Mindfulness

https://doi.org/10.1007/s12671-018-0902-7

ORIGINAL PAPER

On the Association Between Mindfulness and Romantic Relationship

Satisfaction: the Role of Partner Acceptance
Gesa Kappen 1 & Johan C. Karremans 1 & William J. Burk 1 & Asuman Buyukcan-Tetik 2

# The Author(s) 2018

Abstract
In three studies, it was investigated whether trait mindfulness is positively associated with partner acceptance, defined as the
ability and willingness to accept the partner’s imperfections, and whether partner acceptance explains the association between
trait mindfulness and relationship satisfaction. Trait mindfulness, partner acceptance and relationship satisfaction were assessed
in two MTurk samples (n1 = 190; n2 = 140) and a sample of participants of a mindfulness-based stress reduction course (n3 = 118)
and their partners (53 complete couples), using self-report measures. In all three samples, trait mindfulness was related to partner
acceptance and in two out of three studies trait mindfulness was directly positively related to relationship satisfaction. Also, the
results provided initial support for the mediating role of partner acceptance in the association between mindfulness and relation-
ship satisfaction. Dyadic data further suggested that the benefits of mindfulness and partner acceptance on relationship satisfac-
tion extend from the individual to the partner through increased partner acceptance. Together, the results provide initial support
for the hypothesis that partner acceptance may be an important mechanism through which mindfulness promotes relationship
satisfaction in both partners of a romantic couple.

Keywords Trait mindfulness . Partner acceptance . Relationship satisfaction . Dyadic . Couples

Introduction 2004; Kozlowski 2013; for a meta-analysis see McGill et al.

2016; Pakenham and Samios 2013; Wachs and Cordova
An often recurring theme in both popular and scientific liter- 2007), yet, it is less clear how these benefits emerge
ature on mindfulness is that mindfulness may foster interper- (Karremans et al. 2017).
sonal connections by bringing open, non-judgmental attention Cultivating the quality of a romantic relationship can be
into the interactions with people around us (e.g., Brown et al. challenging, particularly because romantic partners are
2007; Grayson 2004). Yet, while empirical support for the seldomly perfect. When asked, more than 90% of people in
beneficial effects of mindfulness for individual well-being healthy, functioning romantic relationships report to have tried
and health is accumulating (see e.g., Baer 2003, Brown and to change at least one aspect of their partner that does not align
Ryan 2003, Keng et al. 2011), research investigating the in- with their ideal expectations (Overall et al. 2006). The term
terpersonal effects of mindfulness is still in its infancy. Initial Bpartner imperfection^ will be used here to refer to any kind of
empirical findings indicate that higher levels of trait mindful- partner behavior or trait that renders a partner less ideal in the
ness are generally associated with higher relationship satisfac- eyes of the individual, and every now and then may trigger
tion in romantic couples (Barnes et al. 2007; Carson et al. negative emotions such as irritation, disappointment, or anger.
Partner imperfections should be understood as relatively in-
nocuous partner behaviors that may occur in every relation-
* Gesa Kappen ship and are not inherently psychologically or physically dam-
[email protected] aging but can nevertheless lead to serious deterioration in
relationship quality (Cunningham et al. 2005).
1
Behavioural Science Institute, Radboud University Nijmegen, Despite the fact that partner imperfections are more rule
Postbus 9104, 6500 HE Nijmegen, the Netherlands than exception, people may be reluctant to accept that roman-
2
Faculty of Arts and Social Sciences, Sabanci University, Universite tic partners are imperfect. Indeed, research demonstrates that
Cad. No. 27 Tuzla, 34956 Istanbul, Turkey partners often try to change one another into the direction of a
 Mindfulness

personal romantic ideal (i.e., partner regulation; Overall et al. natural tendency to immerse themselves in such emotions,
2006). If successful, attempts to change a partner can contrib- which may further increase distress (e.g., Ciesla et al. 2012).
ute to both partners’ relationship satisfaction (Overall et al. Also, people low in trait mindfulness may control or suppress
2006). However, regulation attempts often do not lead to negative emotions, which usually increases emotional distress
change, and in fact may undermine relationship satisfaction (Hayes et al. 1996). As a result, partners who are less tolerant
for both partners (Overall et al. 2006). For example, unsuc- to experiencing such negative emotions in their relationship—
cessful partner regulation attempts increase the salience of the partners low in trait mindfulness—should have a stronger urge
imperfections, and the partner who is the target of change to change the partner, and be less accepting.
attempt may experience a lack of appreciation. Moreover, it In contrast, people high in trait mindfulness tend to be more
has been argued that the pressure of change diminishes a part- tolerant towards negative experiences, considering such expe-
ner’s autonomy and triggers reactance, thereby, paradoxically, riences as naturally fluctuating (Creswell et al. 2007; Hayes-
preventing change and causing distress (Cordova 2001; Skelton and Graham 2013). When encountering a partner im-
Jacobson et al. 2000; Sullivan and Davila 2014). Together, perfection—thus a situation in which the partner behaves in a
this suggests that often it is not the imperfection per se that way that does induce some irritation or anger—a person who
negatively affects the relationship, but rather the partner’s re- is mindfully attending to such emotions while realizing that
sponse of attempting to change the other which may cause they are impermanent, should feel less inclined to change the
relationship distress (Cunningham et al. 2005; Fincham partner (i.e., the Bsource^ of the negative emotions). Put dif-
2003, Fincham and Beach 1999). ferently, an individual high in trait mindfulness should find it
Instead of wanting to change a partner, couples may prof- easier to accept that the partner is not always perfect, and that
it from Bpartner acceptance,^ being able to accept that the the partner sometimes behaves in ways that trigger negative
partner also has less ideal characteristics. Partner accep- emotions. Based on this argumentation, it is conceivable that
tance was conceptualized here as the ability and willingness trait mindfulness should be positively associated with partner
to acknowledge potential imperfections of a partner without acceptance.
feeling the urge to change the partner (Karremans et al. This reasoning is in line with the rationale underlying cou-
2017). While the concept has received surprisingly little ple programs that integrate mindfulness-based exercises to
explicit attention in the empirical literature on relationships, reduce avoidance of negative experiences, and as such to in-
in clinical practice partner acceptance is part of various cou- crease acceptability of partner behaviors in distressed couples
ple therapy programs such as Integrative Behavioral Couple (e.g., see Fruzzetti and Iverson 2006; South et al. 2010).
Therapy (IBCT; Christensen et al. 1995), Acceptance and Moreover, there is some empirical support for the idea that
Commitment Therapy (ACT; Hayes et al. 1999), or the mindfulness promotes acceptance of a partner. Following a
Couple CARE program (Rogge et al. 2002). In these pro- mindfulness-training program for couples, Carson et al.
grams, couples work towards realizing that some incompat- (2004) found that partner acceptance and relationship satisfac-
ibilities or imperfections are inevitable and that distress of- tion increased from pre- to post-intervention. However, in
ten results from one’s own emotional reactions to incompat- addition to mindfulness exercises, the training contained var-
ibilities, rather than that incompatibilities are the inherently ious other elements of couple interventions, making it difficult
distressing factor. Some initial research findings suggest to conclude whether increases in mindfulness were driving the
that such acceptance-based programs (in particular IBCT) effect (Carson et al. 2007). In a qualitative study, Pruitt and
benefit relationships from pre- to post-treatment with equal McCollum (2010) found that mindfulness meditators reported
or even better relationship outcomes than classic, change- that, through their meditation, they had developed an
focused programs (e.g., traditional behavioral couple accepting attitude towards experiences in general, as well as
therapy; see Christensen et al. 2010; Jacobson et al. 2000). towards both their own and other people’s shortcomings.
Moreover, some findings suggest that the mechanism of These preliminary findings point to the potential of mindful-
relationship improvement in IBCT indeed increased accep- ness for fostering relationship quality and point to partner
tance of negative partner behaviors (Doss et al. 2005; South acceptance as a possible mechanism through which this may
et al. 2010). occur.
Whereas some couple therapy programs, such as ACT, rely Three studies were conducted to test the main prediction
strongly on mindfulness-based techniques to increase partner that, within the individual, trait mindfulness is positively as-
acceptance, there is very little previous research that has di- sociated with partner acceptance. Furthermore, partner accep-
rectly examined the association between (trait) mindfulness tance was expected to be positively related to relationship
and partner acceptance. How would mindfulness be related satisfaction and based on the theoretical rationale outlined
to partner acceptance? As noted, every now and then, partner above (see Fig. 1), it was examined whether partner accep-
imperfections may raise irritation, disappointment, or other tance mediated the association between trait mindfulness and
negative emotions. People low in trait mindfulness have a relationship satisfaction. Importantly, in Study 3, dyadic data
Mindfulness

Fig. 1 Path diagram showing conceptual model including the direct pathways tested, alphabetically named in the order in which they were tested and
described in the results section. The upper part of the model (gray) was tested in Studies 1 and 2. In Study 3, the whole conceptual model was tested

were examined in order to answer the question whether any 95% heterosexual (n = 180), 5% bisexual (n = 9), and 0.5%
potential beneficial effects of trait mindfulness may extend homosexual (n = 1). Of the complete sample, 44% (n = 85)
beyond the individual to the partner’s perception of being were married, 3 participants did not answer this question. For
accepted and relationship satisfaction. correlations between demographic variables and study
variables (see Table 1). Marital status had no influence on the
study variables. Gender was not associated with partner accep-
Study 1 tance, however, men were more satisfied with the relationship

Study 1 examined the intraindividual associations between Table 1 Means, standard deviations, and correlations Study 1 and
trait mindfulness, partner acceptance and relationship satisfac- Study 2
tion, and explored whether the link between trait mindfulness
Variable M SD 1 2 3 4
and relationship satisfaction was mediated via partner accep-
tance in a sample of participants who were romantically in- Study 1 (N = 190)
volved at the time of the study. 1. TM 3.60 0.57
2. PA 5.33 0.98 .35**
Method 3. RS 5.38 0.85 .32** .54**
4. Age 33.66 10.34 .22** .10 − .00
Participants 5. RL 8.50 8.45 .22** .14 .08 .70**
Study 2 (N = 140)
Amazon’s Mechanical Turk website was used for participant 1. TM 4.38 0.42
recruitment (MTurk; www.mturk.com). Of the original 224 2. PA 5.02 1.02 .23**
responders, 34 participants were excluded due to incomplete 3. RS 4.04 0.82 .33** .56**
or double responding, or failure to pass the control question 4. Age 35.07 11.27 .13 .11 − .20*
(BIf you read the instructions and if you are paying attention, 5. RL − .03 .16 − .06 .58**
please answer this question with 5 Totally Agree^). The final
sample consisted of 190 participants ranging in age from 18 to Note. TM = Trait Mindfulness, PA = Partner Acceptance, RS =
68 years (M = 33.66, SD = 10.34) with 50% being male. All Relationship Satisfaction, RL = Relationship Length in years; ** indi-
cates p < .01. M and SD are used to represent mean and standard devia-
participants had US citizenship and were involved in a tion, respectively.
romantic relationship with a minimum duration of 1 year, at In this study, relationship length was measured using four intervals
the time of the study (1–50 years, M = 8.5 years, SD = 8. ranging from less than one year to more than ten years. The majority of
45 years). In terms of sexual orientation, the sample was participants indicated a relationship length of 1-5 years.
 Mindfulness

(M = 5.51, SD = .66) than women (M = 5.25, SD = .99; t (146. partner responsiveness scale (Reis et al. in press) includes two
29) = 2.07, p = .04). items that are close to the conceptualization of the present re-
Data had been collected in a larger project for the purpose of search (BI esteem my partner, shortcomings and all^ and BI value
which participants had been recruited with and without medita- and respect the whole package that is my partner’s real self^) but
tion experience based on self-selection (BDo you have experi- the concept of responsiveness is broader, targeting receptiveness
ence with practicing meditation? Yes/No^). Of the final sample, to a partner’s fundamental needs, thoughts and feelings (Reis
84 participants reported some experience with meditation and 2014). A two-item measure of partner acceptance by Carson
106 participants did not. They were equal on all demographic et al. (2004) closely matches the present conceptualization
variables. Regarding our variables of interest, meditators scored (e.g., BConsidering characteristics of your partner, or your rela-
higher on trait mindfulness (M = 3.71, SD = 0.56) than non- tionship, which you find difficult to deal with, over the last 2
meditators (M = 3.51, SD = 0.56, t (188) = 2.40, p = .02). months, how easy has it been for you to stop struggling and just
People with meditation experience were slightly more satisfied allow such things to be?^) but aims at change in acceptance due
in the relationship, M = 5.51, SD = .65 than people without med- to a mindfulness intervention, which makes it unsuitable for
itation experience, M = 5.27, SD = .97; t (183.68) = 2.05, p = .04. cross-sectional data collection. Furthermore, the Frequency and
Acceptability of Partner Behavior Scale (Doss and Christensen
Procedure 2006) measures the frequency and acceptability of a predefined
set of behaviors, mainly for identifying problem areas in the
Data were collected by means of online self-report question- relationship for clinical purposes.
naires, hosted by the online survey platform Qualtrics (www. To capture the idiosyncratic nature of what is considered im-
qualtrics.com). Participants first read the informed consent perfect or less than ideal in a partner, a more general measure of
page, assuring anonymity and confidentiality of data partner acceptance was developed. With five items, this scale
processing and the voluntary nature of participation. measured to what extent the participant acknowledged his/her
Participants were explicitly instructed not to fill in the partner’s imperfections without feeling the urge to change these.
questionnaire together with their partners. Completion of the Examples of positive and negative items are respectively BI can
questionnaires took approximately 30 min. Participants accept the less positive characteristics of my partner^ and BI try
completed the study in exchange for 4 US dollars. Data of all to change the things which I do not like about my partner,^
three studies were derived from larger projects. All measures reverse scored. Participants rated these items on a Likert scale
used and sequences of presentation can be found in the online from 1 (totally disagree) to 7 (totally agree). To check whether
material. this partner acceptance scale measured a construct that was sep-
arate from the general concept of relationship satisfaction, a fac-
Measures tor analyses was conducted on all items of both scales. Initial
analyses identified two factors with eigenvalues > Kaiser’s crite-
Trait Mindfulness Trait mindfulness was assessed with the 24- rion of 1 for all three samples, in combination explaining 51–
item version of the Five Facet Mindfulness Questionnaire 57% of the variance, scree plots showed inflexions pointing to
(FFMQ; Bohlmeijer et al. 2011). The FFMQ covers five facets two components. From subsequent factor analyses with oblique
that have been identified as the main building blocks of trait rotation, retaining 2 factors, item clustering suggested acceptance
mindfulness: observing (BGenerally, I pay attention to sounds, and satisfaction to be two separate components for Study 3. For
such as clocks ticking, birds chirping, or cars passing,^) describ- Studies 1 and 2 cross loadings were found for two items of the
ing (BI’m good at finding words to describe my feelings,^) acting original acceptance scale (item 1 BI appreciate my partner just the
with awareness (BI rush through activities without being really way he/she is with all his/her positive and negative aspects^;
attentive to them,^ reverse coded), accepting without judgment item 4 BI can accept the less pleasant characteristics of my
(BI think some of my emotions are bad or inappropriate and I partner^). After considering the content of the items, item 1
shouldn’t feel them,^ reverse coded), and non-reactivity (BWhen was removed from the scale. Notably, including the item re-
I have distressing thoughts or images, I don’t let myself be car- vealed very similar results across the three studies. The scale
ried away by them^). Respondents rated different experiences on has shown adequate reliability in pilot studies (αs > .70;
a Likert scale from 1 (never or rarely true) to 5 (often or always Kappen 2014a, 2014b) and in the present study, α = .71. The full
true). Reliability was good, α = .92. Responses on all items were 5-item scale can be found in the Appendix. Scores on all items
averaged to form an overall indicator of level of trait were averaged to create an index of partner acceptance.
mindfulness.
Relationship Satisfaction Relationship satisfaction was mea-
Partner Acceptance Existing measures of partner acceptance did sured with the Relationship Assessment Scale (Hendrick et al.
either not cover the conceptualization of the present research or 1998; 7 items, e.g., BHow well does your partner meet your
had been developed for diagnostic purposes. For example, the needs?^ and BIn general, how satisfied are you with your
Mindfulness

relationship?^). Participants indicated how much statements significant values stayed almost identical to the values attained
were applicable to them on a 5-point Likert scale ranging from by the uncontrolled models and are therefore not reported.
1 (low) to 5 (high). Reliability was good, α = .89. Scores on all Notably, we also found support for the alternative mediation
items were averaged to create an index of relationship satisfac- models (find an overview of alternative models across all studies
tion. in the online material). Testing every variable in the role of in-
dependent, dependent and mediating variable, we found support
Data Analysis for the following models: mindfulness → satisfaction → accep-
tance; satisfaction → acceptance → mindfulness; acceptance →
First, the correlations between the three variables of interest were satisfaction → mindfulness; satisfaction → mindfulness → ac-
tested. Mediation was tested using the lavaan package (Rosseel ceptance; acceptance → mindfulness → satisfaction. This sug-
2012) in the R statistical program (R Development Core Team gests that trait mindfulness, relationship satisfaction and partner
2008): A simple regression model including only trait mindful- acceptance may be related in a multidirectional way. In the
ness as a predictor for relationship satisfaction was run first, BDiscussion^, we return to this issue.
followed by a mediation model including trait mindfulness as a
predictor and partner acceptance as a mediator. Unstandardized
path coefficients, bootstrapped standard errors and 95% confi- Study 2
dence intervals based on bias-corrected bootstrapping are report-
ed for all direct and indirect effects (MacKinnon et al. 2004). The The findings of Study 1 provided encouraging support in line
proportion of the effect that was mediated was calculated by with the main prediction that trait mindfulness is positively
dividing the indirect effect from the mediation model by the total associated with partner acceptance within the individual.
effect from the simple model. Study 2 was an attempt to replicate these findings in another
sample of participants.
Results
Method
Table 1 summarizes the correlations and the descriptives of the
key study variables. Correlation analyses supported a positive Participants
relationship between the three variables of interest: (a) there was
a positive association between levels of trait mindfulness and Recruitment was done in a similar way to Study 1, again using
partner acceptance, (b) there was a positive association between MTurk. Of the original 148 responders, eight participants were
partner acceptance and relationship satisfaction, and (c) trait excluded due to incomplete responding or failing to pass the
mindfulness was positively related to relationship satisfaction. control question. The final sample consisted of 140 participants
The simple regression model showed that trait mindfulness ranging in age from 19 to 66 years (M = 35.07, SD = 11.27) with
had a significant direct effect on relationship satisfaction (b = .49, 49% being male. All participants had US citizenship and were in
SE = .10; 95% CIs [.30, .69]). The model including the mediator a romantic relationship. Sexual orientation was not assessed. Of
showed that participants with higher levels of trait mindfulness the whole sample, 8% had been in a relationship for less than a
scored higher on partner acceptance (b = .61, SE = .14, 95% CIs year, 45% had been in a relationship for 1 to 5 years, 16% had
[.31, .86]); participants scoring higher on partner acceptance been in a relationship for 5 to 10 years, 29% had been in a
were more satisfied in their relationship (b = .42, SE = .07, 95% relationship for ten or more years, and 2% did not provide this
CIs [.29, .56]); and partner acceptance indirectly explained the information. Of the complete sample, 62% (n = 86) were mar-
association between trait mindfulness and relationship satisfac- ried. For correlations between demographic variables and study
tion (b = .25, SE = .07, 95% CIs [.12, .42]). Including the medi- variables (see Table 1). Marital status and gender had no influ-
ator increased the amount of explained variance in satisfaction ence on the study variables. Similarly as in Study 1, participants
from 11 to 31%. The direct effect of mindfulness on relationship were asked to report on their meditation experience. Those who
satisfaction remained statistically significant (b = .23, SE = .08, reported meditation experience (21%) scored slightly higher on
95% CIs [.08, .37]), indicating that partner acceptance partially trait mindfulness (M = 4.53, SD = 0.39) than did non-meditators
mediated the association between mindfulness and relationship (M = 4.35, SD = 0.42; t (135) = 2.15, p = .03), but no effects of
satisfaction. The mediator explained 51% of the total effect (see meditation experience on partner acceptance and relationship
Fig. 2 for an overview of regression coefficients for the simple satisfaction were found.
mediation for studies 1 through 3).
To rule out potential third-variable explanations, the model Procedure
was also tested controlling for variables that were related to the
main variables (in this study, gender and meditation experience The procedure of Study 2 was similar to Study 1, with one
were related to relationship satisfaction). Coefficients and exception. Instead of using the short-version of the FFMQ,
 Mindfulness

Fig. 2 Path diagram showing the

mediation mindfulness → partner Partner
acceptance → relationship .61*** Acceptance .42***
satisfaction as tested in all three .56* .41***
studies, including path .49*** .47**
coefficients from Studies 1
through 3 from top to bottom;
***p < 0.001, **p < 0.01,
*p < .05 Relationship
Mindfulness
Satisfaction
.49*** (.23**)
.64*** (.41**)
.19 (-.03)

trait mindfulness was now measured with the full 39-item indirectly explained by relationship satisfaction (mindfulness
version of the FFMQ (Baer et al. 2006; Baer et al. 2008; → satisfaction → acceptance; acceptance → satisfaction →
α = .86). Measures for partner acceptance (α = .73) and rela- mindfulness). Again, this may point to multidirectional asso-
tionship satisfaction (α = .91) were the same as the ones in ciations between the variables of interest.
Study 1.

Data Analysis
Study 3
Data were analyzed as in Study 1.
Studies 1 and 2 provided initial support in line with the primary
hypothesis: within the individual, mindfulness was positively
Results associated with partner acceptance, and results supported that
partner acceptance was in turn associated with relationship satis-
Correlations were similar to those found in Study 1 (see faction. The goal of Study 3 was twofold. First, in addition to
Table 1). Thus, again, we found support for our main pre- replicating the results of Studies 1 and 2, the aim was to examine
diction that trait mindfulness is positively association with whether trait mindfulness in one partner (partner A) affects rela-
partner acceptance. Moreover, a mediation analysis again tionship satisfaction of the other partner (partner B). Relationship
supported the hypothesis that partner acceptance mediates quality is a result of a dyadic process in which behaviors of one
the association between trait mindfulness and relationship partner are perceived by the other, which affect the other’s re-
satisfaction. The simple regression model showed that trait sponse, which again is perceived by the first partner, and so forth
mindfulness had a significant direct effect on relationship (e.g., Wieselquist et al. 1999). For example, literature on partner
satisfaction (b = .64, SE = .16; 95% CIs [.28, .91]). A model support indicates that a person’s supportive behavior benefits the
including the mediator showed that trait mindfulness was partner because the partner perceives the behavior as supportive
positively related to partner acceptance (b = .56, SE = .24, (Lemay et al. 2007). Research on the role of mindfulness in
95% CIs [.11, 1.05]); partner acceptance was positively re- romantic relationships has paid very little attention to this notion,
lated to relationship satisfaction (b = .41, SE = .08, 95% CIs and there are only a few studies that have examined whether a
[.24, .56]) and indirectly explained the association between person’s level of mindfulness is associated with the partner’s
trait mindfulness and relationship satisfaction (b = .23, experiences in the relationship (e.g., Barnes et al. 2007; Iida
SE = .11, 95% CIs [.06, .51]). Including the mediator in- and Shapiro 2017; Pakenham and Samios 2013; Karremans
creased the amount of explained variance in satisfaction from et al. 2017; Williams and Cano 2014). Drawing on this idea, in
11 to 35%. The mediator explained 36% of the total effect. addition to the association between levels of trait mindfulness
The direct effect of mindfulness on relationship satisfaction and partner acceptance within one partner (partner A), in Study
remained statistically significant (b = .41, SE = .16, 95% CIs 3, partner A’s level of mindfulness was expected to be related to
[.12, .73]), indicating that partner acceptance partially medi- partner B’s relationship satisfaction (path d in Fig. 1), through
ated the association between mindfulness and relationship partner A’s partner acceptance and partner B’s level of perceived
satisfaction. The model was also tested controlling for vari- acceptance (a × g × h; see Fig. 1).
ables that were related to the main variables (in this study, Second, in Study 3, these predictions were examined in a
age was related to relationship satisfaction), which produced sample of participants who had at least some degree of formal
almost identical results. training in mindfulness (i.e., had previously followed or were
As in Study 1, we checked alternative mediation models currently following the mindfulness-based stress reduction
and found support for the two models, in which the associa- training). There is some debate about the validity of self-
tion between trait mindfulness and partner acceptance was report mindfulness measures (see for example Bergomi et al.
Mindfulness

2013; Grossman 2011). In particular, some have argued that a 49, SDB = 12.42, t (104) = − .772, p = .44). Couples had been
certain level of experience with mindfulness (training) is a pre- together for 21.43 years on average (0–47, SD = 13.63). Of
requisite for identifying one’s own state of mindfulness, and the complete sample, 60% (n = 70) were married. For correla-
respond to these questionnaires in a valid manner (for an tions between demographic and study variables, see Table 2.
extensive discussion, see Bergomi et al. 2013). Also, previous Marital status had no influence on the study variables for neither
research has found differential item functioning in samples with partner As nor partner Bs. Within partner As, gender was asso-
and without mindfulness experience, indicating that responses ciated with higher relationship satisfaction in men (M = 5.56,
are influenced by different biases or demands (Van Dam et al. SD = .77) as compared to women (M = 5.09, SD = 1.43; t (58.
2009; but see Baer et al. 2010). Hence, Study 3 was conducted in 80) = 2.15, p = .04). Within partner Bs, participants with medita-
a sample of mindfulness trainees, their level of trait mindfulness tion experience reported lower relationship satisfaction (M = 4.
and partner acceptance was measured, and it was explored 52, SD = 1.65) than participants without meditation experience
whether these factors in turn affected perceived acceptance and (M = 5.71, SD = .93; t (51) = − 3.25, p < .01), though this might
relationship satisfaction in the partner. be due to the small number of partner Bs with meditation
experience.
Method
Procedure
Participants
Partner A and B filled in similar questionnaires with the excep-
As part of a larger study, 402 accredited mindfulness trainers tion that partner B reported perceived partner acceptance, and not
were approached with the request to share a survey with their partner acceptance. Once partner A had completed the question-
trainees. Trainers’ contact information was derived from two naire, a link to the questionnaire was sent to partner B. In the
Dutch mindfulness websites (www.instituutvoormindfulness.nl instructions, participants were explicitly asked not to fill in the
and www.vmbn.nl). Thirty-eight trainers distributed the study surveys together or discuss their responses with their partner
link among their trainees. Ten book vouchers of 50 euro each before both had finished the survey.
were raffled among the participants. Thirty-two participants were
excluded from the analyses due to missing data (only filled in Measures
their identification codes) and 5 for not meeting the requirements
for entering the study (i.e., having finished or being currently Trait Mindfulness Trait mindfulness was assessed with the 24-
involved in a mindfulness training). The final sample consisted item version of the FFMQ (Bohlmeijer et al. 2011; in the pres-
of 118 mindfulness trainees (i.e., partner A) and 53 matching ent study, α = .91). Respondents rated different experiences on
partners (partner B), among which one same-sex couple. a 7-point Likert scale from 1 (never or rarely true) to 7 (often or
Among partner As, 85% (n = 100) completed a mindfulness always true). In the present study only partner A’s trait mind-
training in the past and 15% (n = 18) were following a training fulness was analyzed for two reasons. First, as mentioned, the
at the moment when the study took place. Among partner Bs, main goal of the present study was to replicate the findings found
12% (n = 12) had followed a mindfulness training in the past and in Studies 1 and 2 in a sample of participants with mindfulness
2% (n = 2) were currently following it. Partner A and B did not experience. Second, in line with the model to be tested (Fig. 1),
differ in age (22–76 years, MA = 48.70, SDA = 11.48; MB = 50. partner Bs only provided information on their perceived partner

Table 2 Means, standard

deviations, and correlations, Variable M SD 1 2 3 4 5 6 7
Study 3
1. TMA 5.00 0.83
2. PAA 5.15 0.99 .41**
3. RSA 5.18 1.34 .13 .34**
4. PPAA 4.95 1.22 .27 .54** .43**
5. RSB 5.42 1.25 .05 .44** .65** .43**
6. AgeA 48.69 10.91 .35** .07 − .09 − .03 − .18
7. AgeB 49.85 12.68 .29* .08 .02 − .00 − .12 .96**
8. RL 20.39 13.24 .10 − .03 − .10 − .04 − .16 .66** .64**

nA = 53; nB = 53; TM trait mindfulness, PA partner acceptance, PPA perceived partner acceptance, RS relationship
satisfaction, RL relationship length in years; Subscripts of A and B denote measures as assessed in partner A and
B, respectively
**p < .01. M and SD are used to represent mean and standard deviation, respectively
 Mindfulness

acceptance, not their partner acceptance scores (this was also and (b) there was a positive correlation between partner ac-
partly motivated by practical reasons, restricting the number of ceptance and relationship satisfaction within partner A.
measures participants had to complete). However, although in the expected direction (r = .13), unlike
Studies 1 and 2 trait mindfulness was not significantly corre-
Partner Acceptance Partner A (i.e., the mindfulness trainee) lated with self-reports of relationship satisfaction (c). The sim-
completed the partner acceptance scale as in Studies 1 and 2, ple regression model showed that trait mindfulness did not
reliability was not ideal in this sample (α = .62), though all items have a significant direct effect on relationship satisfaction
contributed to internal consistency. Partner B completed an ad- (b = .19, SE = .13; 95% CIs [− .07, .46]). A significant direct
justed version of this scale, using the same items but worded effect between a predictor and an outcome is not a necessary
differently to asses perceived acceptance (e.g., BMy partner tries precondition to test mediation (Hayes 2009) as it may be the
to change the things he/she doesn’t like about me^, BMy partner result of several mediator variables acting in opposite direc-
can accept my less pleasant characteristics^). Reliability was tions, canceling each other out. Therefore, as recommended
very good, α = .84. by Hayes (2009), the product of paths (a) and (b) were esti-
mated, using bootstrapping. In the following, such an effect
Relationship Satisfaction Relationship satisfaction was will be referred to as an Bindirect effect^ (Hayes 2009).
assessed with 5 items from the Investment Model scale A model including partner acceptance supported that mind-
(Rusbult, Martz, & Agnew, 1998; e.g., BI feel satisfied in fulness indirectly affected relationship satisfaction via partner
our relationship^; α = .92). Participants indicated to what ex- acceptance. Specifically, trait mindfulness was positively re-
tent they agreed with the statements on a 7-point Likert scale lated to partner acceptance (b = .49, SE = .10; 95% CIs [.31,
ranging from 1 (disagree) to 7 (completely agree). 69]); partner acceptance was positively related to relationship
satisfaction (b = .47, SE = .15, 95% CIs [.16, .77]); and indi-
Data Analysis rectly explained the association between trait mindfulness and
relationship satisfaction (b = .23, SE = .09, 95% CIs [.08,
First, the same mediation model was tested as in Studies 1 and .44]). Including partner acceptance increased the amount of
2, using only complete data from partner As (n = 105). Then, explained variance in satisfaction from 2 to 13%.Thus, al-
the dyadic predictions were tested (Fig. 1) including only cou- though the direct effect between mindfulness and relationship
ples for which complete data had been collected (53 partners A satisfaction was not significant in this study, the indirect effect
and 53 matching partners B) with the Lavaan package (Rosseel from mindfulness to relationship satisfaction through partner
2012) in the R statistical program (R Development Core Team acceptance was similar to the effects obtained in Studies 1 and
2008). To take interdependence between partners into account, 2, and consistent with our main hypothesis. The model was
the model adjusted for correlations between partner reports of also tested controlling for variables that were related to our
relationship satisfaction. Unstandardized path coefficients, main variables (in this study, gender was related to relation-
bootstrapped standard errors and 95% confidence intervals ship satisfaction), which produced almost identical results.
based on bias-corrected bootstrapping are reported for all direct As in Studies 1 and 2, we tested all alternative mediation
and indirect effects (MacKinnon et al. 2004). models within partner As and found support for one alterna-
Important to note: Using only the 53 couples that provided tive model in which relationship satisfaction was indirectly
complete data is limited, for example, because the sample may associated with mindfulness via partner acceptance (relation-
be biased (e.g., partners who did not complete the questionnaire ship satisfaction → partner acceptance → mindfulness).
may be less satisfied with the relationship than partner who did Again, this may point to multidirectional associations between
complete the questionnaire). The main analyses were therefore the variables of interest.
repeated using data from all couples (n = 118 partner As and 53
partner Bs) to estimate the parameters of the model, using full- Mediation Analyses with Dyadic Data
information maximum likelihood estimation (see for details of
this procedure, Allison 2012). Correlations suggested that Mindfulness of partner A was not
directly associated with partner reports (partner B) of relation-
Results ship satisfaction (d), but it was significantly positively associ-
ated with perceived partner acceptance (e). Partner acceptance
Mediation Analyses within Partner As of partner A was positively related to relationship satisfaction
of partner B (f) and to partner B’s perceived acceptance (g).
Table 2 summarizes the correlations among and the descrip- Partner B’s perceived partner acceptance was positively relat-
tive statistics of the key study variables. Supporting the find- ed to partner B’s relationship satisfaction (h). Thus, in sum,
ings from Studies 1 and 2, (a) there was a positive correlation these initial analyses indicate that partner A’s mindfulness
between levels of trait mindfulness and partner acceptance, again was positively associated with partner A’s partner
Mindfulness

acceptance, and also, that partner B felt more accepted to the to partner B’s relationship satisfaction (d) was not significant
extent that partner A was higher in mindfulness. (b = − .28, SE = .19, 95% CIs [− .69, .04]), there was a signifi-
Next, we included the paths as depicted in Fig. 1 into an cant indirect path from partner A’s mindfulness to partner A’s
overall path analysis. Goodness of fit indices collectively indi- partner acceptance, to partner B’s relationship satisfaction, (a × f;
cated the estimated model did not fit the observed data χ2(1) = b = .28, SE = .14, 95% CIs [.04, .26]). The expected complete
2.78, p = .096, Comparative Fit Index (CFI) = .976, Tucker- indirect path from partner A’s mindfulness to partner B’s satis-
Lewis Index (TLI) = .763, and root mean square error of approx- faction via partner acceptance and perceived acceptance was not
imation (RMSEA) = .183. In order to improve the model fit, the significant (b × g × h; b = .06, SE = .05, 95% CIs [− .02, .22])
direct path from Partner A’s mindfulness to Partner B’s per- (see Fig. 3 for an overview of path coefficients of the final
ceived acceptance (path e) was removed from the model. This model).
adjustment led to an improved model fit, χ2(2) = 2.79, p = .248, A model controlling for demographic variables that were
CFI = .989, TLI = .947, RMSEA = .086. In this combined mod- significantly associated with our main variables (in this study,
el, participants with higher levels of trait mindfulness scored age of partner Awas related to A’s relationship satisfaction and
higher on partner acceptance (a; b = .51, SE = .12, 95% CIs meditation experience of partner B was related to B’s relation-
[.26, .73]); participants scoring higher on partner acceptance ship satisfaction) produced almost identical results.
were more satisfied in their relationship (b; b = .78, SE = .20, As noted, we re-ran the main analyses using full-
95% CIs [.36, 1.18]); and there was an indirect association be- information maximum likelihood estimation to impute values
tween trait mindfulness and relationship satisfaction via partner for the additional 65 partner Bs with missing values on at least
acceptance (a × b; b = .40, SE = .14, 95% CIs [.17, .69]). one of the study measures. A very similar pattern of results
However, as in the simple model and in the correlation analyses, was obtained, with the only difference that the indirect path-
the direct effect from partner A’s mindfulness to partner A’s own way from partner A’s mindfulness to partner B’s relationship
relationship satisfaction (c) was non-significant (b = − .28, satisfaction via partner A’s partner acceptance became non-
SE = .19, 95% CIs [− .69, .04]). Is partner A’s mindfulness as- significant (a × f; b = .20, SE = .12, 95% CIs [− .003, .45]).
sociated with similar outcomes in partner B? First of all, partner
A’s acceptance was associated with partner B’s relationship sat-
isfaction (f; b = .55, SE = .24, 95% CIs [.06 to .98]). Partner A’s Discussion
partner acceptance was associated with perceived acceptance in
partner B (g; b = .65, SE = .13, 95% CIs [.34 to .89]). Unlike the The present findings indicate that trait mindfulness is related
correlation analyses, in this combined model, partner B’s per- to an accepting stance towards a romantic partner’s shortcom-
ceived acceptance was not associated with partner B’s relation- ings. Data from all three studies returned a positive relation-
ship satisfaction, (h; b = .17, SE = .15, 95% CIs [− .10 to .50]). ship between trait mindfulness and partner acceptance, which
Finally, although the direct effect from partner A’s mindfulness in turn was associated with relationship satisfaction, both in

Fig. 3 Final model, showing path coefficients of direct paths, Study 3

 Mindfulness

participants without and with formal mindfulness training. and high on non-judgment (classified as Non-Judgmentally
Study 3 provided some initial evidence that trait mindfulness Aware), and others may have high scores across the whole
of one partner can have beneficial outcomes for the other range of facets (High Mindfulness). They found that such
partner, in that mindfulness in partner A was associated with classes of mindfulness as measured with the FFMQ were
more partner acceptance, which was indirectly associated differentially related to anxious and avoidant attachment. In
with higher levels of relationship satisfaction in partner B line with the notion that awareness of experiences in combi-
(partner A’s levels of mindfulness were not directly associated nation with a non-judging stance towards those experiences
to partner B’s levels of relationship satisfaction). Partner B are both intrinsic aspects of mindfulness, it is conceivable
also felt more accepted to the extent that partner A was higher that scoring high on all facets would be the profile where
in trait mindfulness. Together the results provide initial sup- the level of partner acceptance is highest. Indeed, Kimmes
port for the hypothesis that mindfulness is associated with et al. (2017), found that scoring high across all facets was
partner acceptance, and that this may be an important mech- most strongly related to benign attributions for partner trans-
anism through which mindfulness promotes relationship gressions. Nevertheless, future research should further exam-
satisfaction. ine the specific working mechanisms of mindfulness, and
These findings are in line with the general reasoning that which specific (but not isolated) ingredients of mindfulness,
approaching experiences in a mindful, non-judgmental man- promote partner acceptance, and relationship satisfaction.
ner may generalize to how partners cope with negative emo-
tions that are triggered by a partner’s negative behavior or Strengths, Limitations, and Future Directions
characteristic. Moreover, whereas the link between mindful-
ness and relationship satisfaction has been supported by sev- There are several notable strengths of this research. The pres-
eral studies (for a meta-analysis see McGill et al. 2016), only ent research explicitly investigated the role of partner accep-
little research has been conducted to examine the possible tance as a mechanism that may underlie the association be-
underlying mechanisms. While there certainly may be other tween mindfulness and relationship satisfaction. For the pur-
factors at play (see for an overview Karremans et al. 2017), pose of this research, a questionnaire was composed for the
the present findings indicate that partner acceptance may be assessment of partner acceptance that has strong face validity,
an important process by which mindfulness may promote revealed overall good reliability, and hence seems a suitable
relationship satisfaction. Importantly, the present data pro- measure for further exploration of this topic. Also, the find-
vide some evidence indicating that the effects of mindfulness ings were consistent and fairly robust across studies (see the
in one partner operate at the level of the dyad via partner online materials for an overview of correlations between trait
acceptance, suggesting that effects of mindfulness can extend mindfulness, partner acceptance and relationship satisfaction
beyond the individual (e.g., Pakenham and Samios 2013). as found in additional, unpublished projects). Moreover,
While beneficial effects of mindfulness for the individual Study 3 is one of the few studies to approach the interper-
have been studied extensively, the present findings contribute sonal effects of mindfulness from a dyadic perspective (for
to the emerging but young literature on the potential inter- notable exceptions, see Barnes et al. 2007; Iida and Shapiro
personal benefits of mindfulness. 2017; Pakenham and Samios 2013; Schellekens et al. 2017;
In the present studies, scores across all five facets of the Williams and Cano 2014). Because partners in a relationship
FFMQ were used as a measure for trait mindfulness, based on are by definition interdependent, meaning that one partner’s
the idea that the facets together represent the best index of traits and behaviors affect the other partner’s outcomes (and
dispositional mindfulness (e.g., Hertz et al. 2015; Jones et al. vice versa), understanding the effects of mindfulness at the
2011). While there is some ambiguity in the literature about level of the relationship ultimately requires taking both part-
what is the best way to use the FFMQ, some researchers have ners into account (see Karremans et al. 2017, for an extensive
argued that it is helpful to explore the role of the separate discussion).
facets (Baer et al. 2006). However, no a priori predictions However, a number of limitations should be discussed.
about the possible differential roles of the mindfulness facets First, an important limitation is that the conclusions are based
in affecting partner acceptance had been formulated prior to on participants’ self-reported level of mindfulness. For exam-
conducting the present research, and the sample sizes of the ple, it has been debated whether a person can have good
studies are not ideal to include all facets separately in the insight into their own (especially low) levels of mindfulness
models that were tested. (Grossman and Van Dam 2011), and studies have shown that
Relatedly, Kimmes et al. (2017) recently proposed yet some items may be interpreted differently depending on par-
another approach, which is to examine different latent pro- ticipants’ meditation experience (Gu et al. 2016; Bergomi
files of the FFMQ. For example, some people may score et al. 2013). Thus, in future research, it is important to ex-
high on observing and low on non-judgment (classified as amine the effects of mindfulness training and how it might
Judgmentally Observing), others score high on awareness affect partner acceptance and satisfaction. Second, it remains
Mindfulness

an open question as to what extent the present findings are 2013). Mindfulness may therefore help people to recognize
generalizable to the general population, as there may have automatic or unconscious tendencies to justify a partner’s be-
been sample biases. Studies 1 and 2 were based on MTurk havior, which can occur in the face of abuse (e.g., Rusbult and
participants, and in Study 3 (MBSR trainees) participants Martz 1995). An interesting question would therefore be
knew that the study concerned mindfulness and participants whether mindfulness may in fact help partners to stop
probably have positive attitudes towards mindfulness. Third, accepting severe negative partner behaviors and decide that
given the cross-sectional nature of the present findings, it ending the relationship might be the better option. Related to
remains an empirical question whether the observed associa- this issue, it is not clear whether partner acceptance always
tion between trait mindfulness and partner acceptance trans- promotes relationship satisfaction. For example, accepting a
lates into everyday interactions between partners. For exam- partner’s shortcoming may result in continuation of the be-
ple, earlier studies have found that levels of trait mindfulness havior, while sometimes a lack of acceptance may be required
do not necessarily predict levels of state mindfulness (Bravo to motivate a partner to behave differently and improve the
et al. 2017). Future studies should address the question relationship (cf. Luchies et al. 2010; McNulty and Fincham
whether a mindful state fosters acceptance of a partner’s 2012). Put differently, there may be a thin line between partner
less-than-perfect behavior in daily life situations, using daily acceptance (which would promote relationship satisfaction)
diaries or experience sampling methods. and resignation (which would hurt relationships). These ques-
Fourth, and perhaps most importantly, the present stud- tions are particularly important for the informed integration of
ies were correlational and cross-sectional, and thus do not mindfulness-based techniques into couple interventions.
provide evidence for causality. It is important for future Whereas these techniques are already widely used in this con-
research to examine the relationship among mindfulness, text, scientific investigation into the effectiveness and bound-
partner acceptance, and satisfaction experimentally and/or ary conditions of mindfulness interventions and partner ac-
longitudinally to unravel causality and potential feedback ceptance is lacking. More scientific work is needed to clarify
loops between these variables. Across the studies, results if and under which conditions mindfulness-based techniques
did not only support a model in which partner acceptance can be used to support individual and relationship well-being
explains the association between trait mindfulness and re- in the context of romantic relationships.
lationship satisfaction (this was the most consistent signif- The current research focused on the role of partner acceptance,
icant model across the three studies), but also models in but there may be various additional processes through which
which relationship satisfaction explains the relationship mindfulness may contribute to relationship satisfaction (for a
between trait mindfulness and partner acceptance detailed discussion, see Karremans et al. 2017). For example,
(Studies 1 and 2), in which trait mindfulness explains the (the training of) mindfulness has been associated with basic cog-
relationship between partner acceptance and relationship nitive skills like executive control and emotion regulation that
satisfaction (Study 1), and in which satisfaction was indi- benefit romantic relationship functioning (Chambers et al. 2009;
rectly associated with mindfulness via partner acceptance Goldin and Gross 2010; Teper and Inzlicht 2013). Moreover,
(Study 3). Although these findings do not necessarily un- there is some support that mindfulness promotes access to other-
dermine the validity of the predicted model, they may wise implicit negative feelings and emotions (e.g., Brown and
point to the potential reciprocal nature of the associations Ryan 2003), which may help partners to better regulate those
between these variables. Aside from the proposed model, feelings rather than to act upon them in an automatic fashion.
an accepting attitude towards a partner may also make it Finally, mindfulness has been associated with relationship-
easier for people to stay mindful and satisfied, and high enhancing factors like empathy, compassion, and secure attach-
satisfaction may facilitate mindfulness and partner accep- ment (Birnie et al. 2010; Hertz et al. 2015). Future research should
tance. Also at the dyadic level, partners’ levels of accep- further explore how these different processes, separately or in
tance may mutually reinforce each other and more satisfy- interaction, explain the link between mindfulness and romantic
ing relationships may promote levels of mindfulness and relationship satisfaction. Hopefully, the current findings provide a
partner acceptance in both partners. Future experimental springboard to study such additional questions.
and longitudinal studies should disentangle these various
possible effects. Acknowledgements Completion of these studies would not have been
possible without the help of our research assistants Isabel ten Bokkel,
In addition to these limitations, the present findings present
Gaia Mori, Christiane Paßen, Marieke Roelofs, and Sven van As.
various possibilities for future avenues. An important general
question is whether there are certain boundary conditions that
qualify the present findings. For example, does mindfulness Author Contributions GK designed and executed the studies, analyzed the
data, and wrote the paper. JK co-developed the hypothesized model and
always promote partner acceptance? Research has shown that
study design, consulted on the execution of the studies, and assisted in
mindfulness may improve people’s ability to become aware of writing the paper. WB analyzed the data and gave statistical advice. ABT
otherwise implicit processes (Brown and Ryan 2003; Carlson gave statistical advice and collaborated in editing the final manuscript.
 Mindfulness

Data Availability Statement Additional online material can be found on Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L.
the Open Science Framework: osf.io/8apa6/. Data can be obtained from (2006). Using self-report assessment methods to explore facets of
the first author on request. mindfulness. Assessment, 13, 27–45.
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer,
S., et al. (2008). Construct validity of the Five Facet Mindfulness
Compliance with Ethical Standards Questionnaire in meditating and nonmeditating samples.
Assessment, 15, 329–342.
Conflict of Interest The authors declare that they have no conflict of Baer, R. A., Samuel, D. B., & Lykins, E. L. (2010). Differential item
interest. functioning on the Five Facet Mindfulness Questionnaire is minimal
in demographically matched meditators and nonmeditators.
Ethical Standards All procedures performed were in accordance with Assessment, 18, 3–10.
the ethical standards of the research committee of the Behavioral Science Barnes, S., Brown, K. W., Krusemark, E., Campbell, W. K., & Rogge, R.
Institute of Radboud University. For this type of study, formal consent D. (2007). The role of mindfulness in romantic relationship satisfac-
was not required. Informed consent was obtained from all participants tion and responses to relationship stress. Journal of Marital and
before participation. Family Therapy, 33, 482–500.
Bergomi, C., Tschacher, W., & Kupper, Z. (2013). The assessment of
Appendix mindfulness with self-report measures: Existing scales and open
issues. Mindfulness, 4, 191–202.
Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-
Partner Acceptance Scale compassion and empathy in the context of mindfulness-based stress
reduction (MBSR). Stress and Health, 26, 359–371.
The Partner Acceptance Scale is a 5-item scale measuring to Bohlmeijer, E., Peter, M., Fledderus, M., Veehof, M., & Baer, R. (2011).
what extent the respondent acknowledges his/her partner’s Psychometric properties of the five facet mindfulness questionnaire
in depressed adults and development of a short form. Assessment,
imperfections without feeling the urge to change them. Items 18, 308–320.
1, 4, and 5 should be reverse coded. Bravo, A. J., Pearson, M. R., Wilson, A. D., & Witkiewitz, K. (2017).
Instructions: In the following you read several statements When traits match states: examining the associations between self-
that describe how people relate to their romantic partner. report trait and state mindfulness following a state mindfulness in-
duction. Mindfulness, 1–13.
Please indicate to what degree the statement describes your
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present:
own stance toward your partner on a scale from 1 (totally mindfulness and its role in psychological well-being. Journal of
disagree) to 7 (totally agree). Personality and Social Psychology, 84, 822–848.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness:
theoretical foundations and evidence for its salutary effects.
1 2 3 4 5 6 7 Psychological Inquiry, 18(4), 211–237.
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2. “I try to change the things which I do not Carson, J. W., Carson, K. M., Gil, K. M., & Baucom, D. H. (2004).
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Commons Attribution 4.0 International License (http:// Clinical handbook of couple therapy (pp. 31–64). New York:
creativecommons.org/licenses/by/4.0/), which permits unrestricted use, Guilford Press.
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