Effectiveness of couple therapy based on choice theory in marital burnout and communication styles of infertile couples

Document Type : Original Article


1 Department of Counseling, Shahid Bahonar University of Kerman, Kerman, Iran.

2 Department of Psychology, Islamic Azad University, Sari, Iran.

3 Department of Psychology, Islamic Azad University, Tehran Electronic Branch, Iran.


Background: Infertility is one of the life crises that put a lot of stress on infertile couples and can disrupt the quality of marital life, reduce communion, and helplessness.
Objective: This study aimed to determine the effectiveness of couple therapy based on choice theory on marital burnout and communication styles of infertile couples.
Methods: The research method was semi-experimental or pre-test, post-test, and follow-up with the control group. The statistical population of the study consisted of all infertile couples referred to counseling and treatment centers in Tehran in 2019, among whom 30 were selected by convenience sampling method and randomly assigned to two groups of 15 participants. A couple of therapy program based on choice theory was performed weekly, but the control group did not receive any intervention. Two groups responded to marital burnout and communication styles questionnaires in the pre-test, post-test, and follow-up. Data analysis was performed using covariance analysis using SPSS.22 software.
Results: The results of this study showed that couple therapy based on choice theory is effective on disillusionment (P<0.01) and communication styles (P<0.01) of infertile couples.
Conclusion: Considering the positive effect of couple therapy based on choice theory on marital burnout and communication styles of infertile couples, the use of these capacities and training in planning mental health measures, especially for infertile couples, is recommended.


 1.Di Spiezio Sardo A, Di Carlo C, Minozzi S, Spinelli
M, Pistotti V, Alviggi C, De Placido G, Nappi C, Bifulco
G. Efficacy of hysteroscopy in improving reproductive
outcomes of infertile couples: a systematic review and
meta-analysis. Human reproduction update. 2016 Jun
2.Frederiksen Y, O'Toole MS, Mehlsen MY, Hauge B,
Elbaek HO, Zachariae R, Ingerslev HJ. The effect of
expressive writing intervention for infertile couples: a
randomized controlled trial. Human Reproduction. 2017
Feb 1;32(2):391-402.
3.Vahidi S, Ardalan A, Mohammad K. Prevalence of
primary infertility in the Islamic Republic of Iran in
2004-2005. Asia Pacific Journal of Public Health. 2009
4.Martin J, Yi Y, Alberola T, Rodríguez-Iglesias B,
Jiménez-Almazán J, Li Q, Du H, Alama P, Ruiz A,
Bosch E, Garrido N. Comprehensive carrier genetic test
using next-generation deoxyribonucleic acid sequencing
in infertile couples wishing to conceive through assisted
reproductive technology. Fertility and sterility. 2015 Nov
5.Ten Brinke L, Porter S, Korva N, Fowler K, Lilienfeld
SO, Patrick CJ. An examination of the communication
styles associated with psychopathy and their influence
on observer impressions. Journal of Nonverbal Behavior.
2017 Sep;41(3):269-87. https://doi.org/10.1007/s10919-
6.Barnett MD, Johnson DM. The perfectionism social
The mediating role of
Personality and Individual
7.House J. Communication Styles in English and
German. The International Encyclopedia of Intercultural
Communication. 2017 Nov 29:1-10.
8.Kim BS, Park YS. Communication styles, cultural
values, and counseling effectiveness with Asian
Americans. Journal of Counseling & Development. 2015
Jul;93(3):269-79. https://doi.org/10.1002/jcad.12025
9.Caughlin JP, Vangelisti AL. An individual difference
explanation of why married couples engage in the
demand/withdraw pattern of conflict. Journal of Social
and Personal Relationships. 2000 Aug;17(4-5):523-51.
10.Bidgoli ER, Tamannaeifar M. The Prediction of
Marital Burnout Based on Personality Traits.
International Journal of Scientific Study. 2017;5(4):647-
11.Boone AR. Couches and mattresses: The next
recoverables?. RESOURCE RECYCLING. 1994;13:45-.
12.Jesse MT, Shkokani L, Eshelman A, De Reyck C,
Abouljoud M, Lerut J. Transplant surgeon burnout and
marital distress in the sandwich generation: the call for
organizational support in family life. InTransplantation
proceedings 2018 Dec 1 (Vol. 50, No. 10, pp. 2899-
2904). Elsevier.
13.Bishai D, Grossbard S. Far above rubies: Bride price
and extramarital sexual relations in Uganda. Journal of
Population Economics. 2010 Sep;23(4):1177-87.
14.Robey PA, Wubbolding RE, Malters M. A
comparison of choice theory and reality therapy to
Adlerian Individual Psychology. The Journal of
Individual Psychology. 2017;73(4):283-94.
15.Davaie Markazi M, Karimi J, Goodarzi K.
Investigating the Effectiveness of Couple Therapy based
on Reality Therapy and Emotionally Focused Therapy
(EFT) on Couples’ Happiness and Resilience. Journal of
Counseling Research. 2021 May 10;20(77):89-121.
16.Afghari N, Yazdkhasti F, Mehrabi-Koushki H, Azimi
A. Comparison of the Effect of Group Couple Therapy
Based on Reality Therapy and Acceptance and
Commitment Therapy on Perfectionism and Adjustment
of Couples' Needs. Journal of Health System Research.
2021 Jan 10;16(4):243-50.
17.Perrone-McGovern KM, Oliveira-Silva P, SimonDack S, Lefdahl-Davis E, Adams D, McConnell J,
Howell D, Hess R, Davis A, Gonçalves ÓF. Effects of
empathy and conflict resolution strategies on
psychophysiological arousal and satisfaction in romantic
relationships. Applied psychophysiology and
biofeedback. 2014 Mar 1;39(1):19-25.
18.Lavner JA, Karney BR, Bradbury TN. Does couples'
communication predict marital satisfaction, or does
marital satisfaction predict communication?. Journal of
Marriage and Family. 2016 Jun;78(3):680-94.
19.Javidi, Nasir al-Din, Soleimani, Ali Akbar, Ahmadi,
Khodabakhsh, Samadzadeh, Mena. The effectiveness of
emotionally focused couples therapy (EFT) to improve
communication patterns in couples. Journal of Research
in Behavioural Sciences. 2013;11(5):402-10.
20.Buruck G, Dörfel D, Kugler J, Brom SS. Enhancing
well-being at work: The role of emotion regulation skills
as personal resources. Journal of occupational health
21.Akbari N, Samani S. Forecasts Bbased on Marital
Dissatisfaction and Sexual Dysfunction, Female in
Shiraz City. Quarterly journal of women and society.
2018 Aug 23;9(34):19-34.

Khandani S et al.
Razavi Int J Med. 2022; 10(3):e1194. 55
22.Safipouriyan S, Ghadami A, Khakpour M, Sodani M,
Mehrafarid M. The effect of group counseling using
interpersonal therapy (IPT) in reducing marital boredom
in female divorce applicants. JNE. 2016;5(1):1-11.
23.Christensen A, Sullaway M. Communication patterns
questionnaire, university of California. Los Angeles:
Unpublished manuscript. Journal of Clinical Psychology.
1984;66:53-88. https://doi.org/10.1037/t02529-000
24.Duba D, Jill D, Graham MA, Britzman M, Minatrea
N. Introducing the “Basic Needs Genogram” in Reality
Therapy-based marriage and family counseling.
International Journal of Reality Therapy. 2009;28(2):15.
25.Haji Adineh S, Kalhornia Golkar M. Effectiveness of
Group Training Based on Choice Theory on Marital
Adjustment and Sexual Satisfaction of Couples. Journal
of Research in Behavioural Sciences. 2019;17(2):193-
26.Moatamedy A, Khaki A, Farahbakhsh K, Esmaaili M,
Bejestani HS. The Evaluation of the Effectiveness of
Couple-Therapy based on Ecological Model in Reducing
Marital Conflicts. Executive Editor. 2018;9(3):162.
27.Davaie Markazi M, Karimi J, Goodarzi K.
Investigating the Effectiveness of Couple Therapy based
on Reality Therapy and Emotionally Focused Therapy
(EFT) on Couples’ Happiness and Resilience. Journal of
Counseling Research. 2021;20(77):89-121.
28.Abbasi H, Ahmadi SA, Fatehizadeh M, Bahrami F.
Effect of Couple Therapy Based on the Choice Theory
on Social Commitment of Couples. J Educ Community
29.Banks SG. Using choice theory and reality therapy in
premarital counseling. Contemporary Issues in Couples
Counseling. 2012:211-25.
30.Robey PA. Reality therapy and choice theory: An
interview with Robert Wubbolding. The Family Journal.