Using Acceptance and Commitment Therapy to Treat Distressed Couples: A Case Study With Two Couples Brennan D. Peterson Georg H. Eifert Tal Feingold Sarah Davidson Chapman University Although the field of couple therapy has made significant strides in recent years, there continues to be a need for theoretically sound and empirically supported treatments. The current case study examines whether Acceptance and Commitment Therapy (ACT), an experiential acceptance-based behavior therapy, can be effective in treating distressed couples. Although ACT has demonstrated effectiveness in treating a variety of disorders in individuals, it has not been systemically applied to the treatment of couple distress, and the current study is the first empirical examination of ACT for the treatment of couples. Two married couples participated in the study. A number of core ACT interventions were modified to treat couples in a conjoint format. Cognitive defusion exercises were used to help couples reduce their fusion with and the believability of negative thoughts and feelings related to the relationship. Mindfulness and acceptance techniques were used to help couples increase awareness of their reactions to negative relationship cycles. Finally, value- directed action was used to help partners act in ways consistent with relationship values even in the presence of unwanted thoughts and feelings. The results of this preliminary case study suggest that ACT may be effective in increasing marital adjustment and satisfaction, and in reducing interpersonal and psychological distress in couples. Future studies with larger samples and more controlled designs are needed to build on the results from this single-case study. T REATMENTS FOR DISTRESSED couples have gained considerable attention among researchers and clinicians over the past several decades. In their seminal review of the history of couple therapy, Gurman and Fraenkel (2002) noted that most therapists work with couples on a regular basis, and that couples seek therapy to deal with a variety of relationship difficulties, including communication problems, role conflicts, sexual difficul- ties, extramarital affairs, and poor problem-solving skills. This represents significant progress considering that as little as 40 years ago, approaches to couple therapy lacked empirical support and operated largely without theore- tical foundation (Gurman & Fraenkel). Couple therapy is now the treatment of choice to address relationship dissatisfaction, and a number of studies have demon- strated that couple therapy is effective in reducing relationship distress while increasing relationship satisfac- tion and stability (Christensen & Heavey, 1999; Cordova, Jacobson, & Christensen, 1998; Jacobson et al., 2000; Johnson & Lebow, 2000; Shadish & Baldwin, 2005). A number of studies have examined the effectiveness of couple therapy. Emotionally focused couple therapy (EFT), which focuses on altering negative relationship interaction cycles by accessing emotions and attachment needs, has been shown to be highly effective in treating couple distress (Johnson & Lebow, 2000). In addition, traditional behavioral couple therapy (TBCT) has demonstrated effectiveness in over 20 randomized clinical trials (Jacobson et al., 2000). Although TBCT has shown effectiveness, concerns regarding its limitations and the long-term maintenance of change led the founders of TBCT to create a new approach called integrative behavioral couple therapy (IBCT). This approach com- bines the behavior change strategies of TBCT with acceptance strategies aimed at reducing partners’ insis- tence upon change (Jacobson & Christensen, 1996). When tested, these additive ingredients yield improved therapy outcomes (Christensen et al., 2004; Jacobson et al., 2000). In their study of 21 couples randomly assigned to either IBCT or TBCT, Jacobson and colleagues found that marital satisfaction improved significantly more for husbands and wives receiving IBCT when compared to couples receiving TBCT (Jacobson et al., 2000). A 1077-7229/09/430–442$1.00/0 © 2009 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved. www.elsevier.com/locate/cabp Available online at www.sciencedirect.com Cognitive and Behavioral Practice 16 (2009) 430–442