Effectiveness of the online Hold me Tight course

Rationale and objective:
Relationship problems are prevalent. About 30% of all couples experience serious problems (Whisman et al., 2008). Relationship problems have adverse effects on psychological and somatic well-being of partners and children (Amato, 2000; Kiecolt-Glaser & Newton, 2001; Lebow et al., 2012) and cause societal burden in terms of reduced work productivity, and high health care and social insurance costs (Schramm, 2006). Although evidence-based couple therapies are available, utilization by couples is restricted. In order to reach more couples in an earlier stage of relationship distress we developed an online version of the previously evaluated regular Hold me Tight relationship enhancement course (HmT; 2011-CP-1826). The regular face-to-face version of HmT was evaluated as promising (Conradi et al., 2018). The online version of HmT will have a format comparable to regular HmT. In the current study we want examine the potential effectiveness of online HmT.

Design
The study design is a simple pre-post within-subjects design strengthened with repeated measurements. Therefore, the study will have only one condition meaning randomization does not apply. A control group seems not feasible at the moment as the course is newly developed and a RCT requires more serious investments in terms of time and money.
Measurements will be conducted prior to session 1 (pre-treatment), prior to sessions 3, 5 and 7 and after session 8 (post-treatment). Although we can monitor change rather detailed with these repeated measurements during the intervention, we cannot rule out rule out spontaneous remission, i.e., improvement without online HmT, because of the absence of a control group. However, as spontaneous remission of relationship problems is unlikely the absence of a control group will be less a problem (Baucom et al., 2008).

Couples
Couples consisting of adult partners mastering the Dutch language who want to participate (self-referred) in the online HmT course are included.

Partners participating in the HmT-online course will show improvement on outcome measures post-treatment and at follow-up compared with pre-treatment scores.

5
Partners will be asked to complete the questionnaires on their own in silence without consulting their partner. Repeated measures at 5 time points are needed to follow the process of change and to optimize statistical power. The 5 assessment points and the measures administered per time point (for descriptions see above under 'primary and secondary outcomes') are:
(1) pre-treatment, i.e., prior to online session 1, administered: ECR-RS, CSI-4, RDS, MI.
(2) prior to online session 3, administered: CSI-4, RDS.
(3) prior to online session 5, administered: ECR-RS, CSI-4, RDS, MI.
(4) prior to session 7, administered: CSI-4, RDS.
(5) post-treatment, i.e., prior to session 8, administered: ECR-RS, CSI-4, RDS, MI.

The protocolized intervention is based on the official Dutch translation of the HmT program (Eekhoudt et al, 2010) and adapted for online use (Siderius et al., unpublished). The eight online sessions consist of psycho education, videos, role play and homework assignments. During the eight sessions the following themes are covered by the program: (1) psycho education about love and attachment, (2) identification of dysfunctional patterns of interaction (the so called demon dialogues), (3) identification of reciprocal vulnerabilities underneath the dysfunctional dialogues, (4) resolving misunderstandings and creating a secure base, (5) open and responsive communication, (6) forgiving and building of trust, (7) tenderness and sexuality (8) caring for your romantic relationship. Main goals of the program are enhancement of relationship satisfaction and secure attachment and reduction of dysfunctional interaction and separation potential. The program aims at strengthening of reciprocal: (1) expression of attachment needs of validation, support and comfort, (2) while the other partner is available and responsive regarding such expressions.