Journal of Consulting and Clinical Psychology 1991, Vol. 59, No. 4, 547-557 In the public domain Marital Therapy as a Treatment for Depression Neil S. Jacobson University of Washington Keith Dobson University of Calgary Alan E. Fruzzetti University of Washington Karen B. Schmaling Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine Department of Psychiatry, : University of Colorado Health Sciences Center Sheppard Salusky University of Washington The purpose of this study was to compare cognitive-behavioral therapy (CT; n = 20), behavioral marital therapy (BMT; n = 19), and a treatment combining BMT and CT (CO; n = 21) in the alleviation of wives' depression and the enhancement of marital satisfaction. BMT was less effec- tive than CT for depression in maritally nondistressed couples, whereas for maritally distressed couples the two treatments were equally effective. BMT was the only treatment to have a significant positive impact on relationship satisfaction in distressed couples, whereas CO was the only treat- ment to enhance the marital satisfaction of nondistressed couples. On marital interaction measures CO was the only treatment to significantly reduce both husband and wife aversive behavior and to significantly increase wife facilitative behavior. Although many pharmacological and psychosocial treat- ments have been shown to be effective in alleviating depression, the treatments examined to date appear to have significant limi- tations. Pharmacological treatments produce only temporary effects, and relapse rates are high even among those who are maintained on medication subsequent to recovery (Prien et al, 1984). Although various psychosocial treatments such as cogni- tive-behavioral therapy may have prophylactic effects (Black- burn, Eunson, & Bishop, 1986; Evans et al., 1990; Simons, Murphy, Levine, & Wetzel, 1986), there is no definitive evidence that any existing treatment prevents recurrence. Moreover, when appropriately conservative criteria for recovery were in- voked to evaluate the clinical significance of treatment effects, the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (Elkin et al., 1989) reported recovery rates of 57% for pharmacology plus clinical This research was supported by Grant MH33838 from the National Institute of Mental Health, awarded to Neil S. Jacobson. We wish to thank many valuable contributors to this research pro- gram: Sandra Coffman, Joyce Victor, Steve Sholl, David Coppel, Red- mond Reams, and Leanne Wilson, who served as therapists; Victoria Follette and Mark Whisman, who served as project coordinators; Jen- nifer Waltz, Kelly Koerner, and Michael Addis, who rated therapy session tapes; Joan Giacomini, who served as program assistant; and Hyman Hops, who supervised the coding of marital interaction. We are especially grateful to three anonymous reviewers, whose comments on our initial draft led to a greatly improved article. Correspondence concerning this article should be addressed to Neil S. Jacobson, Department of Psychology NI-25, University of Washing- ton, Seattle, Washington 98195. management, 55% for interpersonal psychotherapy, and 51% for cognitive-behavioral therapy. Although these rates exceeded the 29%recovery rate found in a placebo/clinical management condition, almost half of the treated outpatients remained at least somewhat depressed at the conclusion of therapy. There is room for improvement in the technology for treating depres- sion. Many of the treatments studied in clinical trials are intraper- sonal in focus, treating the depressed person in relative isola- tion from other family members. Focusing on the depressed individual is in keeping with the prevailing theories of depres- sion. However, there is reason to suspect that the involvement of family members, and in particular the spouses of depressed individuals, could have a facilitative effect on treatment out- come (Jacobson, Holtzworth-Munroe, & Schmaling, 1989). First, studies have reported a significant inverse relationship between depression and marital satisfaction (e.g., Coleman & Miller, 1975). Second, disruptions in close relationships may be the single most common precipitant of depressive episodes (Paykel et al., 1969). Third, marital distress is a good predictor of depressive relapse following recovery from an acute episode (e.g., Hooley & Teasdale, 1989). Fourth, the extent to which marital satisfaction improves during the course of therapy bears an inverse relationship to relapse (e.g., Rounsaville, Weiss- man, Prusoff, Herceg-Baron, 1979). Finally, a close, confiding relationship with a spouse can buffer the otherwise depresso- genic effects of stressful life events (e.g., Brown & Harris, 1978). Thus, it seems reasonable to hypothesize that marital therapy has a role to play in the treatment of depression. The primary purpose of the present study was to investigate the effects of marital therapy (the behavioral approach de- 547