Older women with osteoarthritis and their caregiving husbands: Effects of pain and pain expression on husbands' well-being and support.

Objectives: To examine the moderating effects of wives' pain expression (verbal disclosure, nonverbal behavior) on the relationship between wives' pain and husbands' well-being and support provision. Design: Interviews were conducted with couples at baseline; questionnaires were mailed 6 months later. Setting: All women were patients at a rheumatology clinic. Participants: The sample included older women (n = 101) with a diagnosis of osteoarthritis (OA) and their caregiving husbands. Main Outcome Measures: Outcomes were husbands' psychological well-being (depressive symptoms, life satisfaction) and the quality of their support to wives (emotional support, critical attitudes). Results: Verbal and nonverbal expression of OA pain increased the likelihood that women experiencing severe pain would have husbands with poor psychological well-being. Moreover, verbal pain disclosure strengthened the association between the severity of wives' pain and less emotional support from husbands. Conclusions: Findings suggest that wives' verbal and nonverbal communications about their pain, especially about severe pain, have the potential to decrease the psychological well-being and support resources of their caregiving spouses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spousal support and cardiac patients' distress: The moderating role of attachment orientation.

Based on the Person–Environment Fit Model, the current prospective study explored the contribution of the interaction between spouses' ways of providing support and patients' attachment orientations to the patients' levels of psychological distress 6 months after experiencing a first Acute Coronary Syndrome (ACS). One hundred and eleven patients completed a measure of attachment orientations during hospitalization, while their spouses completed a measure of ways of providing support 1 month later. The outcome measures were patients' depressive and anxiety symptoms 6 months after their ACS. Whereas active engagement was associated with lower levels of anxiety symptoms among patients high in attachment anxiety, it was also associated with higher levels of anxiety symptoms among patients low on this orientation. In addition, none of the ways of providing support moderated the association between avoidance and distress. These results shed light on the possible interplay between providers' support and recipients' personalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Dyadic Investigation of Exercise Support Between Cardiac Patients and Their Spouses.

The authors examined married partners' similarity in reported exercise behavior as a moderator of the association between social support for exercise provided and received by extending an actor-partner dyadic effects model. Participants were married cardiac rehabilitation patients and their spouses (N=99 couples). For couples similar in their reported exercise behavior, a significant association was found between both partners' independent reports of providing exercise support to and receiving exercise support from one another (n=49 couples). However, for couples differing in their reported exercise behavior (n=50 couples), no association was found between either partner's provision and receipt of support for exercise. Findings have the potential to inform practitioners of patients who may not be receiving adequate social support for their recommended exercise. Future interventions may consider implementing dyadic educational or motivational strategies with patients and their spouses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

To Know You Is to Love You: The Implications of Global Adoration and Specific Accuracy for Marital Relationships.

Despite the strong positive feelings that characterize newlyweds, many marriages end in disappointment. To understand this shift, the authors argue that although newlyweds' global relationship evaluations may be uniformly positive, not all spouses base their global adoration on an accurate perception of their partner's specific qualities. Two longitudinal studies confirmed that whereas most newlyweds enhanced their partners at the level of their global perceptions, spouses varied significantly in their perceptions of their partners' specific qualities. For wives, but not for husbands, more accurate specific perceptions were associated with their supportive behaviors, feelings of control in the marriage, and whether or not the marriage ended in divorce. Thus, love grounded in specific accuracy appears to be stronger than love absent accuracy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trust, variability in relationship evaluations, and relationship processes.

Little is known about why some people experience greater temporal fluctuations of relationship perceptions over short periods of time, or how these fluctuations within individuals are associated with relational processes that can destabilize relationships. Two studies were conducted to address these questions. In Study 1, long-term dating partners completed a 14-day diary study that assessed each partner's daily partner and relationship perceptions. Following the diary phase, each couple was videotaped trying to resolve the most important unresolved problem from the diary period. As predicted, (a) individuals who trusted their partners less reported greater variability in perceptions of relationship quality across the diary period; (b) they also perceived daily relationship-based conflict as a relatively more negative experience; and (c) greater variability in relationship perceptions predicted greater self-reported distress, more negative behavior, and less positive behavior during a postdiary conflict resolution task (rated by observers). The diary results were conceptually replicated in Study 2a, in which older cohabiting couples completed a 21-day diary. These same participants also took part in a reaction-time decision-making study (Study 2b), which revealed that individuals tend to compartmentalize positive and negative features of their partners if they (individuals) experienced greater variability in relationship quality during the 21-day diary period and were involved in higher quality relationships. These findings advance researchers' understanding of trust in intimate relationships and provide some insight into how temporal fluctuations in relationship quality may undermine relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult attachment, the transition to parenthood, and depressive symptoms.

Testing a model suggested by J. Bowlby (1988), this study investigated how a personal vulnerability (attachment ambivalence) interacts with perceptions of deficient spousal support before and during a major life stressor (the transition to parenthood) to predict pre-to-postnatal increases in depressive symptoms. Highly ambivalent women who entered parenthood perceiving either less support or greater anger from their husbands experienced pre-to-postnatal increases in depressive symptoms at 6 months postpartum. The associations between these 2 prenatal interaction terms and pre-to-postnatal increases in depressive symptoms were mediated by perceptions of declining spousal support across the transition period. Moreover, for highly ambivalent women, the association between prenatal and postnatal depression scores was mediated by perceptions of the amount of support available from their husbands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of relapse in unipolar depressives: Expressed emotion, marital distress, and perceived criticism.

The predictive validity of expressed emotion (EE) and two conceptually related but more easily measured alternatives—marital distress, and patients' perceptions of criticism from spouses—were examined in a sample of hospitalized unipolar depressives. All three psychosocial variables were significantly associated with 9-month relapse rates. Expressed emotion and marital distress predicted the same proportion of variance in patients' outcomes. The single best predictor of relapse, however, was a patient's response to the question "How critical is your spouse of you?" Patients who relapsed rated their spouses as significantly more critical than did patients who remained well. Alone, the perceived criticism variable accounted for more of the variance in relapse rates than that explained by EE and marital distress combined. The results suggest that asking depressed patients how critical they believe their relatives are may facilitate the identification of individuals at high risk for relapse subsequent to hospital discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple-oriented education and support intervention: Effects on individuals with osteoarthritis and their spouses.

Objective: To determine whether a couple-oriented intervention for osteoarthritis (OA) was more efficacious than a patient-oriented intervention and whether each intervention was more efficacious than usual medical care. Research Design: 242 older adults with OA and their spouses were randomly assigned to patient-oriented education and support, couple-oriented education and support, or usual care. Results: Intent-to-treat analyses indicated no significant differences between the 3 study conditions in outcomes for individuals with OA or their spouses. Completers analyses showed that at the 6-month follow-up, contrary to prediction, individuals with OA who received the patient-oriented intervention reported greater reductions in pain and improvements in physical function than those who received the couple-oriented intervention. At the postintervention assessment, spouses who received the coupleoriented intervention reported greater reductions in stress and a trend toward less critical attitudes than spouses of individuals with OA who received the patient-oriented intervention. Moderator analyses indicated that female spouses and spouses with high marital satisfaction who received the couple-oriented intervention also experienced better outcomes in terms of depressive symptoms and caregiver mastery. Conclusions: A couples approach to education and support for OA may offer no advantage for individuals with OA but may prove helpful for spouses, thereby indirectly benefiting individuals with OA over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamics of support perceptions among couples coping with cardiac illness: The effect on recovery outcomes.

Objective: The current prospective study explored how male cardiac patients' perceptions of received support (i.e., active engagement, protective buffering, and overprotection) moderated the associations between female partners' perceptions of provided support and patients' recovery outcomes: psychological well-being, cholesterol levels, and smoking cessation. Methods: Couples (N = 86) completed surveys at the initial hospitalization after patients' Acute Coronary Syndrome (ACS), and 1 and 6 months later. Partners' ways of providing support and patients' concurrent perceptions of these ways were measured using the Ways of Giving Support Questionnaire; patients' depressive and anxiety symptoms were measured using the Brief Symptom Inventory (BSI). Patients' cholesterol levels were assessed during hospitalization and 6 months later, and smoking habits were reported by the patients. Results: Female partners' protective buffering was positively associated with male patients' depressive symptoms at follow-up only when male patients' own perceptions of partners' protective buffering were low. Female partners' active engagement was positively associated with better odds for male patients' cessation of smoking only when patients' own perceptions of partners' active engagement were high. Finally, female partners' overprotection was associated with higher levels of male patients' harmful blood lipids at follow-up, but only when patients' own perceptions of partners' overprotection were high. Conclusions: As hypothesized, the effect of partners' perceptions of support provided on patients' recovery was moderated by patients' own perceptions of the support received. The effect of this interaction was determined by the specific types of support provided or received and by the specific recovery outcome that was measured. The clinical and theoretical implications of the findings are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Functioning and life context among spouses of remitted and nonremitted depressed patients.

The functioning and life context of spouses of depressed patients were examined at the patients' treatment intake and again after 1 year. Three groups of spouses were defined according to their depressed partner's recovery status at follow-up: remitted (n?=?39), partially remitted (n?=?39), or nonremitted (n?=?40). These spouse groups were compared with each other and with spouses of demographically matched community control participants (n?=?157). At both assessments, the remitted and control spouses were comparable in functioning, stressors, and coping, but the remitted spouses had more social and family problems than control spouses. In contrast, nonremitted spouses had significantly more problems than control spouses on most indices, both at intake and at follow-up. There was no evidence that adaptation of remitted spouses improved or that adaptation of nonremitted spouses deteriorated. Spouse adaptation was typically unrelated to changes in the depression of the depressed partner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive and negative characteristics of marital interaction and their association with marital satisfaction in middle-aged and older couples.

The study examined age differences in positive (e.g., warm) and negative (e.g., hostile) characteristics of marital interactions between middle-aged and older couples and whether these characteristics were differentially associated with marital satisfaction by age. Spouses' perception of partners' positive and negative behavior during marital interaction was assessed in general and following disagreement and collaborative tasks. Trained observers coded spouses' positive and negative behavior during interactions. Older individuals reported higher marital satisfaction and perceived their spouse's behavior as less negative in general and more positive across all contexts than middle-aged individuals. Spouses' perceptions of their partners' positive and negative behavior independently predicted marital satisfaction for both age groups across contexts. Perceptions of partners' negative behavior in general and of both positive and negative behavior in the disagreement task were more closely associated with marital satisfaction for older spouses than for middle-aged spouses. Results point to the importance of positive and negative characteristics in marital functioning across age cohorts and indicate that such characteristics may be context dependent. Findings suggest that, in some contexts, both positive and negative characteristics are more salient for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perfectionism and relationship adjustment in pain patients and their spouses.

The authors assessed whether social facets of perfectionism were associated with indexes of dyadic and family adjustment. A sample of 83 pain patients and their spouses completed the Multidimensional Perfectionism Scale, Dyadic Adjustment Scale, Family Assessment Device, Beck Depression Inventory, and Multiaxial Pain Inventory. After controlling for depression, the authors found that pain patients' relationship adjustments were associated with their spouses' other-oriented perfectionism. Also, pain patients rated their other-oriented perfectionistic spouses as less supportive. Spouses' reports of poor dyadic and family adjustment were associated with their own socially prescribed perfectionism. The findings suggest that social aspects of perfectionism contribute to poor family adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of marital interaction on chronic pain and disability: Examining the down side of social support.

Discusses family systems, social support, operant conditioning, and cognitive-behavioral (CB) perspectives on the role of families in chronic illness and, specifically, chronic pain. A reformulated CB model is advanced that emphasizes patients' appraisals and interpretations of their spouses' responses to communications of pain. Using data from 148 married patients with chronic pain and their spouses, the quality of the marital relationship was specifically documented as a critical mediator. Relationships between spouses' responses to pain and important dimensions of the pain experience generally were present only among maritally satisfied couples. A CB model that integrates patients' appraisals, attributions, and expectancies with actual reinforcement contingencies appears to provide a reasonable way to conceptualize the role of spousal interactions and responses in perpetuation of pain, disability, and extent of suffering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Projection of responsiveness to needs and the construction of satisfying communal relationships.

This research tested a social projection model of perceived partner responsiveness to needs. According to this model, people project their own care and supportiveness for a partner onto their perceptions of their partner's caring and supportiveness. In 2 dyadic marriage studies, participants' self-reported responsiveness to the needs of a spouse predicted perceptions of the spouse's responsiveness to the self more strongly than did the spouse's self-reported responsiveness. These projected perceptions of responsiveness, in turn, appeared to promote perceivers' relationship satisfaction. These effects were independent of individual differences in attachment, self-esteem, depression, and communal orientation. A daily-diary component suggested that people projected their own chronic responsiveness as well as their daily enacted support onto perceptions of the specific benefits received from their spouses. A 3rd study found that experimentally manipulated feelings of difficulty in recalling examples of own support provision reduced perceptions of partner responsiveness. Results suggest that projection of own responsiveness is an important determinant of perceived social support and is a means by which caring perceivers maintain satisfying and subjectively communal relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support, conflict, and the development of marital dysfunction.

How spouses help each other contend with personal difficulties is an unexplored but potentially important domain for understanding how marital distress develops. Newly married couples participated in 2 interaction tasks: a problem-solving task in which spouses discussed a marital conflict and a social support task in which spouses discussed personal, nonmarital difficulties. Observational coding of these interactions showed that wives' support solicitation and provision behaviors predicted marital outcomes 2 years later, independent of negative behaviors during marital problem-solving discussions. In addition, couples who exhibited relatively poor skills in both behavioral domains were at particular risk for later marital dysfunction. These results suggest that social support exchanges should be incorporated into social learning analyses of marriage and into programs designed to prevent marital distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery.

Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of relationship maintenance on psychological distress and dyadic adjustment among couples coping with lung cancer.

Objective: Relationship maintenance strategies help to ensure the continuation of valued relationships by keeping them at a certain level of intimacy. This study evaluated how lung cancer patients' and spouses' efforts to maintain their relationships affected their psychological and marital adjustment over time. Design: Psychosocial questionnaires were administered within 1 month of lung cancer treatment initiation (baseline) and 3 and 6 months later to 158 lung cancer patients and their spouses. Main Outcome Measures: Study outcomes were global severity index scores on the Brief Symptom Inventory, and total scores on the Dyadic Adjustment Scale. Results: Multilevel modeling analyses using the Actor-Partner Interdependence Model showed that, regardless of gender or social role (i.e., patient or spouse), individuals who engaged in the strategies of positivity, networks, and shared tasks reported less distress at baseline than other participants. Over time, the effects of providing more assurances and experiencing a partner's increased reliance on social networks differed: patient distress was exacerbated, and spouse distress was alleviated. Couples where both partners engaged in more frequent maintenance behaviors reported greater dyadic adjustment at baseline and over time. Conclusion: For couples coping with lung cancer, the initial treatment period may be an important time that sets the tone for future spousal interactions. Engaging in relationship maintenance during this stressful time may help mold more resilient relationships and facilitate adjustment as the disease progresses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and long-term recovery from coronary artery surgery: Effects on patients and spouses.

Using a longitudinal design, the effect of social support on recovery from coronary bypass surgery was examined in 155 patients and 103 of their spouses. Perception of the availability of 5 types of social support was relatively stable from preoperation to 1 yr after surgery and was significantly related to emotional and functional outcomes. Of the 5 types of support measured, only esteem support was significantly and consistently related to outcomes for patients and spouses. This relationship was strongest within-time, and across-time relationships effects were weaker. Spouse's perception of support was related to patient outcomes, controlling for patient perceptions of support. Results suggest that perception of esteem support may be the most salient type of support related to feelings of well-being during and after an acute health-care event. In addition, perception of social support may be characterized by stable individual differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shifts in attention biases in response to acute pain induction: Examination of a model of "conversion" among repressors.

Unlike most people, those who are characterized by a repressive coping style report high levels of physical (sensory) pain but low levels of emotional distress (affective pain), which is a discrepancy that may suggest a “conversion” process. In two studies, we tested an attention allocation model, proposing that repressors direct attention away from threatening negative affective information and toward nonthreatening physical pain information during emotionally arousing (painful) situations. In Study 1, 84 participants underwent a cold pressor and then recovered. Repressors reported greater pain during recovery than low- and high-anxious participants, but they reported lower distress than high-anxious participants. Repressors reported significant and large discrepancies between high pain and low distress, whereas these differences were less pronounced for other groups. In Study 2, 77 participants underwent an ischemic pain task while performing a modified dot-probe task with sensory and negative affective pain words as stimuli. Repressors showed increasing biases away from affective pain words and toward sensory pain words as the pain task continued, whereas low- and high-anxious participants did not show these shifts in attention. The results support the notion that conversion among repressors may involve a process by which attention is directed away from emotional distress during noxious stimulation and is focused instead on sensory information from pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)