Keywords

Introduction

Alex and Jo have been in a committed romantic relationship for 5 years. Despite both expressing a strong desire to spend their lives together, they often feel unhappy in their relationship, which frequently escalates into conflict between them. Both Alex and Jo have busy careers and very active social lives and report it can be difficult to ensure they have time together as a couple. When Alex and Jo do spend time together, they both find that they are often preoccupied with thoughts about work. Alex also complains that Jo is often texting and calling friends when he tries to talk with her and that “we never can just be there and talk”. For example, he reported she spent nearly 45 min on the telephone to a friend when they were out to dinner as a couple recently. Jo complains that Alex is preoccupied with his work and is often distracted by a call or message when they speak. She mentioned how they were talking about coming to therapy when Alex dashed off to respond to an incoming message alert on his mobile telephone. These patterns make it very difficult to fully engage in positive shared activities together. They both report wanting to make their relationship work but are feeling increasingly unsure of how to improve things.

The above case illustrates an increasingly common complaint of couples that distraction, particularly around social media, work responsibilities, and online activity, prevents full engagement in the couple relationship. In the present chapter, we review the potential contribution that mindfulness can have on understanding and enhancing couple relationships.

Couple Relationships

Being in a satisfying romantic relationship is one of the strongest predictors of life satisfaction and well-being (Diener, Eunkook, Lucas, & Smith, 1999; Schmaling & Sher, 2000; Wade & Pevalin, 2004) and is associated with greater physical health (Dupre & Meadows, 2007; Waite & Gallagher, 2002) and increased life expectancy (Waite & Gallagher, 2002). Individuals in distressed relationships, however, experience lower well-being (Diener et al., 1999) and are at greater risk for the development of mood and anxiety disorders and substance misuse (Overbeek et al., 2006; Whisman, Uebelacker, & Bruce, 2006). Importantly, much evidence indicates that relationship quality influences mental health; relationship quality is not simply an outcome of mental health. Firstly, relationship distress prospectively predicts mental health problems. For example, national surveys in the USA and the Netherlands demonstrate that relationship dissatisfaction predicts the onset of adults’ first episode of depression (Overbeek et al., 2006; Whisman & Bruce, 1999. Further, relationship distress predicts future alcohol abuse, even when controlling for prior history of alcohol abuse (Whisman et al., 2006).

With regard to treatment of psychological disorders , when disorders are treated with individual evidence-based treatments, relationship distress predicts poor outcome in depression (Denton et al., 2010; Whisman, 2001), alcohol abuse (Fals-Stewart, O’Farrell, & Lam, 2009), and a range of anxiety disorders (Dewey & Hunsley, 1990; Durham, Allan, & Hackett, 1997). Further, enhancing couple relationships via clinical interventions improves the mental health of individual partners. Specifically, couple interventions enhance both the couple relationship and individual adjustment when treating substance abuse (Powers, Vedel, & Emmelkamp, 2008), depression (Barbato & D’Avanzo, 2008), and possibly eating disorders, obsessive-compulsive disorder (Baucom, Whisman, & Paprocki, 2012), and post-traumatic stress disorder (PTSD) (Monson et al., 2012). In addition, couple relationship education (CRE) (a relatively brief educational intervention) assists couples to sustain high relationship satisfaction (Halford & Bodenmann, 2013), and this promotes the individual spouse’s mental health (Wadsworth & Markman, 2012).

Here, we examine the possibility that mindfulness may be beneficial to romantic relationships. To date, most of the scientific literature has examined whether mindfulness enhances individual well-being and functioning or reduces individual distress (Keng, Smoski, & Robins, 2011). However, more recently, there has been increasing focus on the potential benefits of mindfulness for interpersonal outcomes . We begin by reviewing the available theoretical and empirical evidence pertaining to the influence of dispositional mindfulness on relationship outcomes and then discuss the use of mindfulness-based interventions to enhance couple relationships. We conclude with a discussion of the clinical utility of mindfulness for use with distressed couples and outline directions for future research.

Mindfulness

Mindfulness is commonly defined as the process of “paying attention in a particular way: on purpose, in the present moment, non-judgementally” (Kabat-Zinn, 1994, p. 4). Almost all individuals are capable of mindfulness, but there are individual differences in naturally occurring levels of mindfulness (Brown & Ryan, 2003; Kabat-Zinn, 2003). As such, dispositional mindfulness refers to an individual’s capacity and “tendency to abide in mindful states over time” (Brown, Ryan, & Creswell, 2007a, p. 218). The enhanced awareness to the present moment that characterises high dispositional mindfulness is said to facilitate cognitive and behavioural flexibility, which allows for more adaptive responses to situations as opposed to responding in a habitual or impulsive manner to situations (Baer, 2003; Bishop et al., 2004; Brown et al., 2007a, 2007b; Brown, Ryan, & Creswell, 2007a). Much evidence converges as to the beneficial effects of dispositional mindfulness (Keng et al., 2011). Individuals higher in dispositional mindfulness fare better on a variety of psychosocial outcomes than their less mindful counterparts (Brown & Ryan, 2003; Brown et al., 2007a; Keng et al., 2011), many of which are likely to contribute to satisfying romantic relationships.

Dispositional Mindfulness and Relationship Outcomes

Theoretically, dispositional mindfulness should facilitate a relationally focussed, non-judgemental, and experientially non-avoidant stance towards difficult emotions that can arise in interactions with others and in relationships (Wachs & Cordova, 2007). This non-judgemental and accepting stance towards difficult emotions in relationships may allow appropriate, constructive responses in relationships rather than reactive, impulsive responses. Consistent with this proposition, high dispositional mindfulness is associated with increased romantic relationship satisfaction (Barnes, Brown, Krusemark, Campbell, & Rogee, 2007; Wachs & Cordova, 2007) and satisfaction with interpersonal relationships more broadly (Pepping, O’Donovan, Zimmer-Gembeck, & Hanish, 2014). Here, we review six broad reasons as to why dispositional mindfulness may enhance couple relationships, namely, (1) enhanced individual adjustment, (2) greater emotion regulation capacity, (3) increased acceptance of one’s own experiences and acceptance of one’s partner, (4) enhanced capacity for self-reflection and relationship self-regulation, (5) increased empathy and support-giving skills, and (6) greater capacity to engage in shared enjoyable couple activities.

Individual Adjustment

High dispositional mindfulness is associated with less psychopathology and enhanced psychological adjustment (Keng et al., 2011). Much evidence indicates that psychopathology in one or both partners is a strong predictor of couple relationship distress (Whisman & Baucom, 2012; Whisman, Uebelacker, & Weinstock, 2004). For example, in a sample of 774 married couples, Whisman and colleagues (2004) found that anxiety and depression predicted one’s own relationship distress and that depression also predicted partner distress. Mindfulness is associated with lower levels of depression (Brown & Ryan, 2003), anxiety (Brown & Ryan, 2003; Dekeyser, Raes, Leijssen, Leysen, & Dewulf, 2008), eating pathology (Pepping, O’Donovan, Zimmer-Gembeck, & Hanisch, 2015), and substance misuse (Bowen & Enkema, 2014). Further, mindfulness-based clinical interventions, such as mindfulness-based stress reduction, have been effective for the treatment of depression (Grossman et al., 2010; Shapiro, Schwartz, & Bonner, 1998; Vollestad, Sivertsen, & Nielsen, 2011) and anxiety disorders (Anderson, Lau, Segal, & Bishop, 2007; Shapiro et al., 1998; Vollestad et al., 2011). Further, dialectical behaviour therapy, which incorporates mindfulness skills, is effective for the treatment of borderline personality disorder (Kliem, Kroger, & Kosfelder, 2010). In brief, there is clear evidence that mindfulness is protective against psychopathology. Thus, one plausible mechanism by which mindfulness might enhance romantic relationships is that it moderates the risk of psychopathology.

High dispositional mindfulness is also associated with a wide range of positive psychological outcomes likely to affect individual well-being and, in turn, romantic relationship functioning. Of particular relevance to couple relationship processes, low dispositional mindfulness is associated with insecure attachment (specifically, attachment anxiety and avoidance; Pepping, O’Donovan, & Davis, 2014). Attachment anxiety refers to the tendency to be fearful of abandonment and rejection in romantic relationships, whereas attachment avoidance reflects discomfort with emotional intimacy and closeness (Mikulincer & Shaver, 2007). Both forms of attachment insecurity are associated with poor relationship outcomes, including maladaptive communication, low relationship satisfaction, and negative partner attributions (Mikulincer & Shaver, 2007). Moreover, in a sample of 104 married adults, Jones, Welton, Oliver, and Thoburn (2011) found that mindfulness was associated with increased relationship satisfaction, and this association was mediated by low attachment avoidance. Thus, mindfulness may, over time, impact upon relationships via attachment processes and, in particular, by reducing avoidant attachment. However, it is important to note that the established association between low mindfulness and attachment insecurity is cross-sectional (Pepping, Davis, & O’Donovan, 2015), and further longitudinal work is needed to eliminate competing explanations for the associations. For example, low avoidant attachment might enable mindful engagement with relationships. Alternatively, a third variable, such as low neuroticism or quality of parenting received in childhood, might lead to both high mindfulness and low avoidant attachment.

Attachment insecurity is a risk factor for relationship break-up (Mikulincer & Shaver, 2007) as well as low relationship satisfaction. Saavedra, Chapman, and Rogge (2010) found that mindfulness attenuated the negative effects of attachment anxiety on risk of relationship break-up. This finding combined with the Jones and colleagues’ (2011) findings that attachment avoidance mediated effects of mindfulness on relationship satisfaction suggests a possible reciprocal influence between insecure attachment and mindfulness. That is, high mindfulness might promote low insecure attachment and vice versa.

In summary, mindfulness is associated with a wide range of positive individual qualities, including low risk of psychopathology and secure attachment. It seems likely that the association between mindfulness and greater relationship satisfaction is, at least in part, due to the association between mindfulness and individual adjustment.

Emotion Regulation

High unregulated negative affect is one of the characteristic features of couple relationship distress (Cordova, Gee, & Warren, 2005; Gottman, 2014; Gottman, Coan, Carrere, & Swanson, 1998; Greenberg & Johnson, 1988), which often prevents the successful resolution of relationship conflicts (Gottman, 2014). On the other hand, the ability to effectively identify and communicate emotion is associated with high romantic relationship satisfaction (Cordova et al., 2005). High negative emotion can lead to negative cycles of couple interaction (Christensen & Heavey, 1993; Gottman, 2014; Greenberg & Johnson, 1988). For example, couples often engage in mutual blaming and escalating conflict, which predicts deteriorating relationship satisfaction and risk of separation (Gottman, 2014). Sometimes the demand-withdraw pattern of interaction develops when one partner exerts pressure for change through criticism or complaints and the spouse responds with defensiveness and emotional withdrawal (Christensen & Heavey, 1990, 1993).

Emotion-focussed couple therapy (Greenberg & Johnson, 1988; Johnson, 1999) is an empirically supported approach to couple therapy that aims to modify distressed couples’ negative cycles of interaction (such as the demand-withdraw pattern described earlier). A critical component of emotion-focussed couple therapy is the identification and expression of previously unacknowledged primary emotions such as fear, hurt, or sadness. It is suggested people often express secondary emotions, notably anger, as a response to unacknowledged primary emotions. In other words, individuals are often most aware of, and express most freely, the secondary emotions such as anger. Emotion-focussed therapy facilitates the expression of the vulnerable primary emotions between partners in an effort to de-escalate the negative cycle of interaction (Johnson & Greenberg, 1987; Johnson, 1999).

Individuals higher in dispositional mindfulness may be better able to identify emotion and, in particular, more vulnerable primary emotions and may also have greater capacity to tolerate, cope with, and respond to difficult emotion that can occur in couple relationships. Much evidence indicates that mindfulness is associated with enhanced ability to recognise and tolerate difficult emotion (Baer, Smith, & Allen, 2004; Brown & Ryan, 2003; Liu, Wang, Chang, Chen, & Si, 2013) and regulate emotion effectively (e.g. Arch & Craske, 2006; Broderick, 2005; Campbell-Sills, Barlow, Brown, & Hofmann, 2006). Further, Wachs and Cordova (2007) found that individuals higher in mindfulness rated themselves as better able to respond adaptively to intense emotion (Wachs & Cordova, 2007). Wachs and Cordova (2007) proposed that dispositional mindfulness should assist individuals to maintain openness and receptiveness to difficult emotions that can arise in romantic relationships. The authors also posited that mindfulness should prevent experiential avoidance in response to emotion in relationships, for example, by not withdrawing.

A non-judgmental accepting stance towards emotion in relationships should facilitate the open expression of emotion and enhance each partner’s ability to respond in a constructive way to intense emotion. For example, mindful acceptance of strong emotion arising in response to difficult relationship experiences should enable an individual to respond in a constructive manner that will enhance the relationship (Gambrel & Keeling, 2010; Wachs & Cordova, 2007). On the other hand, low capacity to tolerate negative affect might lead to unhelpful behaviours to terminate the interaction (e.g. yelling to shut the other person up) or attempts to experientially avoid difficult emotion arising through emotional withdrawal and distancing.

Consistent with the above-mentioned possibilities of mindfulness enhancing emotion regulation in the context of couple relationships, in a sample of 33 couples, Wachs and Cordova (2007) found that high dispositional mindfulness was associated with low emotional distress, ability to identify and communicate emotion, and effective regulation of anger and impulsivity. Importantly, identifying and communicating emotion, and anger regulation, fully mediated the association between mindfulness and relationship satisfaction. Barnes and colleagues (2007) investigated the impact of dispositional mindfulness on communication behaviours during couple conflict discussion and found that individuals’ own mindfulness predicted lower anger and hostility following the conflict discussion and female mindfulness also predicted less anger and hostility in men following the discussion. In brief, high dispositional mindfulness may enhance couple relationships via the capacity to identify, accept, tolerate, and respond to difficult emotions that can arise in romantic relationships.

Acceptance

A defining feature of mindfulness is the concept of acceptance (Baer, 2003; Keng et al., 2011). Mindfulness-based interventions include a strong focus on acceptance of experiences as they are, without engaging in efforts to avoid or escape from these experiences (Kabat-Zinn, 1994; Baer, 2003). Individuals who are dispositionally high in mindfulness may be able to accept their internal experiences of relationship challenges. Being able to accept these experiences could reduce the felt need to reduce these experiences, whereas desperation to modify distressing internal experience can sometimes induce impulsive responses like aggression or substance abuse (Peterson, Eifert, Feingold, & Davidson, 2009). It is also likely that high dispositional mindfulness facilitates acceptance of one’s partner’s qualities that may be challenging (Christensen, Sevier, Simpson, & Gattis, 2004; Peterson et al., 2009). The question of whether acceptance of internal reactions and one’s partner is responsible for the association between mindfulness and relationship satisfaction is yet to be investigated empirically.

Enhanced Self-reflection and Self-regulation

Mindfulness may enhance an i ndividual’s ability to reflect on their own behaviour and implement self-change to enhance the relationship (Carson, Carson, Gil, & Baucom, 2006). High dispositional mindfulness is cross-sectionally associated with greater self-reflection and insight into one’s own thoughts, emotions, and behaviours (Harrington, Loffredo, & Perz, 2014). Further, this insight mediates the relationship between dispositional mindfulness and psychological well-being (Harrington et al., 2014). Although this research is cross-sectional, it does provide some preliminary evidence that the mechanism underlying the mindfulness-well-being association may, at least in part, be due to enhanced insight. Mindfulness is also associated with insight problem-solving abilities, which refers to the process of restructuring a problem (Ostafin & Kassman, 2012). For example, a person who becomes resentful that their partner is not keen to attend their favourite sporting event might mindfully note that the desire to attend the sporting event reflects two desires: to spend time with the partner and to attend the sporting event. That mindfulness might lead to the insight that these two desires need not be met simultaneously, they could go to the sporting event with someone else and plan a mutually enjoyable activity with their partner. Perhaps the greater insight, personal reflection, and creative problem-solving abilities associated with mindfulness contribute not only to individual well-being but also to relationship outcomes. Individuals high in dispositional mindfulness may be able to reflect on their own behaviour in relationships and engage in efforts to modify or adapt their behaviour to enhance the relationship.

The concept of relationship self-regulation refers to the extent to which partners work at their relationship and engage in relationship-enhancing behaviours (Wilson, Charker, Lizzio, Halford, & Kimlin, 2005). Specifically, it involves self-appraisal of the impact of one’s own behaviour on the quality of the relationship and identifying aspects of one’s behaviour that may be modified in order to enhance the quality of the relationship. Relationship self-regulation is associated with relationship satisfaction in newlywed and long-term married couples (Wilson et al., 2005) and also longitudinally predicts relationship satisfaction (Halford & Wilson, 2009). It seems likely that individuals high in dispositional mindfulness may be able to non-judgementally reflect on their relationship, identify aspects of their behaviour they wish to modify, and subsequently engage in a process of self-change directed towards building the relationship they desire.

Finally, distressed couples tend to attribute negative relationship behaviours or relationship difficulties to their partner’s behaviour and internal qualities of the partner (Bradbury & Fincham, 1990; Durtschi, Fincham, Cui, Lorenz, & Conger, 2011). Further, these negative partner attributions tend to be global (i.e. reflecting a personal quality of the partner rather than being situationally specific) and stable (i.e. the belief that one’s partner always acts in this manner). Negative partner attributions predict poor relationship quality longitudinally, and importantly, this effect is mediated by negative partner behaviour (Durtschi et al., 2011). Given that mindfulness is characterised by a non-judgemental and nonreactive stance towards the present moment and internal experiences, it is possible that individuals higher in mindfulness may be less likely to form negative partner attributions in the first place. However, even when mindful individuals do experience negative partner attributions, they may be better able to remain nonreactive to these thoughts, as opposed to engaging in partner blaming or criticism of one’s partner in response. Although this possibility seems theoretically plausible, research is needed to address this proposition empirically.

Empathy and Support

Mindfulness involves a non-judgemental stance towards, and non-elaborative processing of, thoughts, emotions, and experiences (Kabat-Zinn, 1990; Baer, 2003). Individuals high in dispositional mindfulness are likely to have capacity to suspend judgement in the context of difficult experiences in relationships and engage constructively with their relationship partner. The capacity to feel empathic concern for the other person may be facilitated by the awareness of experiences associated with mindfulness and thus enhance relationship outcomes (Block‐Lerner, Adair, Plumb, Rhatigan, & Orsillo, 2007; Kozlowski, 2013). Wachs and Cordova (2007) found associations between dispositional mindfulness and self-reported empathy and perspective taking in a sample of married couples. Further, Shapiro and colleagues (1998) investigated the effects of an 8-week mindfulness intervention and found that increased mindfulness was associated with increased empathy. It therefore seems likely that individuals high in dispositional mindfulness enjoy enhanced romantic relationships because they have greater capacity for empathy and perspective taking.

Related to the concept of empathy is the provision of mutual support by partners during times of stress. There is now a wealth of evidence that major life stress can impact negatively on couple relationship satisfaction, but that these negative effects can be attenuated if the couples are effective in coping with these stresses together (Bodenmann, 2005). The term dyadic coping is used by Bodenmann and Shantinath (2004) to describe a process whereby partners communicate with each other empathically to develop a shared understanding of the effect of particular stresses on each partner and then develop an agreed-upon conjoint approach to manage these stresses. Dyadic coping is strongly associated with relationship satisfaction in couples confronting both major life stresses such as a cancer diagnosis (Kuijer et al., 2000), as well as couples managing more common daily life hassles (Dehle, Larsen, & Landers, 2001).

To date, very little empirical research has examined the association between mindfulness and dyadic coping in couples. However, in a sample of 51 couples in which one partner was suffering chronic pain, Williams and Cano (2014) found that chronic pain patients who were better able to remain nonreactive to fluctuating internal pain experiences perceived their partners as being more supportive. For example, individuals who are suffering from chronic pain can experience substantial negative emotion, physical pain, and disturbing thoughts about the condition. Those high in mindfulness are able to accept these experiences and not react in unhelpful ways (e.g. trying to avoid these experiences by substance abuse or becoming angry at their spouse). The mindful acceptance of pain experiences likely allows them to accept and perceive support from their partner more readily, despite these difficult internal experiences.

In addition, partners’ who scored high on the acting with awareness subscale of mindfulness were rated by the pain patients as being high in emotional and instrumental support (Williams & Cano, 2014). That is, partners who were more aware were perceived by chronic pain sufferers as more emotionally and instrumentally supportive. This makes theoretical sense, as the supporting partner who is high in mindful awareness is likely to be better able to detect the needs of their partner and their pain. In brief, this study provides some preliminary evidence that aspects of mindfulness play a role in couple support and dyadic coping, which may be an additional mechanism by which mindfulness influences relationship processes.

Engagement in Positive Couple Activities

The final mechanism by which mindfulness might enhance romantic relationship functioning is via increased engagement within the relationship. As mentioned earlier, mindfulness is associated with increased positive affect and lower negative affect (Brown & Ryan, 2003). It seems plausible that mindfulness may enhance engagement in, and enjoyment of, positive couple interactions. The couple described at the start of the chapter were low in mindfulness of the couple relationship, with both partners being preoccupied with thoughts of work and distracted by social media. Perhaps cultivating mindfulness would enhance their ability to be fully present with each other and engage more completely in activities they do as a couple. Research from a clinical trial of a mindfulness-based relationship enhancement programme supports this contention. Carson, Carson, Gil, and Baucom (2007) found that the beneficial effects of a mindfulness-based relationship enhancement programme were mediated largely by couples reporting they increased engagement in exciting and absorbing activities.

In summary, there are numerous potential mechanisms by which high mindfulness may enhance romantic relationship functioning. Individuals high in mindfulness enjoy more positive romantic relationships (Barnes et al., 2007; Wachs & Cordova, 2007), which may be because of enhanced individual adjustment, emotion regulation capacity, self-regulation, acceptance of self and partner, heightened empathy, and increased engagement in positive couple activities. We now turn to the use of mindfulness-based clinical interventions to enhance relationship functioning in couples.

Mindfulness-Based Interventions to Enhance Couple Relationships

There are two broad approaches to enhancing couple relationships: couple relationship education and couple therapy. Couple relationship education (RE) was developed to enrich couples’ relationships and help couples to sustain a healthy, mutually satisfying, and stable relationship (Halford, Markman, Kling, & Stanley, 2003). RE usually works with couples who are currently satisfied in their relationship and are committed to that relationship. Evidence-based RE usually is brief, typically consisting of a 12–15 h curriculum that introduces key relationship knowledge (e.g. the importance of commitment, developing shared and realistic relationship expectations) and skills (e.g. couple communication, problem-solving, coping) (Halford, Markman, & Stanley, 2008). Here, RE builds upon the high level of positive emotion typical of currently satisfied couples and has a strong emphasis on building the positive foundations for a mutually satisfying life together.

Couple therapy is usually addressed to couples who are distressed in their relationship. In contrast to the typically fixed curriculum of RE, evidence-based couple therapy typically involves developing a couple specific conceptualisation of distress and an individually tailored treatment programme (Snyder & Halford, 2012). Couple therapists usually are trained mental health professionals who have the skills to deliver this specialised treatment and to manage the high levels of negative affect many distressed couples feel (Halford & Snyder, 2012).

There are well replicated short-term benefits of RE, particularly if the programmes are of sufficient duration. A meta-analysis of 117 studies of curriculum-based RE reported medium effect size improvements in couple communication, d = 0.44, and small increases in relationship satisfaction, d = 0.36, immediately after RE (Hawkins, Blanchard, Baldwin, & Fawcett, 2008). Programmes with moderate dosage (9–20 h) had substantially larger effect sizes than low-dose programmes (1–8 h) on satisfaction, with limited variability in pre-RE means across studies.

The modest magnitude of short-term effects of RE has been a source of debate in the literature. Bradbury and Lavner (2012) argued that the effect of existing forms of RE on relationship satisfaction was variable across studies, with a mixture of null and small (possibly trivial) effects. The overall null findings of the recent large, multisite Building Strong Families (BSF) study (Wood, McConnell, Moore, Clarkwest, & Hsueh, 2012) and the very small effects observed in the large multisite Supporting Healthy Marriage (SHM) study (Hsueh et al., 2012) might seem to support the view of Bradbury and Lavner. However, both BSF and SHM involved extensive contact hours for couples, and there was a lot of attrition from the programmes. Nonetheless there have been calls to seek to be more innovative in the content of RE in an attempt to enhance its effects (e.g. Bradbury & Lavner, 2012).

There are over 30 randomised controlled trials of couple therapy for distressed couples, most of which have examined efficacy of behavioural couple therapy (BCT) or emotion-focussed couple therapy (Snyder & Halford, 2012). Meta-analyses demonstrate a large effect size gain in couple adjustment for couple therapy compared to control conditions (Shadish & Baldwin, 2003) and pre-therapy to post-therapy in couple adjustment (Baucom, Hahlweg, & Kuschel, 2003). There is little evidence of systematic differences in the efficacy of different approaches to couple therapy (Shadish & Baldwin, 2003; Snyder & Halford, 2012). However, although couple therapy is beneficial for many distressed couples, only approximately 50 % of couples who end treatment are no longer distressed, 25–30 % increase in satisfaction but remain distressed following therapy, and 20 % do not significantly benefit from treatment (Snyder & Halford, 2012). Although to date no new approach has been replicated as being more efficacious than pre-existing approaches (Snyder, Castellani, & Whisman, 2006), researchers are continuing to develop new approaches to couple therapy, or refine existing approaches, in attempts to enhance efficacy of couple therapy.

The evidence reviewed earlier clearly indicates that mindfulness is associated with many outcomes related to satisfying romantic relationships. It therefore seems likely that enhancing mindfulness via mindfulness-based clinical interventions may have beneficial effects on couple relationships. Specifically, mindfulness- and acceptance-based interventions may be useful for the treatment of couple relationship distress but may also be beneficial for relationship enhancement. In this section, we describe mindfulness-based relationship enhancement (Carson, Carson, Gil, & Baucom, 2004, 2006; Carson et al., 2006) and integrative behavioural couple therapy (Jacobson, Christensen, Prince, Cordova, & Eldridge, 2000; Christensen et al., 2004) which incorporates acceptance-based strategies for treatment of couple relationship distress.

Mindfulness-Based Relationship Education

Carson and colleagues (2004) developed and evaluated mindfulness-based relationship education for non-distressed couples. The intervention was closely modelled on mindfulness-based stress reduction programmes (Kabat-Zinn, 1990), modified to be appropriate for couple relationships. Consistent with mindfulness-based approaches (Kabat-Zinn, 1990), the intervention focussed on the cultivation and development of mindful attention and awareness. Further, a non-striving stance was encouraged, and couples were not encouraged to strive for the development of particular outcomes or behaviours as their primary goal (Carson et al., 2004).

The intervention consisted of eight 2.5-h weekly sessions and a full day mindfulness retreat. Several important modifications to the standard mindfulness-based stress reduction protocol were made in order to be more suitable for the purposes of enhancing couple relationships. For example, participants were encouraged to meditate upon and cultivate loving-kindness towards their partners (Carson et al., 2004). Couples were “asked to recall the days when they first fell in love and decided to be together, and observe whether they could actually ‘feel’ again in the present moment the sense of discovery, closeness, trust, sweetness, or fun that they had at the time” (Carson et al., 2006, p. 318).

Couples also completed yoga exercises as a couple and physically supported each other in various yoga postures. In addition, there were mindful touch exercises completed by the couples (e.g. giving each other a mindful back massage and discussing any implications of this activity for sexuality). The authors also described an eye-gazing exercise in which the two partners gaze into each other’s eyes while focussing on the inherent goodness in each other. Couples were encouraged to develop enhanced awareness of shared pleasant activities, as well as unp leasant or challenging situations, and to reflect on what each individual learned from such situations.

Carson and colleagues (2004) also reviewed the use of mindfulness skills for managing life stressors and relationship difficulties, focussing on the use of mindfulness to promote emotion and problem-focussed coping. In addition, a key focus was on the cultivation of mindful attention and awareness to relationship processes and activities. For example, the authors emphasised the importance of cultivation of mindfulness skills during shared positive and enjoyable activities, as well as during difficult or stressful situations or activities. Importantly, mindfulness skills were practised within each session, and regular practice of mindfulness skills was encouraged as homework activities.

Carson and colleagues (2004) evaluated the efficacy of the above-mentioned mindfulness-based relationship enhancement intervention in a sample of 44 non-distressed couples relative to a wait-list control condition. Couples assigned to the mindfulness-based relationship enhancement programme evidenced higher relationship satisfaction, acceptance of partner, autonomy, relatedness, closeness, and less relationship distress compared to the wait-list control group. In addition, partners in the intervention condition displayed enhanced optimism, spirituality, daily coping and relaxation, relative to the control condition, and less psychological distress. Importantly, those in the mindfulness group who practised mindfulness meditation more frequently evidenced greater relationship satisfaction and coping with stress.

Couple Therapy

Emotion-focussed couple therapy has a very strong empirical base for its efficacy (see Halford & Snyder, 2012 for a recent review of the evidence). The emotion-focussed approach has as its central tenet that emotional reactions to the partner are at the heart of couple distress and that enhancing distressed relationships requires a focus on those emotional reactions (Greenberg & Goldman, 2008; Johnson, 2007). More specifically, emotion-focussed couple therapists seek to help the couple become more aware of their emotional reactions, how these emotional reactions influence couple interaction, and how to modify these reactions. Central ideas in the emotion-focussed approach overlap considerably with mindfulness concepts. For example, Johnson (2007, p. 47) suggests that emotion-focussed couple therapy is about helping individuals be “open to experience” and that “problems arise then from lack of or denial of awareness, constriction in processing ongoing experience so that this experience cannot be understood and trusted”.

The attempt to facilitate emotional awareness in emotion-focussed couple therapy is done by increasing mindfulness of the experienced emotion. For example, Johnson and Greenberg (1987) describe the process of tracking the emotional cycle of a couple’s interactions in terms of the therapist being empathic by reflecting back emotional statements, having the partners amplify emotions through repeating statements and gestures, having the partners focus on their subjective experiences of feelings, and the therapist making tentative interpretations of partially expressed emotions. Greenberg and Goldman (2008) refer to this process as emotional coaching, by which they mean teaching the individual to better tune in to their own emotional experience and using that emotional mindfulness constructively within their relationship. Three studies of emotion-focussed couple therapy show that couples make the predicted increase in emotional expression, particularly revealing more primary and vulnerable emotions across the course of therapy (Bradley & Furrow, 2004; Greenberg, Ford, Alden, & Johnson, 1993; Makinen & Johnson, 2006).

Integrative behavioural couple therapy (IBCT ) is an acceptance-based intervention for the treatment of relationship distress (Jacobson et al., 2000). Whereas traditional behavioural couple therapy (TBCT) is focussed on assisting partners to change their behaviour to enhance the relationship and alleviate distress, IBCT emphasises the importance of emotional acceptance of aspects of their partner and relationship that may have been considered problematic and may not be able to be changed (Jacobson et al., 2000). Specifically, IBCT facilitates acceptance of the emotional responses, the conditions that elicit them, and the outcomes of such responses, for each partner (Christensen et al., 2004; Jacobson et al., 2000). Importantly, however, acceptance does not refer to passive resignation to relationship challenges and should not be encouraged for abusive behaviour or addictive behaviour (Christensen et al., 2004). Rather, it recognises that there are often aspects of a partner that are not able to be changed and problems in relationships that do not have solutions to them, and thus acceptance is often warranted (Christensen et al., 2004; Jacobson et al., 2000). However, the authors note that acceptance can often paradoxically lead to change.

IBCT uses three specific strategies to facilitate acceptance in couple relationships: empathic joining, unified detachment, and tolerance building (Christensen et al., 2004; Jacobson et al., 2000). With regard to empathic joining, therapists engage in strategies to elicit emotion associated with the couple’s challenges that the partner’s may not typically express. Often partners may not be fully aware of these emotions until a therapist conjectures as to what a client may be experiencing. However, at other times, partners may be aware of the emotion but may avoid expressing these softer, more vulnerable emotions because of fear or embarrassment (Christensen et al., 2004; Jacobson et al., 2000). The therapist therefore aims to facilitate an empathic connection between the partners about the emotionally charged difficulties the couple is experiencing (Christensen et al., 2004). These strategies seem to overlap considerably with emotion-focussed couple therapy approaches to tracking the cycle.

Unified detachment refers to the process of generating an objective stance to the relationship difficulties and obtaining some distance from these problems (Christensen et al., 2004). That is, the therapist encourages the partner’s to view their ongoing relationship difficulties from a distance and engage in a descriptive analysis of the problematic behavioural patterns and the sequence of events. Therapists may also make use of metaphors, humour, and labelling the problem with names to generate distance from the problems, in a similar way to defusion exercises in acceptance and commitment therapy (Hayes, Strosahl, & Wilson, 2012) or decentring (Shapiro, Carlson, Astin, & Freedman, 2006). One goal of unified detachment is to view the actual relationship difficulties as the problem, as opposed to blaming any one partner. Importantly, both emotional exploration of the problem (empathic joining) and unified detachment serve to develop mindfulness of their relationship and non-judgemental awareness of relationship patterns and sequences of interactions (Christensen et al., 2004; Jacobson et al., 2000).

Finally, tolerance building recognises that relationship challenges stemming from differences between partners are likely to always exist. These differences between partners are unlikely to be completely removed. However, it is possible to reduce the intensity of the emotional impact of these differences. Building tolerance and acceptance of these differences can take many forms during therapy. For example, a therapist might review the benefits of differences between partners. A therapist may also ask a client to enact problematic behaviours in session when both partners are “not” feeling highly emotionally charged at the time so that the couple experiences these behaviours differently (Christensen et al., 2004). Because the typical sequence of negative events is unlikely to occur in the absence of intense emotional arousal, partner’s can experience these behavioural patterns and respond in ways that differ from their usual pattern of responding, and thus gain tolerance of these usually distressing behaviours, and more adaptive ways to respond (Christensen et al., 2004; Jacobson et al., 2000).

The focus of IBCT is emotional acceptance. However, when it becomes apparent that a couple may benefit from direct skills training to rectify a skill deficit, the IBCT therapist may engage in direct change strategies (Christensen et al., 2004; Jacobson et al., 2000). For example, a couple may benefit from communication skills training or problem-solving training, and thus these change skills can be incorporated into the couple therapy in addition to the key acceptance-based strategies. Christensen and colleagues (2004) note that these change strategies are, however, generally taught in an individualised manner and applied to the specific sequences of problematic behaviour occurring in the couple. Further, when strong emotions appear in the context of change-based strategies, the IBCT therapist reverts back to acceptance-based strategies of emotional acceptance (e.g. empathic joining).

Evidence indicates that the acceptance-based IBCT is at least as efficacious as traditional behavioural couple therapy (TBCT; Christensen et al., 2004; Christensen, Atkins, Baucom, & Yi, 2010). Christensen and colleagues (2004) compared IBCT with TBCT in a sample of significantly and chronically distressed married couples. Results revealed that couples in both intervention conditions improved in satisfaction. Although there were somewhat different trajectories of change between the two conditions, with TBCT evidencing more rapid improvement early in therapy and IBCT displaying steady improvement over therapy, both conditions were similar in regard to clinically significant improvement at post-therapy. These results held at 5-year follow-up (Christensen et al., 2010). Interestingly, with regard to observed couple communication at 2-year follow-up, Baucom, Sevier, Eldridge, Doss, and Christensen (2011) found that couples in the acceptance-based IBCT evidenced more positive communication compared to those in the TBCT. Thus, IBCT is at least as efficacious as existing evidence-based couple therapies, and there is some evidence that it may be more beneficial on communication behaviours.

Conclusions and Future Directions

In this chapter, we have outlined how mindfulness may be beneficial to romantic relationship functioning and the utility of mindfulness-based clinical interventions to enhance romantic relationships and alleviate relationship distress. Evidence clearly indicates that high mindfulness is associated with enhanced relationship satisfaction (Barnes et al., 2007; Wachs & Cordova, 2007). This may be because high mindfulness is associated with less psychopathology, secure attachment, enhanced emotion regulation and self-regulation, increased acceptance of self and partner, and greater capacity to be empathic and enjoy positive couple activities. The challenge for future research is to examine the relative importance of these and other potential mechanisms underlying the association between mindfulness and relationship outcomes. Further, it would be useful to examine not only cognitive and emotional mechanisms but also behavioural mediators. In other words, it is important that we begin to understand what individuals higher in mindfulness actually “do” that enhances the relationship for themselves and their partner.

With regard to the use of mindfulness-based interventions to enhance couple relationships and reduce relationship distress, the evidence to date is promising. Specifically, one randomised controlled trial demonstrates that mindfulness-based relationship enhancement is beneficial for non-distressed couples and found larger effect size improvements than existing evidence-based relationship enhancement programmes on satisfied couples (Carson et al., 2004). It is important, however, to directly compare the efficacy of mindfulness-based relationship enhancement with existing evidence-based programmes. Emotion-focussed couple therapy seems to do things that are closely associated with mindfulness. Acceptance-based integrative behavioural couple therapy also seems to promote mindfulness.

In summary, much evidence indicates that mindfulness and mindfulness-based clinical interventions produce beneficial outcomes on a wide range of psychological factors (Keng et al., 2011). It is encouraging that research is beginning to examine not only the individual benefits of mindfulness but also the interpersonal and relational outcomes of mindfulness and mindfulness-based interventions. Although there is further work to be done to elucidate the mechanisms underlying the beneficial effects of mindfulness on relationship outcomes, the available evidence pertaining to the benefits of mindfulness on romantic relationships is promising.