program; these effects were maintained in the 4 months after treatment. However, neither program significantly reduced the frequency of breakups by the 6-month follow-up. Differences between couples in the two interventions were minimal (Mdn Cohen's |d| ϭ 0.11); however, couples in the OurRelationship program experienced significantly greater decreases in conflict (d ϭ 0.24). Conclusions: The results indicate that brief, web-based interventions can serve a central role in delivering effective services to low-income couples. Additionally, the general equivalence of the two interventions indicates that both communication-focused and problem-focused interventions can be successful in improving the relationship functioning of low-income couples. What is the public health significance of this article? Web-based interventions are effective in improving relationship functioning of low-income couples. Brief interventions, narrowly focused on improving relationship dynamics, are effective in overcoming multiple barriers to intervention reach and effectiveness in low-income populations. Both communication-focused and problem/insight-focused interventions can be effective for low-income couples.

Couple therapy positively impacts multiple domains of relationship functioning (e.g., satisfaction, communication) during treatment, and gains remain evident at short-term and long-term follow-up. Couples assigned to waitlist control groups generally do not improve. Couple therapy's effects on relationship satisfaction are consistent across individual, couple, and study characteristics.

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Technological advances provide tremendous opportunities for couple and family interventions to overcome logistical, financial, and stigma-related barriers to treatment access. Given technology’s ability to facilitate, augment, or at times even substitute face-to-face interventions, it is important to consider the appropriate role of different technologies in treatment and how that may vary across specific instances of technology use. To that end, this article reviews the potential contributions of telemental health (aka telehealth; e.g., videoconferencing to remotely deliver real-time services) and asynchronous behavioral intervention technologies (BITs; e.g., apps, web-based programs) for couple and family interventions. Design considerations – such as software and hardware requirements and recommendations, characteristics of intended users, ways to maximize engagement, and tips for integrating therapists/coaches – are included for both types of technology-based intervention. We also present suggestions for the most effective recruitment and evaluation strategies for technology-based couple and family interventions. Finally, we present legal and ethical issues that are especially pertinent when integrating technology into couple and family interventions.