15-23 - International Journal of Psychology and Behavioral Research

International Journal of Psychology and Behavioral Research. Vol., 4(1), 15-23, 2015
Available online at http:// www. ijpbrjournal.com
ISSN 2322-4002 ©2015 Victor Quest Publications
The Effect of Empowerment Intervention on Declining Marital Conflict
in Spouses of Veterans with Mental Illness in Bandar Abbas
1
2
Zoleykha Raeisipoor , Reza Fallahchai , Maryam Fallahi
3
1- M.A in Family Counseling, Bandar Abbas, Iran
2- Assistant Professor, Department of Consultant & Psychology, Faculty of Human Sciences,
University of Hormozgan, Bandar Abbas, Iran
3- M.A student in Family Counseling, University of Hormozgan, Bandar Abbas, Iran
Corresponding Author E-mail: [email protected]
Abstract
The purpose of the present study was to examine the impact of training
spouses of veterans in empowerment skills on their marital conflict which was
conducted in Bandar Abbas. This study was quasi-experiment (pre and
posttest) with control group. From 95 spouses of veterans with mental illness
who wished to participate and had the criteria to take part in the study, 50 were
selected and randomly were assigned to experimental and control groups.
Before manipulating the independent variable in both control and experimental
groups, pre-test was performed by using marital conflict questionnaire. Then,
women in experimental group received empowerment skills training for 8
sessions while women in control group didn't. In the end, both groups took the
posttest. Our findings indicated that the impact of empowerment skills training
on declining marital conflicts of wives of veterans with mental illness was
significant (P <.001, F=45.13). Moreover, the results indicated that empowerment
skills have significantly improved the following dimensions, "reduced
cooperation", "sexual intercourse", "increased emotional reactions", and
"relationship with spouse’s relatives and friends" respectively (p < 0.05). The
study showed that empowerment skills can be taught and learned and lead to
decline marital conflict.
Key words: Empowerment skills training, Spouses of veterans with mental illness,
Marital conflict
Introduction
Marriage has been described as one of the most important and fundamental human
relationships because it provides a basic structure for establishing family relationships and nurturing
the next generation (Rosen-Grandon, Myers & Hatti, 2004) and has long been recognized as an
institution of society (Durkheim [1897], 1997), as well as it has been viewed as a central and common
way to organize personal and social life in all cultures (Coontz, 2005). Family which is a natural social
system with its own characteristics are formed through marriage. The relationship between members
of this micro culture is deep and multi-layered which is mainly based on shared history, shared and
internalized perceptions and assumptions about the world as well as common goals. In such a system,
people have been connected through the strong, lasting and mutual interests and emotional
attachment. Families who enjoy a healthy relationship cause potential of each family member to
develop (Goldenberg& Goldenberg, 1991).
Family is the most fundamental institution of each society. Every family should be considered as
the foundation of society, the main focus of preserving traditions (Rajabi et al., 2009) customs and
prominent and respectful values (Seif, 1989) , the stable basis of social relationships and kinship ties;
and it is vital to creating human emotions and rearing [next] generations (Rajabi et al., 2009). Family
as a social institution, like other social institutions, is becoming more complex in the world in the
present day, so that the membership and durability of family life requires more skill for couples versus
Intl. J. Phys. Beh. Res. Vol., 4(1), 15-23, 2015
the past. The lack of this skill has led to increase conflicts between couples thus divorce will occur
(Floyd et al., 1998).
Although family ties are often considered as separate entities, there is increasing evidence that
suggests any relationship influence other relationships and are influenced by them (Cox and Paley,
1997). On the other hand, health or dysfunction of family as a whole or system has an impact on its
members. Statistics published in Iran have indicated that marital satisfaction among couples has been
increasing in the past few decades that in most cases couples seek to separate and divorce takes
place.
Disagreement and misunderstanding in family are widespread. Marital conflicts or differences
between the preferences, desires, goals, or needs of couples are inevitable (Birditt et al., 2010).
Marital conflict is defined as a clear conflict between couples with different forms of verbal, nonverbal
or physical aggression (Erel and Burman, 1995). Conflict between parents is the term which has been
utilized in meta-analytic study of Krishnakumar and Buehler (2000) as a multi dimension construct that
encompasses several different aspects including frequency, mode of expression, or being chronic or
the intensity of duration, content and the degree of clarification.
These disputes cause loss of good and healthy functioning of family that is viewed as the first
and the oldest social institution. The institution of which the main task is to create morale and healthy
personality becomes a key factor in emotional, behavioral and personality disputes. On the other
hand, in family life, there is a lot of stress that is quite diverse, among the stress it can be mentioned
the stress related to relatives and friends of spouse, compatibility with infants, children and
adolescents, reintegrating the children, solitude or loneliness of couples and accepting the agingrelated changes (Ellis et al., 1989, translated by Salehi and Amin Yazdi, 1996, p 36).
Experts believe that marriage is dealing with ongoing crises so that the problem of marital
discord is the main reason of clients referred to the counseling center more than any other psychiatric
diagnostic categories (Rahmatollahi et al., 1996). Research results indicate that 40 percent of mental
health referrals include marital conflict (Budman & Gurman, 1998, Donavan 1999).
In contemporary society couples have experienced severe and pervasive problems when
communicating and maintaining intimate relationships. In fact, more than any other category, the
problem of marital distress is the reason for referral and receipt of counseling and psychotherapy
services. The divorce rate shows only one aspect of the total population of couples who have
communication problems. Other couples have communication problems, but for some reason decide
to continue to live together (For reasons such as financial hardship of divorce and personal and
cultural perceptions about divorce, etc.). Indeed, after the sudden death in the family, marital distress
and divorce are the most severe stress that people experience (Bloom, Asher and White, 1987;
Hallford, 2001, p 21).
Eight-year imposed war led to physical injuries, adverse neuropsychiatric effect, changes in the
pattern of life, financial problems and decline in communication. The incidence of physical and
psychological problems is the consequences of war which occurs for the people who had been directly
or indirectly involved in the war. Health problems often lead to disability, but mental injuries grip the
victims for a long time, even after the war. Not only the victim suffers from mental disorders but also
his family environment is in danger (Parande et al., 2006). During the imposed war, some of the
courageous men were martyred defending our country's honor and territorial integrity, thus their
families were deprived from their presence and support; and some of them suffer from physical and
mental disorders as a result of the wounds, disablement, captivity and mental and physical pressures
due to war. Each of these disorders requires special attention and treatment. But the considerable
point is that the continuation of these problems has a profound effect on family relationship especially
marital relationship.
The psychological trauma caused by war has continual impact (Covan, Smith, Gudyer, 2011).
Veterans experience outstanding levels of stress leading to secondary health problems and mortality
increase (McLean, 2010). Recent studies suggest that the stress associated with the war has similar
effects on the spouses of veterans in various way (Cozza et al., 2010) Gimbel and Booth (1994) have
mentioned that war directly increases violence and stress which in turn affects the quality and stability
of marital relations.
McLeland and Sutton (2005), in their study, compared marital satisfaction in the military families
and civilians. The result indicated that there are significant differences between the two groups and
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Intl. J. Phys. Beh. Res. Vol., 4(1), 15-23, 2015
couples of military families have lower marital satisfaction. Renshaw, Rodrigues and Jones (2009),
based on their studies concluded that such the experience of long presence in war was positively
associated with posttraumatic stress disorder and depression and lead to lower marital satisfaction in
them. Dejkam and Aminoroaya (2004) indicated that the amount of anxiety of spouses of veterans
with mental illness was more than the wives of people who suffered from mental illness. In a study on
the quality of life of wives of veterans with PTSD, Parande et al. (2006) found that their quality of life
was low. Sirati (2004) suggested that lack of compromise and consensus with wives and children and
interpersonal relationships with both family and community was a key factor in the escalation of the
veterans' psychological problems. Mental and physical problems affect the family adjustment and
system and propose new actions. These families are suffering from undesirable thoughts and feelings
such as guilt, anger, aversion, grief and despair due to tolerance of overwhelming stress and new
roles. The results of Salimi and associates research (2009), revealed a positive correlation between
the severity of psychological symptoms of veteran and marital satisfaction of their spouses. A study
which aimed to investigate factors associated with marital discord of veterans with PTSD was
conducted by Ahmadi, Zarei & Arabnia (2007). Results of that showed that about 45.5% of veterans
with PTSD were dissatisfied with their marriage and relationships. A positive significant relationship
was indicated between sexual problems and intensity of PTSD symptoms and marital maladjustment
(p>0.05). Sexual problems and PTSD symptom intensity were the most important factors in the
prediction of marital discord among veterans with PTSD. 65.4% of them suffer from some form of
sexual dysfunction.
According to Solomon's findings (1988), the disabled's relationship with family and friends is an
integral part of their life, and in many cases, disability affect the entire family and can have a
detrimental effect on family cohesion. Sometimes disability causes confusion and conflict in family
roles. Because in many cases, the man has to stay at home and his wife becomes the breadwinner.
Research demonstrates that when one of the spouses suffers from disability and illness, the
other is under obligation to care for the patient; therefore it has a great effect on family environment;
moreover, family members spend less emotional time for union or joining together, or don't have any
time at all. It is evident that having a physically challenged veteran with serious and chronic disability
can have a detrimental effect on family cohesion and leads to communication problems. How marital
conflict and discord form and ways of dealing with them has been studied from multiple perspectives.
Family as a very important psychosocial institution requires more attention.
Research support for marriage skills training programs in the past two decades has increasingly
accelerated (Fincham & Beach, 2010). Studies have shown that the programs are effective to help
couples with diverse marital conflict in the range of mild to severe; and have specifically increased
knowledge and skills to cope with marital conflict and reduced divorce rates in participants in these
programs (Giblin, 1996; Stanley et al. 2006).
Marriage enhancement or couple empowerment program is a preventive and educational
approach which helps couples strengthen and enrich their relationship with primary or secondary
prevention approach. This approach aims to help couples to understand themselves and their
spouses, examine spouses' thoughts and feelings, encourage empathy and intimacy, as well as
develop emotional relationships and problem solving skills. Prevention programs that are used to
empower couples comprise Relationship Enhancement, Couples Coping Enhancement Training and
Prevention and Relationship Enhancement Program. Studies show that marriage enhancement
programs improve communication, interpersonal conflict management, coping and problem-solving
skills, empathy and intimacy that cause to increase marital satisfaction and decline marital distress.
Therefore, interventions are needed to be done to decrease the factors which decline marital
satisfaction and intimacy. Furthermore, studies indicate that approaches to prevent marital problems
are highly effective and affordable in the long term (Stanley, 2001).
Concerning the effectiveness of this program, research has demonstrated that couples who
participated in these programs make a remarkable progress in their relationship (Burentt, 1994,
Stanley, 2001), conflict management skills (Markman et al. 1988, Markman et al. 1993, Stanley,
2001), reduction in negative interactions and aggression in relationships (Markman et al., 1988) and
rise in marital satisfaction (Markman et al., 1993, Heavey et al., 1997, Schilling et al., 2003). Moreover,
in a study which was conducted on a large random sample, finding showed that couples who had
participated in the program had lower levels of marital conflict and higher levels of marital satisfaction
and commitment and were less likely to divorce in comparison with those who didn't have this
experience (Stanley et al., 2006).
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Intl. J. Phys. Beh. Res. Vol., 4(1), 15-23, 2015
In spite of the importance of family in creating, maintaining and promoting the mental health of
individuals and society, as well as an undeniable women's impact on this, women don't benefit from
planned and useful education concerning effective and proper relationship with family members,
especially spouses. As a result, family is faced with serious risks and challenges due to this situation;
for this reason, training spouses of veterans in empowerment skills is considered as a major step
forward in society and family health improvement and increasing marital adjustment.
In addition, considering the high rates of depression and interpersonal conflicts, and anxiety in
spouses of veterans and a lower quality of life, to evaluate the effectiveness of empowerment training
on marital satisfaction of veterans with mental illness acquires greater importance, because these
factors can cause behavioral changes in their children that the most obvious of them are depression
and academic failure.
Despite the research evidence regarding the effectiveness of empowerment training in
improving the couple relationship, increasing marital satisfaction, and decreasing marital conflicts in
other countries, in order to perform this program, Iranian research evidence is needed. Accordingly,
this study sought to examine that if the empowerment training skills had an impact on increasing
establishment and maintenance of communication skills, conflict management, problem-solving and
awareness of expectations, assumptions and beliefs concerning relationship and marital roles of
spouses of veterans with mental illness in Bandar Abbas.
Method
This study utilized a quasi-experimental research design with two groups (experimental and
control) taking pre and post-tests. First, the counseling veterans' family records in counseling center of
Foundation of Martyrs and Veterans Affairs in Bandar Abbas were studied, 95 women who had the
necessary criteria, were contacted; after explaining the purpose of the study,50 women who were
willing to participate in the study and were available were selected. Then, women were matched by
their education, length of marriage, number of children and occupation and randomly assigned to an
experimental and a control group.
Measures
Demographic Questionnaire: This form was drafted by a researcher aiming at gathering information
such as age, educational level, marriage duration, etc.
Marital Conflict Questionnaire: This questionnaire is a 42-question instrument that is developed to
measure the amount of marital conflict and its dimensions. This test which has been prepared by
Torabi and under the supervision of Sanaei (1996), measures seven dimensions or areas of marital
conflict. These dimensions are as follows: reduced cooperation, reduced sexual intercourse, increased
emotional reactions, increased child support, increased personal relationships with relatives, reduced
family relationship with spouse’s relatives, and separating finances (Sanaei, 2000). In order to
assess the reliability and validity, Torabi and Sanaei (1994) conducted a study on 111-member group
consists of 53 men and 58 women who went to counseling and judiciary's centers to resolve their
marital conflicts, as well as a control group of 108 normal couples including 53 men and 55 women.
Comparison of the means of both groups revealed significant differences between compatible and
incompatible males and females that indicated high item discrimination for the diagnosis of couples
with conflicts and couples who didn't deal with conflict. Furthermore, there was a high and significant
correlation between each question and total scores (Sanaei, 2001). Dehghan (1006) reported the
reliability of each scale of test as follows 0.73, 0. 60, 0.74, 0.65, 0.81, 0.82 and 0.69 respectively.
Moreover, Farhabakhash (2004) reported the reliability coefficient for each scale of test as follows
0.62, 0.52, 0.51, 0.53, 0.62, 0.60 and 0.42 respectively. In the present study, the reliability of marital
conflict questionnaire was calculated by using Cronbach's alpha that reliability coefficient of the
instrument was 0.78, and it was calculated to be 0.72 by using split half for the whole questionnaire.
Research Procedures
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Intl. J. Phys. Beh. Res. Vol., 4(1), 15-23, 2015
Implementation phases of the study were as follows "administration of the pretest",
"implementation of test variable" and "administration of the posttest". The experimental variable was
prevention and relationship enhancement program which comprised couples preparations,
familiarizing with the concept of communication, destructive relation and its effect on marital
relationship, familiarizing with the conflict in the marital relationship and its aspects and conflict
management in marital relationship. The content of each of the main stages as follows: stage of
"couples preparations" contained "introduction of the program" including introducing the program and
its purpose, the stage of "familiarizing with the concept of communication and destructive relation and
its effect on marital relationship" comprised training concept of communication, communication
components, teaching varieties of communication and effects of each on the marital relationship, the
stage of "communication skills" consisted of teaching listening and speaking skills, establishment and
maintenance relationship skills, the stage of the " familiarizing veteran wives with the conflict in the
marital relationship and its aspects" consisted of teaching them about conflict, conflict in marital
relationships, destructive and constructive conflicts, conflict areas, and lastly, the stage of "conflict
management in marital relationship" comprised training steps of marital conflict development, conflict
resolution strategies and its management .
The program was done as a group activity and all members of the experimental group were
trained in the eight one- hour and half sessions. After training, both the control and experimental
groups were assessed or took the posttest in the ninth week.
Result
Descriptive indicators such as marital status, number of children, occupation and education of
subjects are shown in the following table:
Table 1.Descriptive indicators sample
Experimental
group
Control group
Average
duration
marital
status
21.76
21
of
of
Occupation
Education
Average of
number of
children
Housewife
Employe
d
Elementary
Secondary
Diploma
3.36
21
4
10
8
4
Associate's
degree or
higher
3
3.44
21
4
9
10
3
3
Table1 shows the mean and standard deviation demographic data in experimental and control
group. Descriptive findings of demographics questionnaire in two groups shows that both are nearly
the same in length of marriage, number of children, occupation and level of education.
Table2.Results of ANOVA assumption of marital conflict of spouses of veterans with mental illness for
homogeneity of regression slope
dependent variable Source of variation
SS
df
MS
F
P
Marital conflict
Group
Pre-test
Reactive effect
Error
total
23.31
2.07
25.12
433.51
1
1
1
47
17661
50
23.31
2.07
25.12
9.22
2.52
0.23
2.72
0.15
0.73
0.11
Before conducting covariance analysis of marital conflict of spouses of veterans with mental
illness, the assumptions of the covariance analytic test were examined. The results of above table
show that the interactive effect of pre-test and group on the dependent variable, marital conflict of
veterans' wives, (f= 2.72, p= 0.11) was not significant. Therefore, lack of significance this interaction in
these data supported the hypothesis of homogeneity of regression slope.
The main hypothesis of the research: Empowerment training program has an effect on marital conflict
of spouses of veterans with mental illness.
Table 3.T-test of dependent groups in marital conflict between the experimental and control groups
variable
groups
test
mean
n
standard
df
t
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Intl. J. Phys. Beh. Res. Vol., 4(1), 15-23, 2015
Marital
conflict
control
experimental
Pre-test
131.38
25
deviation
5.65
Post-test
Pre-test
Post-test
134.2
134.26
141.78
25
25
25
5.33
4.96
4.96
24
0.41
24
***-10.44
First, T-test for dependent groups was used to analyze the marital conflict. The results above indicate
that no significant differences were observed in the pretest and posttest of control group (t=0.41). The
result of the T-test gave t= -10.44, P <.001 which indicates that there was a significant difference
between pretest and posttest of marital conflict after empowerment training program in experimental
group. So we can say that empowerment training program has been effective in marital conflict of
spouses of veterans with mental illness.
Dependent
variable
Marital conflict
Table 4.The result of covariance analysis for marital conflict
Source of variation SS
df
MS
F
P
Pre-test
Group
Error
Total
1523.97
4128.72
4300.81
57484
1
1
47
50
1523.97
4128.72
91.55
16.667
45.13
0.001
0.001
Coefficient
eta
0.22
0.53
Then, covariance analytic test was conducted to analyze the marital conflict scores. The above results
in table.4 demonstrate that there was a significant difference between the mean of pretest scores of
experimental and control groups in marital conflict (f=16.667, p=0.001). Furthermore, the independent
variable, group, had an effect on the dependent variable, marital conflict and there was significant
difference between experimental and control groups (f= 45.13, p= 0.001). According to coefficient eta,
0.53 of the effect of group differences in posttest scores of marital conflict was related to the impact of
empowerment training.
Table 5.A Comparison between experimental and control groups with a view to marital conflict through
a covariance analytic test
Dependent variable
SS
df
MS
F
P
coefficient eta
cooperation
179.90
1
179.90
8.87
0.05
0.16
sexual relationship
278.06
1
278.06
8.99
0.05
0.18
emotional reactions
331.89
1
331.89
16.61
0.05
0.27
child support
6.96
1
6.96
0.34
0.56
0.007
personal relationships 864.43
1
864.43
7.9
0.09
0.011
with relatives
relationship with the 21.40
1
21.40
9.37
0.05
0.16
spouse’s relatives
separating finances
114.02
1
114.02
2.78
0.13
0.063
The above table shows the impact of the empowerment training program of spouses of veterans
with mental illness on cooperation (f= 8.87; p= 0.05) sexual relationship (f= 8.99; p= 0.05), and
emotional reactions (f= 16.61; p= 0.05) was significant. The highest eta squared or coefficient of
impact was related to subscale of emotional reactions (0.27) which means 0.27 of the difference
between the average of experimental group and the control group was related to the impact of the
empowerment training program. The subscales sex with coefficient eta of (0.61) and cooperation with
(0.16) showed the maximum effectiveness of the empowerment training program spouses of veterans
with mental illness after emotional reactions. However, empowerment training on other components,
such as child support, personal relationships with relatives, relationship with the spouse’s relatives and
separating finances was not significant.
Discussion and Conclusions
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Intl. J. Phys. Beh. Res. Vol., 4(1), 15-23, 2015
The purpose of the present study was to assess the effect of empowerment program of wives of
veterans with mental illness on the decline of marital conflicts. On the one hand, marital conflict is an
important issue because it has negative and adverse physical and psychological effects on both
couples and their children. On the other hand, the wives of veterans with mental illness training is a
practical way to identify problems and issues that may cause conflict and includes teaching strategies
that could lead to its reduction; as a result training can be useful in the short term and long term.
Accordingly, in this study, an empowerment program was implemented for spouses of veterans with
mental illness in the experimental group and it was compared with the control group through using
pretest and posttest.
The results show that empowerment training can be taught and learned. The results listed in
tables 3 and 4 shows that this training leads to the ability of veterans' spouses to solve marital
problems raises. This is important since many of the couples are incapable of solving various issues
that are in conflict during their married life. Moreover, there are many unsolved problems in families
with marital conflicts. Hence, if the couples are familiarized with marital conflicts and learn their
resolution and management, they will be able to reduce their conflicts and consequently increase their
marital satisfaction.
Empowerment training program for wives of veterans with mental illness contributes to marital
conflict reduction and as a result marital satisfaction can be increased. This finding was consistent
with the previous findings (such as Markman et al. 1988, Markman et al. 1993, Burentt, 1994, Heavey
et al., 1997, Stanley et al., 1999, Stanley et al., 2001, Schilling et al., 2003, Stanley et al., 2006 and
Lambert et al., 2009)
In explaining this finding, Hawkins et al. (2008) demonstrated that empowerment training taught
couples the skills needed to face the challenges of marital life and prepared them to deal effectively
with the problems of life. In addition, it trained couples set of skills to prevent the occurrence and
development of marital problems (Cornelius et al., 2007, Lieser et al., 2007). One of the other main
reasons of effectiveness of empowerment training program on the decline of marital conflicts is the
homework that is given to the participants in each session to practice the session content at home.
Homework which is given in training session provides the opportunity to practice the experience.
Homework focusing on the structure of the treatment session instructions will strengthen these
instructions and the participants will be more motivated to change by practicing specific homework. In
addition, family members are involved in doing homework and the treatment process, therefore the
change process will be facilitated and the insight, positive self-expression and coping behaviors can
be strengthened during therapy sessions.
However, in this study, the effectiveness of the empowerment training program of wives of
veterans with mental illness was not confirmed in the dimensions of child support, personal
relationships with relatives, relationship with the spouse’s relatives and separating finances.
Therefore, more research is needed on the most appropriate intervention methods to decline marital
conflicts in these aspects.
It should be noted that most of the subjects participating in this study were high school or lower
than high school graduates and 80 percent of them were housewives; as a result it limits
generalization of the results to women who are more educated or employed. Further research should
be carried out on larger and more diverse samples. Furthermore, lack of follow-up test that can
examine the variations in the level of marital satisfaction of spouses of veterans with mental illness at
intervals is the other limitation of the study.
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