With nearly $2M in defense funding, Clark-based startup expands mental health research

Clark psychologist James Córdova envisions that, one day, couples’ “relationship checkups” with mental health professionals will be as easy to schedule as dental appointments.

That could have significant effects on individuals’ mental health, he adds. Even just one or two brief sessions of relationship counseling have been proven to decrease individual depression and suicidal ideation, according to studies conducted by Córdova and his co-authors — psychiatrists, psychologists, and public health experts from research institutions in Texas and Ohio.

“The thing about relationships is, a rising tide raises all boats,” says Córdova, professor of psychology and director of the Center for Couples and Family Research at Clark. “If you improve relationship health, everything else comes with it.”

Córdova’s Clark-based startup company, Arammu Inc., has an almost $2 million multiyear contract with the U.S. Department of Defense to train more than 1,000 military family life counselors around the world to apply his Relationship Checkup model to couples counseling.

He created the model — originally called the Marriage Checkup and consisting of two 1-hour sessions — 25 years ago. His book, “The Marriage Checkup: A Scientific Program for Sustaining and Strengthening Marital Health,” was published in 2009, and it has been popular ever since with psychologists and couples alike.

“We’re starting in the military with regular relationship health checkups and then hoping to be able to follow that path out into the civilian world,” Córdova explains.

The next “stop” on this path includes military veterans, who have re-entered civilian life, often with stress in tow, he says. Arammu has extended its Relationship Checkups to couples obtaining mental health services through the Veterans Administration (VA) and veterans hospitals.

When military personnel retire and leave active duty, “they experience a lot of relationship  upheaval as they cross that transition back into civilian life,” Córdova notes. “They also can experience PTSD, depression, anxiety, interpersonal violence, substance abuse, and a higher risk of suicide.”

“The thing about relationships is, a rising tide raises all boats. If you improve relationship health, everything else comes with it.”

— Professor James Córdova

A pilot study by Córdova and his co-authors focused on “couples experiencing the dual suicide risk factors of relationship distress and mental health problems,” they explain in an article published last fall in the journal Suicide and Life-Threatening Behavior. The study found that three 30-minute sessions deploying the Relationship Checkup model helped military veterans and their partners not only improve their relationships but also led to a decrease in individuals’ depression and suicidal ideation.

“Both the Defense Department and the VA are laser-focused on trying to drive down the rates of suicide, which is why this study is looking specifically at the variables that have an effect on suicide risk,” Córdova says.

The study “found that if you improve a relationship, even if you’re not in any way targeting depressive symptoms, depressive symptoms are always alleviated,” he adds.

One to two sessions of the Relationship Checkup, according to Córdova, had the same effect of alleviating depression as did a more commonly prescribed approach — individual cognitive behavioral therapy plus medication such as Prozac.

The outcomes with veterans were similar to those of other groups — including expecting parents, active military, LGBTQ, low-income unmarried, and married couples — that he and fellow researchers have studied over more than two decades of trials, according to Córdova.

“We’re getting outcomes on par with those in all our other studies showing positive effects on relationship health, like relationship satisfaction and intimacy and cohesion and connectedness, and also on broader mental health variables like depression,” Córdova says.

Relationship therapy is not usually considered when individuals seek treatment for suicidal ideation, he and his co-authors point out in their study on veterans. In addition, research around family-based treatments for suicide “has disproportionately focused on adolescents,” the authors note.

“The great majority of empirically supported treatments target psychiatric diagnoses, without addressing the health of key interpersonal relationships,” the authors write. “Nevertheless, systematic reviews consistently link romantic relationship distress, conflict, and separation/breakup to suicidal behavior.”

The statistics are stark. “National psychological autopsy studies found romantic relationship problems occurred in the two weeks prior to 24% of veteran suicide deaths and were found for 50% of suicide deaths for veterans below 35 years of age,” the authors report.

However, brief relationship counseling, they emphasize, highlights “an opportunity to expand [suicide] prevention efforts.”

Córdova’s co-authors on the study included faculty experts from the Peter O’Donnell Jr. Brain Institute, Center for Depression Research and Clinical Care, Department of Psychiatry, and Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas; Nationwide Children’s Hospital, The Ohio State University, Columbus; University of Texas Health Science Center, San Antonio; Department of Psychiatry, Texas Tech University Health Science Center, Lubbock; and Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston.