A Cognitive-Behavioral Intervention for Marital Adjustment Among Patients with Type 2 Diabetes: Model Development, Implementation, and Mixed Methods Assessment Within the Iranian Cultural Context

Introduction: Marital adjustment changes after serious diseases such as diabetes mellitus. Psychological therapies and training are required to aid couples in their marital adjustment. To improve marital adjustment in the context of type 2 diabetes within Iranian families, the present study designed and tested a training program centered on the cognitive-behavioral approach. Methods: Adopting an exploratory mixed-methods approach, this study followed the six-step framework proposed by Talbot and Verrinder for program development. The initial phase involved a conventional qualitative inquiry to identify core themes. Subsequently, through a synthesis of literature, evidence-based practices, and two expert panel reviews, the intervention was developed and finalized. The program was then implemented using a quasi-experimental design involving 40 couples with type 2 diabetes. To assess effectiveness, marital adjustment was measured at baseline and at a one-month follow-up. Using SPSS version 22, independent and paired t-tests, along with ANCOVA, were employed to perform the necessary statistical computations for this study. Results: A systematic framework was employed to identify the core components of the psycho-educational intervention. The resulting program, consisting of 11 structured sessions, was implemented to achieve measurable therapeutic outcomes. Quantitative analysis revealed that the cognitive-behavioral couple training significantly enhanced marital adjustment. Following the intervention, the treatment group’s total DAS scores (95.9 ± 7.42) showed a marked improvement compared to the control group (62.1 ± 5.49) (t = 0.14, P < 0.001), and the study showed a robust effect size (Cohen’s d = 5.17). Furthermore, statistical significance was maintained across all DAS subscales according to the ANCOVA results, even after neutralizing the influence of baseline variables (P ≤ 0.05). Conclusion: The evidence presented confirms that marital adjustment can be substantially enhanced through a CBT-informed psycho-educational intervention. Therefore, this approach holds promise as a valuable addition to multi-disciplinary rehabilitation programs for various patient populations.