The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Marital Satisfaction: A Validation Approach

It was hypothesized that the desire for equity in relationships and the desire for validation from significant others are common human concerns which affect marital relationship satisfaction. Sixty married couples completed a series of questionnaires which assessed equity in 23 areas of the marital relationship, global equity in the marital relationship, relationship satisfaction, perceptions of relationship stability, understanding from spouse, validation from spouse, assistance from spouse in intellectual and emotional growth, frequency of stimulating conversations between the marital pair, frequency of affectionate touching from spouse, and sexual satisfaction in the marital relationship. Subjects who felt validated by their spouses reported more relationship satisfaction, greater relationship stability, more assistance from their spouses in intellectual and emotional growth, and greater sexual satisfaction than did subjects who did not feel validated by their spouses. Overall, equitably treated subjects reported more relationship satisfaction, greater relationship stability, more assistance from spouse in emotional growth, greater sexual satisfaction, and a greater frequency of affectionate touching from their spouses than did inequitably treated subjects. However, these differences between equitably treated and inequitably treated subjects applied primarily to non-validated subjects.     

Spouse marital adjustment and patient dietary adherence in chronic hemodialysis: A Comparison of Afro-Americans and Caucasians

Abstract

This study investigated racial differences in the relationship between spouse marital adjustment and dietary adherence of chronic hemodialysis patients. Sixty-eight adult patients and their spouse were subjects. Fifty-two percent of the patients were Caucasians while 48% were Afro-Americans. Spouses completed the Locke-Marital-Questionnaire (LMQ) and provided demographic data pertaining to their patient spouses. The patients' predialysis potassium levels (indices of food intake compliance) for the previous three months were matched with the respective questionnaires. Afro-American spouses, especially males, evidenced significantly lower marital satisfaction than Caucasian spouses. Afro-American female patients seemed to be most compliant as far as food intake wasconcemed. Although the spouse LMQ score was negatively correlated with interdialysis weight gain. Afro-Americans who generally scored lower on the LMQ did not differ from Caucasians in so far as their adherence to the dietary regimen was concerned. Implications for improving quality of life of hemodialysis couples in general, and Afro-Americans in particular are discussed.     

Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses.

This study investigated contextual determinants of psychological distress among 197 spouses of cancer patients. It was hypothesized that higher levels of patient functional impairment would lead to greater patient distress. Patient distress, in turn, would lead to lower spouse marital satisfaction and ultimately to higher spouse distress. Spouses completed measures of distress and marital quality at three time points. Cancer patients rated their functional impairment and psychological distress at the same time points. Results indicated that at all time points, greater patient impairment was associated with higher levels of patient distress, which, in turn, was related to lower marital satisfaction. However, marital quality was related to spouse distress at only 1 time point, but spouse distress was directly associated with patient distress at each time point. Implications for cancer patients and spouses are discussed.     

Stroke patients' well-being as a function of caregiving spouses' helpful and unhelpful actions

This study examined the perceptions that 55 older married stroke patients had about themselves and about the motivations of their caregiving spouses when they judged their spouses' actions to be helpful and when they judged them to be unhelpful. It also examined how these perceptions were related to patients' well-being (depression, positive affect, marital satisfaction). Patients had more negative perceptions of themselves and of their spouses when they judged the actions to be unhelpful than when they judged them to be helpful. The hypothesis that perceptions about unhelpful actions would be more strongly related to patients' well-being than would perceptions about helpful actions was only partially supported. Perceptions about unhelpful actions were related to patients' depression, but perceptions about helpful actions were related to positive affect. Both kinds of perceptions were related to marital satisfaction. Findings begin to explicate the complex relationship between perceived helpfulness of actions and well-being.     

Accuracy and Bias in Perceptions of Spouses' Life‐Sustaining Medical Treatment Preferences1

This research investigated accuracy, projection bias, and base‐rate utilization in spouses' perceptions of end‐stage renal disease patients' preferences for life‐sustaining medical treatment in hypothetical conditions of declining health. Multilevel models revealed that spouses' perceptions were largely biased, determined by their own preferences for the patients' treatment (projection bias) and by typical treatment preferences (base‐rate utilization). Both biases, however, served as indirect routes to a modest degree of accuracy. Moreover, spouses who overestimated patients' preferences for life‐sustaining treatment and who perceived patients' preferences as consistent with their own reported higher levels of marital adjustment than did those who were less biased. Results suggest that spouses' biases in judgments of patients' treatment preferences may promote accuracy and marital adjustment functionally.     

Life With a Partner with ADHD: The Moderating Role of Intimacy

Adult attention deficit and hyperactivity disorder (ADHD) manifests itself through a variety of symptoms, some of which affect not only occupational and recreational activities but also intimate relationships. Previous findings have focused on the effects of adult ADHD on intimacy and relationships from the ADHD diagnosed person’s point of view. However, spouses of people with ADHD are a neglected population with regard to the effects that ADHD has on their romantic relationships. Our aim was to assess the effects of being married to a spouse with ADHD on marital relationships, and the moderating role of intimacy. We compared healthy spouses of people with ADHD to healthy spouses of healthy adults (M?=?38.23, SD?=?4.78) in their degree of self-reported intimacy and marital satisfaction. Our findings indicate that spouses of individuals with ADHD report significantly lower intimacy and lower marital satisfaction compared to spouses of individuals without ADHD. Moreover, our findings indicate that spousal reports about their degree of intimacy mediate the relationships between their spouses’ ADHD and their marital satisfaction. Results are discussed in relation to the broad implications that adult ADHD has for romantic intimacy. Our research addresses healthy partners married to a spouse with ADHD, suggesting that living with a partner with ADHD behaviors is challenging. ADHD symptoms negatively affect various qualities in the person experiencing them, but of equal importance is the damage occurring to his or her spouse. Implications for future research and recommendations for clinical work are suggested.     

Potential Bone-Marrow Donors and Their Spouses: The Effects of Volunteerism on Distress Levels1

The current study sought to provide a better understanding of the reactions of bone-marrow volunteers to the possibility of donating by examining these volunteers in the context of their closest relationships. Using Tesser's (1988) self-evaluation maintenance (SEM) model as a guide, we examined the influence of spouses who are also volunteers on each member of the couple's distress levels and on the marrow volunteer's ambivalence about donating. We also examined the independent effects of known risk factors for donation-related distress and the combined effects of spouse volunteer status and these risk factors on distress levels. Questionnaire data were collected from 278 couples selected from 39 bone-marrow donor centers. Results demonstrated that when spouses of potential donors were engaged in any type of volunteer activity, members of the couple felt greater anxiety than when spouses were not volunteers. Additionally, other variables were found to have a conjoint effect with spouse volunteer status on volunteer and spouse anxiety levels.     

Attribution processes in distressed and nondistressed couples: 4. Self-partner attribution differences

The importance of the self-other distinction for understanding the relation between attributions and marital satisfaction is examined in two studies. In Study 1, causal attributions for naturally occurring behavior by the self and spouse were investigated. Study 2 examined both causal and responsibility attributions for hypothetical behaviors. In both studies, the attributions of spouses seeking therapy were investigated in relation to those of happily married persons in the community. The results showed that self-other attribution differences varied as a function of marital distress. Nondistressed spouses showed a positive attribution bias by making more benign attributions for partner behavior as opposed to self-behavior, whereas distressed spouses showed a negative attribution bias by making less benign attributions for partner behavior than for self-behavior. These findings suggest that self-attributions may, in part, determine the impact of attributions for spouse behavior on marital satisfaction. The clinical relevance of the results and their implications for research on actor-observer attribution differences are outlined.     

Pronouns in marital interaction

Recent studies in social psychology have found that the frequency of certain words in people's speech and writing is related to psychological aspects of their personal health. We investigated whether counts of "self" and "other" pronouns used by 59 couples engaged in a problem-solving discussion were related to indices of marital health. One spouse in each couple had a diagnosis of obsessive-compulsive disorder or panic disorder with agoraphobia; 50% of the patients and 40% of their spouses reported marital dissatisfaction. Regardless of patients' diagnostic status, spouses who used more second-person pronouns were more negative during interactions, whereas those who used more first-person plural pronouns produced more positive problem solutions, even when negative behavior was statistically controlled. Moreover, use of first-person singular pronouns was positively associated with marital satisfaction. These findings suggest that pronouns used by spouses during conflict-resolution discussions provide insight into the quality of their interactions and marriages.     

Stress resilience in early marriage: can practice make perfect?

As all couples experience stressful life events, addressing how couples adapt to stress is imperative for understanding marital development. Drawing from theories of stress inoculation, which suggest that the successful adaptation to moderately stressful events may help individuals develop a resilience to future stress, the current studies examined whether experiences with manageable stressors early in the marriage may serve to make the relationship more resilient to future stress. In Study 1, 61 newlywed couples provided data regarding their stressful life events, relationship resources (i.e., observed problem-solving behaviors), and marital satisfaction at multiple points over 2? years. Results revealed that among spouses displaying more effective problem-solving behaviors, those who experienced moderate stress during the early months of marriage exhibited fewer future stress spillover effects and reported greater increases in felt efficacy than did spouses who had less experience with early stress. Study 2 examined stress resilience following the transition to parenthood in a new sample of 50 newlywed couples. Again, spouses who experienced moderate stress during the early months of marriage and had good initial relationship resources (i.e., observed support behaviors) reported greater marital adjustment following the transition to parenthood than did spouses who had good initial resources but less prior experience coping with stress. Together, results indicate that entering marriage with better relationship resources may not be sufficient to shield marital satisfaction from the detrimental effects of stress; rather, couples may also need practice in using those resources to navigate manageable stressful events.     

Interactional Patterns and Marital Satisfaction Among Dual-Career Couples

The relationships of interactional patterns to the marital satisfaction of dual-career cou~lews ere exolored. Greater marital satisfaction was related to create; equality and reciprocity in the relationships. Couples experiencing reater marital satisfaction were apt to both give and ta e supports, to be involved in each other's careers, have equal commitment to the relationship, and to practice equal decision making. Holding non-traditional sex-role attitudes. and the husbands' approving of their wives' careers were related to higher marital satisfaction. Women who began their career after their marriages were apt to experience less marital satisfaction, less job satisfaction, fewer spouse supports, and greater inequality in decision making. Implications for clinicians are included.     

Construct Validity of the Perceived Criticism Measure

The construct validity of the Perceived Criticism Measure (PCM) was examined in 2 studies. In Study 1, 50 community couples participated in problem-solving interactions after which they rated interaction-specific perceived criticism and their criticism of their spouses. In addition, they provided ratings of perceived criticism for their relationship overall and completed measures of psychopathology and marital satisfaction. For both husbands and wives, convergent validity was demonstrated by moderate-to-large correlations between the PCM and spouses' own ratings of their criticism for both general and interaction-specific perceived criticism. In Study 2, 37 patients with obsessive-compulsive disorder and their spouses participated in problem-solving interactions and provided ratings of marital satisfaction and general perceived criticism. Five untrained coders rated the interactions according to their own definitions of the relatives' destructive criticism of the patient. Their aggregated ratings proved strongly related to patients' PCM scores. Higher PCM scores were related to lower marital satisfaction in both Studies 1 and 2. The results of these studies are supportive of the convergent validity of the Perceived Criticism Measure. Evidence of discriminant validity was mixed.     

Humor and Marital Satisfaction

Abstract

Fifty married Israeli couples were administered a humor test measuring humor creation and humor appreciation, as well as a questionnaire measuring marital satisfaction. Each spouse completed the measurement for self and for his or her partner. Results obtained showed that marital satisfaction was related to perception of the partner's humor more than the spouse's own humor. There was a significant relation for husbands between their scores on humor appreciation and their marital satisfaction. No relation was found for wives between their humor scores and their marital satisfaction. Multiple stepwise regressions on humor scores showed that complementarity between spouses' perceptions of partners' humor explains most of the variance of marital satisfaction.     

Attributions in marriage: state or trait? A growth curve analysis

Research on attributions in marriage rests on 2 assumptions. First, the attributions spouses make for their partners' behaviors have been treated as a style or a trait, reflecting enduring aspects of the perceiver. Second, attributions have been described as a causal factor in the development of the marriage over time. To evaluate the evidence for these assumptions, the authors analyzed 8 waves of longitudinal data from a sample of newlywed couples. Results offered no support for the idea of an enduring attributional style; attributions changed linearly, and changes in attributions were strongly associated with changes in marital satisfaction within each spouse. Nevertheless, controlling for these associations, initial levels of attributions predicted changes in marital satisfaction more than initial satisfaction predicted changes in attributions. Effects of neuroticism and effects on marital dissolution were also examined.     

Adult attachment,sexual satisfaction,and relationship satisfaction: A study of married couples

The goal of this research was to extend prior work on adult attachment and sexuality, which has tended to focus on samples of adolescents and undergraduate students. A Canadian sample of 116 married couples aged 21–75 years completed self‐report measures of adult attachment, marital, and sexual satisfaction. Results revealed that participants with higher levels of anxiety and avoidance reported lower levels of sexual satisfaction at the individual level. Individuals with more avoidant spouses also reported lower levels of sexual satisfaction. Furthermore, the relationship between sexual and marital satisfaction was stronger for more anxiously attached individuals and those with more anxiously attached spouses. These results suggest that attachment is linked in theoretically predictable ways to marital and sexual satisfaction.     

His and Her Perspectives: Gender Ideology, Work-to-Family Conflict, and Marital Satisfaction

This study examines the relationships between gender ideology, work-to-family conflict, and marital satisfaction. We hypothesize that gender ideology will moderate relationships between both the respondent’s work-to-family conflict and their spouse’s work-to-family conflict in predicting marital satisfaction, and that spouses’ gender ideologies will interact in predicting marital satisfaction. The hypotheses are addressed using data from a random sample of U.S. dual-earner couples (N?=?156) in a western state. The findings indicate that the more egalitarian women’s gender ideologies, the stronger the negative relationship between women’s marital satisfaction and women’s work-to-family conflict. The results also indicate that the dependence of men’s marital satisfaction on wives’ gender ideologies varies according to men’s own gender ideologies. Implications of the study are discussed.     

Physiological and affective predictors of change in relationship satisfaction

In 1980, 30 married couples had engaged in a low-conflict and a high-conflict conversational interaction while continuous physiological data were obtained. In a separate session each spouse had provided a continuous self-report of affect while viewing the videotape of the interaction. In 1983, 19 of these couples were re-located to determine the change in relationship satisfaction that had occurred over the preceding 3 years. A broadly based pattern of physiological arousal (across spouses, interaction segments, and physiological measures) in 1980 was found to predict decline in marital satisfaction; the more aroused the couple was during the 1980 interactions, the more their marital satisfaction declined over the ensuing 3 years. Several affective variables also predicted decline in marital satisfaction, including a pronounced sex difference in negative affect reciprocity: Marital satisfaction declined most when husbands did not reciprocate their wives' negative affect, and when wives did reciprocate their husbands' negative affect.     

Spouses' responses to the dietary nonadherence of their partners managing diabetes

The association between patients' dietary nonadherence and spouses' involvement in patients' diabetes diet was examined, with spouses' anxiety about nonadherence considered as a mediator of this association. Daily diary data from 128 older adult patients with type 2 diabetes and their spouses were analyzed using multilevel models. Results revealed that on days when patients reported less adherence to their diabetes diet than usual, spouses reported greater anxiety about patients' diabetes management, which, in turn, was related to greater spousal persuasion and pressure the same day. The association between patients' nonadherence and diet‐related support on the same day was not mediated, however, through spouses' anxiety. The findings contribute to an understanding of spouses' responses to patients' nonadherence to their diabetes regimen.     

The Demand/Withdraw Pattern of Communication as a Predictor of Marital Satisfaction Over Time

There is ample evidence that marital dissatisfaction is associated concurrently with demand/withdraw, the marital pattern of communication in which one spouse nags or criticizes while the other avoids. However, the connection between demand/withdraw and changes in satisfaction is less clear. Some studies suggest that demand/withdraw is associated with low but steady marital satisfaction; other studies imply that demand/withdraw predicts declines in satisfaction; and still others indicate that demand/withdraw foreshadows increases in marital satisfaction. The current longitudinal study of married couples (N = 46) examined the connection between demand/withdraw and changes in satisfaction. The results suggest that the correlation between demand/withdraw and dissatisfaction endures to some extent, but also that demand/withdraw predicts increases in wives' satisfaction. Comparisons of the current study to previous studies of demand/withdraw imply that the association between demand/withdraw and marital satisfaction may be more complex than heretofore assumed, suggesting that future research ought to consider whether different ways of enacting demand/withdraw vary in their impact on marriage.