cesar.rey@uptc.edu.co
http://www.dx.doi.org/10.14718/ACP.2020.23.1.5
Articles
César Armando Rey-Anacona 1 ;
Jorge Arturo Martínez-Gómez 2;
Paola Andrea Castro-Rodríguez 3 ;
Lizeth Fernanda Lozano-Jácome 4
1 Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia, Calle 24 n.° 5-63, Antiguo Hospital San Rafael, Tunja, Colombia. C. P.: 150001. Tel.: 57-8-7405626.
cesar.rey@uptc.edu.co
0000-0002-9528-2199
2 Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
0000-0002-1423-3812
3 Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
0000-0003-2563-781X
4 Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
0000-0003-4418-4801
Recibido, octubre 16/2018;
Concepto de evaluación, febrero 10/2019;
Aceptado, febrero 24/2019
Como citar este articulo / How to cite this article: Rey-Anacona, C.A., Martínez-Gómez, J.A., Castro-Rodríguez, P.A. & Lozano-Jácome, L.F. (2020). Evaluation of a Treatment Program for Dating Violence Acta Colombiana de Psicología, 23(1), 92-105. doi: http://www.doi.org/10.14718/ACP.2019.23.1.5
Abstract
The specialized literature does not report the design and evaluation of intervention alternatives for adolescents and young adults involved in acts of dating violence, a problem that reaches high prevalence rates. This study aimed to implement and evaluate the effectiveness of a program for young unmarried couples who have experienced violence, using a quasi-experimental design with pretest-posttest and intact groups (experimental and control), in which 12 heterosexual couples of young people participated, all of them between 17 and 26 years-old, linked through a call made by different media in their city of residence, six assigned to the experimental group and six to the control group. The program is developed in 10 sessions, in addition a follow-up, including psychoeducation about dating violence, beliefs and expectations about the relationship, communication skills, empathy, anger management and management of jealousy. The results showed statistically significant decreases at post-treatment level in the experimental group compared with the control group, in attitudes in favor of intimate violence, submissive communication and frequency of abuse, as well as an increase in assertive communication, changes that were maintained a month after the intervention ended. These results support the effectiveness of the program.
Key words: dating, violence, teens, young adult, program outcomes.
Resumen
En la literatura especializada no se reporta el diseño ni la evaluación de alternativas de intervención para adolescentes y adultos jóvenes involucrados en actos de violencia en el noviazgo, una problemática que alcanza una alta prevalencia en la actualidad. Por tanto, el presente estudio tuvo como objetivo implementar y evaluar la efectividad de un programa para parejas jóvenes no casadas que han vivenciado malos tratos, mediante un diseño cuasi-experimental con prueba-posprueba y grupos intactos —experimental y control—. En total, participaron 12 parejas heterosexuales de adolescentes y jóvenes entre los 17 y 26 años, vinculadas mediante una convocatoria realizada por diferentes medios en su ciudad de residencia, seis asignadas al grupo experimental y seis al grupo control. El programa se desarrolló en 10 sesiones, más una de seguimiento, e incluyó psicoeducación sobre la violencia en el noviazgo, creencias y expectativas sobre la relación de pareja, habilidades de comunicación, empatía, manejo de la ira y manejo de los celos. Los resultados evidenciaron disminuciones estadísticamente significativas a nivel de postratamiento en el grupo experimental —en comparación con el grupo control— en actitudes a favor de la violencia íntima, comunicación sumisa y frecuencia de los malos tratos, así como un incremento en la comunicación asertiva, cambios que se mantuvieron al mes de finalizada la intervención. Estos resultados respaldan la efectividad del programa.
Palabras clave: noviazgo, violencia, adolescente, adulto joven, resultados del programa.
Introduction
In recent years, the high prevalence of violence among young couples has produced significant interest in relation to their risk factors, their associated difficulties and their prevention (López-Cepero, Rodríguez-Franco, Rodríguez-Díaz, Bringas, & Paíno, 2015; Rubio-Garay, Carrasco, Amor & López-González, 2015). Although these figures vary according to the samples studied and the methodologies used, they indicate that around 50% of the young people surveyed have been mistreated by their partner (Garrido & Taussig, 2013). A systematic review carried out with 101 studies on the prevalence of dating violence among adolescents revealed percentages that ranged between 1% and 61% for participants who had perpetrated or had been subjected to physical violence and between less than 1% and 54% of participants who had been victims of sexual violence (Wincentak, Connolly & Card, 2017). Many of these studies report abuse in a bidirectional manner, with figures approaching 50% of cases (Alegría & Rodríguez, 2015; Rubio-Garay, López-González, Carrasco & Amor, 2017).
In Latin America, several studies also indicate that this problem is widespread among adolescents and young adults (see Rubio-Garay et al., 2017, for a review). In Colombia, in particular, an investigation conducted with 589 high school and university students, between 12 and 22 years of age, found that 70.9% had been subjected, at least once, to some abusive behavior by their partner (Martínez, Vargas & Novoa, 2016). The National Institute of Legal Medicine and Forensic Sciences (2015), noted 48849 cases of dating violence in 2014, of which 21.13% corresponded to people between 20 and 24 years of age and 8.96% to people between 10 and 19 years of age, which confirms that this type of violence could affect a significant number of adolescents and young Colombians.
Studies conducted in Latin America and around the world on the physical and mental health difficulties associated with this problem, indicate, furthermore, that this form of violence could negatively affect the victims' quality of life, relating to difficulties such as low self-esteem, depression, anxiety, suicidal ideation and attempts, consumption of alcohol and illegal substances, risky sexual behaviors and poor academic performance (eg, Foshee, McNaughton, Gottfredson, Chang & Ennett, 2013; Goncy, Sullivan, Farrell, Mehari & Garthe, 2017; Muñoz-Rivas, Graña, O'Leary & González, 2007; Singh, Epstein-Ngo, Cunningham, Stoddard, Chermack & Walton, 2015; Van Ouytsel, Ponnet & Walrave, 2017).
These difficulties, together with the high prevalence figures, require the design and evaluation of alternatives for the discontinuation of mistreatment that occurs between victims and perpetrators. However, the programs that have been developed to address this problem have mostly focused on their primary and secondary prevention (Martínez & Rey, 2014). A systematic review of violence prevention and intervention programs aimed at adolescents, published between 2000 and 2011, found a total of nine studies conducted mostly in educational institutions in the United States or Canada, which corresponded to primary and secondary prevention programs but none with treatment alternatives for victims and perpetrators of this type of violence (Leen et al., 2013). De La Rue, Polanin, Espelage and Pigott (2017), for their part, carried out a meta-analysis with the results of 23 studies on programs developed in middle and high school institutions in the United States, which exhibited significant results with respect to the knowledge and attitudes of the participants, but a minor impact at the behavioral level, which suggests the need for treatment alternatives that can halt abuse to prevent worse consequences and the continuation of violence in subsequent relationships (Garrido & Taussig, 2013; Mercy & Tharp, 2015; Rubio-Garay et al., 2015; Temple, Le, Muir, Goforth & McElhany, 2013).
From the cognitive behavioral approach, several alternatives for the treatment of couples have been developed for a number of years, where the development of conflict resolution, communication and emotional self-control skills is promoted, evidencing an improvement in the positive interaction of the couple and a decrease in discontent in the relationship (Halford & Doss, 2016; Lebow, Chambers, Christensen & Johnson, 2012; Markman & Rhoades, 2012).
The "Program for the Improvement of Dating Relationships" is a cognitive behavioral approach treatment program aimed at unmarried couples who experience abuse in their intimate relationship, which includes components of these programs, such as training in assertive skills and conflict resolution, anger management training, promoting the development of empathy and jealousy management skills, to improve the way in which participants handle conflicts and interact with their partners. It also involves a psychoeducational process regarding abuse in the relationship and clarification of beliefs and expectations about the relationship (Rey & Martínez, 2018).
This trial program was carried out with four heterosexual couples who had experienced mistreatment, whose members were between 17 and 22 years of age, through a design of a single pretest-posttest group, evidencing statistically significant reductions at the post-treatment level in the frequency of abuse, in the state of anger and in attitudes towards violence. The participants expressed a good level of satisfaction with the program, and evaluated it positively in terms of the techniques and methodologies used (Rey-Anacona, Martínez-Gómez, Villate-Hernández, González-Blanco & Cárdenas-Vallejo, 2014). These results indicate that this program could help many adolescents and young adults to positively modify their interaction patterns toward their partner, although more rigorous clinical studies are required to weigh their effectiveness.
In accordance with the above, this study proposed as a general objective to implement and evaluate this program with adolescent and young adult couples, assigned to an experimental group and a control group, assuming the following working hypothesis:
- The experimental group will exhibit significantly lower scores on the Scale of Attitudes toward Intimate Violence (Póo & Vizcarra, 2011), after treatment, with respect to the control group.
- The experimental group will exhibit significantly lower scores on the Checklist of Experiences of Partner Abuse - Form B (Rey-Anacona, 2009), after treatment, with respect to the control group.
- The experimental group will exhibit significantly higher scores on the assertive communication scale and lower scores on the aggressive communication, submissive and passive-aggressive communication scales on the Couple Assertion Questionnaire (Carrasco, 1998), after treatment, with respect to the control group .
- The experimental group will exhibit significantly lower scores on the scales of the Inventory of Expression of State of Anger II (Miguel-Tobal, Casado, Cano-Videl & Spielberger, 2001), after treatment, with respect to the control group.
- There will be no statistically significant differences between post-treatment measurements and follow-up measurements made to the experimental group.
Method
Design
A quasi-experimental design with test/post-test and intact groups was used, one of them a control (Hernández, Fernández & Baptista, 2014), implementing a monthly follow-up measure. This design has the same characteristics of the true experimental design, differing in terms of group allocation, which is not random, and was used for convenience due to practical limitations.
Participants
There were 12 heterosexual couples between 17 and 26 years of age (M = 20; SD = 2.61), with a relationship time ranging from 4 to 96 months (M = 23.92 months; SD = 25.71 months) The majority of the participants were university students (87.5%), lower middle class (50%), from a nuclear family (75%) and were recruited through an open invitation held in the city of Tunja ( Boyacá, Colombia), as described in the procedure by a non-randomized sampling by availability. The couples were assigned to the two groups according to their availability of time to participate in the program, starting with the experimental group (six couples) and after the study, for ethical reasons, with the control group (six couples).
The inclusion and exclusion criteria were: (a) that the couple had the disposition and the time necessary to attend all the program sessions; (b) that they were single, without children, and (c) that there had been unidirectional or bidirectional abuse on more than one occasion, according to the information provided by the two members in the Semi-Structured Interview for Victims of Domestic Abuse (adapted from Echeburúa & Corral, 1998).
Instruments
The same trial instruments of the study by Rey-Anacona et al. (2014) were used, that is to say:
Semi-structured interview for Victims of Domestic Abuse (adapted from Echebúrua & Corral, 1998). It contains open and closed questions about acts of violence of a physical, psychological and sexual nature that the person has been subjected to by their partner, and biographical information regarding the interviewee's relationship with their parents, history of violence inside and outside the family of origin, health problems, drug and alcohol use and attempts and persistent thoughts of suicide.
Inventory of Expression of State of Anger II (STAXI-II, Miguel-Tobal et al., 2009). It allows measuring anger as a state, as a trait and its expression and control, by way of 49 items with four response options, which yield a general score and scores in the three aspects mentioned. The response options are: "No, not at all": 1; "Some": 2; "Moderately": 3 and "Considerably": 4, for the status scales and "Almost never": 1; "Sometimes": 2; "Often": 3 and "Almost always": 4, for the anger trait/expression/control scale. The instrument evidenced internal consistency in two studies with indexes that ranged between 0.64 and 0.89, and test-retest correlation indexes between 0.64 and 0.77, results that indicate an adequate level of reliability, showing statistically significant correlations with other studies with similar or theoretically related measures (Miguel-Tobal et al., 2009). This study showed alpha values that ranged from 0.07 to 0.80, with a global alpha of 0.38.
Couple Assertion Questionnaire (ASPA; Carrasco, 1998). It measures four communication styles: assertive, aggressive, submissive and passive- aggressive, in relation to aspects such as manifestations of affection, free time, sexual relations and household chores. It contains two forms with 40 questions each, with four answer options ("Almost never": 1; "Rarely": 2; "Occasionally": 3; "Frequently": 4; "Generally": 5 and "Almost always": 6). In Form A the person is evaluated in relation to these communication styles, and with Form B they evaluate the communication styles of their partner. According to its author, the ASPA scales correlated significantly with marital adjustment and assertiveness measures, showing alpha indexes that ranged between 0.72 and 0.84 for Form A and between 0.92 and 0.96 for Form B. Test-retest correlation coefficients fluctuated between 0.76 and 0.88 in Form A (Carrasco, 1998). In this study, Form B was used, which showed alpha values that ranged between 0.56 and 0.82, with a global alpha of 0.83.
Checklist of Experiences of Partner Abuse Form A (Rey-Anacona, 2009). It is designed to report the frequency of execution of 79 physical, psychological, emotional, negligent, economic and sexual abuse behaviors by the couple, through a Likert scale with four response options ("Never": 0, "One time": 1;"Sometimes": 2 and "Many times": 3), which allows calculating the general frequency as well as each particular type of abuse. The last 11 items are addressed to people who live with their partner and / or have children, so they were not considered in the study. This instrument was subject to a methodological and content review by experts, evidencing an alpha of 0.92 with a sample of 403 individuals aged 15 to 30 years (Rey-Anacona, 2009). In this study it presented an alpha of 0.94.
Scale of Attitudes toward Intimate Violence (adapted from Vizcarra & Póo, 2011). It contains 10 Likert items with five response options ("Strongly agree": 0; "Agree": 1; "Neither agree nor disagree": 2; "Disagree": 3 and "Strongly disagree": 4), where the person responds how much they consider the use of violence toward the partner is justified in situations such as infidelity, invalidation, refusal to engage in intimate relationships, a low level of educational, history of abuse, emotional disturbances and drug and alcohol use. According to the authors, the instrument presented an alpha of 0.90 when administered to 427 university students (Vizcarra & Póo, 2011). In the study by Rey-Anacona et al. (2014) some adjustments were made to use it as a measure of the effects of the program in order to compare the score obtained in each item and throughout the scale. This study showed an alpha value of 0.84.
Satisfaction with Treatment Questionnaire (adapted from Echeburúa & Corral, 1998). It allows to evaluate the satisfaction of the users of psychotherapeutic services, based on eight items that introduce different response options, referring to the fulfillment of their needs and expectations. In the aforementioned study, some linguistic adaptations were made and two items were added in order to evaluate the methodology, the techniques used, the space and the materials, the topics and the skills learned.
Procedure
The implementation and evaluation of the program was carried out taking into account the following steps:
1. Formation of the work team. As stipulated in the treatment manual (see Rey & Martínez, 2018), the team consisted of a supervisor, a therapist and two assistants, the first two with a Doctoral and Master's degree, respectively, who trained two students during their last semesters of the psychology degree program.
2. Sample selection. For this, an open invitation was made for young adult and teenage couples, who lived in the city of Tunja, disseminating the relevant information of the program (objective, population, time and dates), through different means: at a local radio station, with the delivery of flyers in strategic places throughout the city, providing information to ninth, tenth and eleventh grade students in 12 educational institutions in the city, providing information to young people from different career paths and in different semesters at the University that sponsored the study and through a Facebook page. With those interested couples who were not married and had no children, and were available to attend all the sessions, an interview was conducted to identify the existence of violence in their dating relationship, using the Semi-structured Interview for Victims of Domestic Abuse (adapted from Echebúrua & Corral, 1998). Subsequently, the selected couples were assigned to the experimental and control groups, according to their availability.
For informed consent, participants were told that they could withdraw at any time during the study without any negative consequences at the legal or social level. They were guaranteed that their names would not appear in any academic report, presentation or publication of the study and that the information collected would be used only for research and academic training purposes, in compliance with the rules governing research and the practice of psychology in Colombia. Participation in the study was completely voluntary, unpaid and participants signed an informed consent form authorizing such participation; in the case of minors, they signed the consent together with their guardians or legal representatives.
3. Performing pre-treatment measurements to both the control group and the experimental group, through the application of all instruments, except the Semi-structured Interview for Victims of Domestic Abuse (adapted from Echeburúa & Corral, 1998), which was only administered for the selection of the sample and the Satisfaction Questionnaire with Treatment (adapted from Echeburúa & Corral, 1998), which was only applied at the post-treatment level.
4. Application of the program to the experimental group for approximately a month and a half, during which time the 10 sessions of the program were developed, with an intensity of two hours per session. The sessions were developed with the following methodology, as indicated in the treatment manual: (a) Welcome greeting and strengthening of rapport; (b) activation dynamics related to the topic to be developed; (c) presentation of the session; (d) homework review; (e) presentation of content and skills accompanied by individual and partner exercises on the topics that were being developed; (f) task assignment, and (g) feedback, clarification of doubts and conclusion. The topics and objectives addressed were the following (see Rey & Martínez, 2018):
• Session 1: Presentation of the program, clarification of expectations and establishment of standards, signing of the therapeutic and psycho-education contract: what it is and how violence is learned.
• Session 2: Beliefs and expectations about the relationship. Its objective is to analyze and describe the beliefs and expectations that young people have about relationships and their effect on the way of communicating and the way of living in those relationships.
• Session 3, session 4 and session 5: Communication skills. Its objective is to provide the couple with tools to deal with their problems peacefully and successfully, as well as learn to identify and communicate positive and negative emotions and feelings, in order to understand each other's thoughts and affective and emotional needs.
• Session 6: Empathy. The objective is to promote the ability to recognize thoughts and emotions in their partner, for effective communication and assertive conflict resolution, highlighting the importance of this recognition in the relationship.
• Session 7 and session 8: Anger management. It seeks to promote greater self-knowledge about situations and the emotional response characteristic of anger; generate cognitive and behavioral skills to control this emotional response and promote skills to successfully deal with situations that commonly produce anger in participants.
• Session 9: Jealousy management. Its objective is to identify irrational thinking about the behavior in the couple that generates jealousy and modify the behavior and look into the ideas of cheating in the jealous person.
• Session 10: Conclusion. The topics of each session are resumed to reinforce achievements and identify and help overcome difficulties and give final general guidelines.
The team prepared these sessions in advance and met at the end of each session to provide feedback on their development, during which the most relevant events were recorded in a logbook.
5. Post-treatment measurements were made both in the experimental group and in the control group, using the same instruments as the pre-treatment phase, also applying the Satisfaction Questionnaire with Treatment (adapted from Echeburúa & Corral, 1998), but only to the experimental group.
6. Carrying out a follow-up measure with the experimental group one month after the end of the program, administering the same instruments as the pre and post-treatment measurements, except for the two instruments already indicated.
Data analysis
The following intra-group and inter-group comparisons were made, using the SPSS Statistics program version 22.0: (a) pre-treatment comparisons between the experimental group and the control group, to determine if there were no differences between the groups before the program implementation, (b) post-treatment comparisons between the experimental group and the control group, in order to evaluate the effect of the treatment, (c) pre and post-treatment comparisons in the experimental group, with the same objective, (d ) pre and post-treatment comparisons in the control group, to take as a comparison parameter in relation to the experimental group and (e) comparisons between post-treatment measurements and follow-up measurements in the experimental group, to deliberate the sustaining of goals. Because the sample was not distributed normally in the variables measured at the pre and post-treatment level, according to the results of the Shapiro-Wilk test, inter-group comparisons were made through Mann-Whitney's non-parametric U test, while intra-group comparisons were carried out with the Wilcoxon W test, accepting a minimum significance level of 0.05, while also calculating the size of the non-parametric effect, considering effect sizes lower than 0.3 as small, those below 0.5 as moderate and those equal to or greater than 0.5 as high(Cohen, 1988).
Results
Comparisons between the two groups at the pre-treatment level did not show statistically significant differences in the measurements made (see Table 1).
Table 1. Results of pre-treatment comparisons between the experimental group and the control group.
Note. U: Mann-Whitney,p: probability, r: size of the non-parametric effect.
1. Inter-group comparisons at the post-treatment level, on the other hand, showed significantly lower scores in the experimental group, compared with those in the control group, in relation to the general frequency and in the scores on the scales of emotional and economic violence from the Checklist of Experiences of Partner Abuse - Form A (Rey-Anacona, 2009), with moderate effect sizes for general frequency and emotional violence and high for economic violence. The experimental group also showed an increase in the assertive communication style and a decrease in the submissive communication style, with statistically significant differences in relation to the control group and with moderate effect sizes. There were no statistically significant differences in the STAXI-II scales (Miguel-Tobal et al., 2009; see Table 2).
Table 2. Results of post-treatment comparisons between the experimental group and the control group.
Note. U: Mann-Whitney,p: probability, r: size of the non-parametric effect. *p < 0.05, **p < 0.01
The experimental group also showed a statistically significant increase in the degree of disagreement with respect to three of the eleven statements in the Scale of Attitudes toward Intimate Violence (adapted from Póo & Vizcarra, 2011). These were: "When one member of the couple is unfaithful" (high effect size), "When one member of the couple insults the other" (moderate effect size) and "The use of violence is not justified under any circumstances" (high effect size).
The results of the intragroup comparisons made with the experimental group indicate a statistically significant reduction in the general frequency of abuse behaviors and in economic mistreatment, examined with the Checklist of Experiences of Partner Abuse - Form A (Rey -Anacona, 2009), with high effect sizes. In the ASPA (Carrasco, 1998), there was a statistically significant difference that indicates an increase in assertive style scores, with a high effect size. There were no statistically significant differences in the STAXI scales (Miguel-Tobal et al., 2009) or in relation to the eleven statements and the total score obtained in the Scale of Attitudes toward Intimate Violence (adapted from Póo & Vizcarra, 2011 ; see Table 3).
Table 3. Results of pre and post-treatment comparisons in the experimental group.
Note. Z: W of Wicolxon,p: probability, r: size of the non-parametric effect.*p < 0.05, **p < 0.01
In the control group there were no statistically significant differences in relation to the pre and post-treatment measurements (see table 4).
Table 4. Results of pre and post-treatment comparisons in the control group.
Nota. Z: W de Wilcoxon, p: probabilidad, r: tamaño del efecto no paramétrico.
Finally, the results of the comparisons between post-treatment and follow-up measurements in the experimental group did not show statistically significant differences between the two measurements (see Table 5).
Table 5. Results of post-treatment and follow-up comparisons in the experimental group.
Note. Z: W of Wilcoxon, p: probability, r: size of the non-parametric effect.
The results of the evaluation of the program carried out by the participants of the experimental group through the Satisfaction Questionnaire with Treatment (adapted from Echeburúa & Corral, 1998), showed that they considered the techniques and methodology to be relevant, rating these aspects as excellent or good. The space and materials used were rated by the majority as excellent or good, stating that they were satisfied with the program "a lot" or "considerably".
Discussion
The objective of this research was to evaluate through a quasi-experimental design with test/post-test and intact groups, a program for the improvement of dating relationships that had already undergone a preliminary evaluation, where it showed statistically significant positive effects regarding the decrease in abusive behaviors, anger management and attitudes in favor of the use of violence in the relationship (Rey-Anacona et al., 2014).
The results obtained support several of the work hypotheses posed. Thus, with respect to the first hypothesis, the results indicate significant differences in the change in attitudes that justify the use of violence in relationships in the group of adolescents and young adults who received the program, in relation to the control group. This suggests that the program could improve the level of awareness about attitudes that justify the use of violence against a partner. These results are similar to those obtained in the preliminary study developed by Rey-Anacona et al. (2014) and those in other studies where attitudes were engaged as a form of violence prevention in dating (De La Rue et al., 2017).
In relation to the second hypothesis about the decrease in abusive behaviors, the results revealed significant differences in pre-treatment and post-treatment scores in the experimental group, and in comparison with the control group, which supports the working hypothesis and suggests that the program could also reduce the use of this type of behavior against the partner. It is important to highlight that the instrument used allowed participants to respond in relation to their partner's behavior, thus avoiding biases of social desirability that could affect the results.
With respect to the third hypothesis, related to changes in communication styles, the results indicate an increase in assertive responses in the experimental group at the post-treatment level, as well as a reduction in submissive responses and an increase in assertive responses compared to the control group, in which these differences were not exhibited. This indicates that the program could encourage a change in communication styles and reinforces the idea that improving assertive communication skills could be effective in the reduction of abusive behaviors in the relationship (Secretary of Public Health, 2012).
Finally, with the STAXI II scales (Miguel-Tobal et al., 2009), no statistically significant changes were evidenced at the pre and post-treatment level in the experimental group, and in relation to the control group, which leads to reject the working hypothesis. However, this instrument presented low internal consistency indexes in this study, which indicates that the results obtained with it are not very reliable.
With respect to the last hypothesis, the results of the follow-up measurements carried out one month after the completion of the program, indicate the preservation of achievements, since there were no statistically significant differences between the post-treatment measurements and those measurements.
The attendance and evaluation of the program by the participants showed a good level of adherence and an active participation, since all the couples successfully completed the treatment and were generally satisfied with it, as indicated by the results of the questionnaire used, in relation to the techniques, methodology, space and materials used. This is consistent with the results obtained with the same instrument in the preliminary study of the program (Rey-Anacona et al., 2014).
The previous results, plus the fact that the participants of the control group did not show statistically significant changes between the pre and post-treatment measurements, suggest that the "Program for the Improvement of Dating Relationships" presents a methodological structure that could generate behavioral and attitudinal changes in its participants. Since the instruments used make it possible to evaluate the main aspects mediated through the program, they could be used to evaluate their effects. However, it is necessary to implement experimental designs to evaluate the effectiveness of the program, initially by the research group that developed the program and subsequently by independent research groups, to obtain stronger evidence on its effectiveness according to criteria such as those posed by Chambless and Hollon (1998). Likewise, it would be convenient to examine the relative importance of each of the components of this program, in order to rationalize or increase the therapeutic resources used in its development.
As strengths of this research, the possibility of having a control group to compare the effects of the program should be noted; the use of a manual for its application where the objectives, activities, topics and resources of each session are specified; the selection and training of the work team; the solicitation and the selection process of the participants; the use of several instruments for the evaluation of the results and the evaluation of the program by the participants, were noted. However, it should also be noted that the research presented some limitations, such as the difficult access to a sample of participants, due to the nature of the problematic purpose of the program and the inclusion criteria, which required the availability of both members of the couple to participate in its progress, as well as a willingness to share personal experiences with other couples, transportation to the program development site, among others. Another limitation was the non-random assignment to the groups, so it is recommended that this study be replicated through a controlled clinical trial and with a larger sample of participants, in addition to adopting follow-up measures with longer time intervals.
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