BEHAWORTI-IEgAPY25, 407-429, 1994 Marital Functioning and the Anxiety Disorders PAUL M. G. EMMELKAMP COBY GERLSMA University of Groningen, The Netherlands The present paper provides a review of the literature on the relationship between marital factors and anxiety disorders. The review is based on both a descriptive and quantitative analysis. Studies of the marital relationship and outcome of exposure therapy are reviev~d, as are studies investigating the effects of exposure therapy on the partner and on the marital relationship. Results with respect to the effects of marital distress on outcome are inconclusive. Exposure does not have a negative impact on the partner or the relationship. In agoraphobia, spouse-aided therapy is no more effective than individual exposure therapy. In obsessive-compulsive patients, results are inconclusiv~ The interest in the marital relationship of anxious patients is not of recent date. Both psychodynamically oriented and system-theoretically oriented ther- apists hold that anxiety is the result of conflict. Psychodynamically oriented clinicians regard the phobic symptoms as deriving from interpersonal and in- trapersonal conflicts that are recapitulations of early childhood patterns (e.g., Arieti, 1961; Bowlby, 1969; 1973; Goodstein & Swift, 1977; Symonds, 1971). These conflicts may manifest themselves in the interpersonal relationships of phobic patients. Thus, proponents of this view hold that phobic symptoms are dynamically related to faulty interpersonal patterns. A basic assumption for communication theorists is that psychiatric symp- toms have interpersonal meaning in relationships. Systems-theoretically- oriented family therapists such as Haley (1963) and Fry (1962) hold that anxiety in the patient may serve the purpose of denying a marital problem. According to Fry (1962), partners of individuals with (agora)phobia are often phobic them- selves, but are reluctant to admit this. In this view, the agoraphobia develops in order to maintain the marriage when it is threatened by a crisis. Haley (1963) and Fry (1962) define the resulting relationship as a compulsory marriage, in which partners do not stay together out of love but are forced to stay together because of the symptoms. Behavior therapists such as Wolpe (1970) and Lazarus (1966) have also sug- gested that agoraphobia often is associated with marital problems. Lazarus Requests for reprints should be sent to Paul M. G. Emmelkamp, University of Groningen, Department of Clinical Psychology, Oostcrsingel 59, 9713 EZ Groningen, The Netherlands. 407 0005-7894/94/0407-042951.00/0 Copyright 1994 by Association for Advancementof Behavior Therapy All rights of reproduction in any form reserved.