Examining the role of posttraumatic stress disorder symptoms in intimate partner violence among couples with alcohol use disorder.

Separate literatures indicate that both alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are robust risk factors for using intimate partner violence (IPV). Despite the strength of these relative literatures, and the common co-occurrence of AUD and PTSD, their combined effects on IPV have rarely been examined. This study begins to address this gap by exploring the moderating effects of provisional PTSD diagnosis on the relation between heavy alcohol consumption and physical IPV using a multilevel modeling approach. Participants were adult romantic couples (N = 100) with current AUD and a history of physical IPV in their relationship. Results from the between-couple comparison indicate that couples who reported more heavy drinking days also experienced more physical IPV when at least one partner had probable PTSD. However, the within-couple comparison indicated that among partners without a provisional PTSD diagnosis, those with fewer heavy drinking days compared to their partner also reported more physical IPV perpetration. These preliminary and exploratory findings require replication and extension but provide new and important information regarding the complex intersection of heavy drinking, PTSD, and IPV among couples with AUD.

Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence.

Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.

Parent-Child Concordance and Discordance in Family Violence Reporting: A Descriptive Analysis from the Adolescent Brain Cognitive Development Study®.

Childhood trauma exposure, including witnessing or experiencing family violence, is associated with a variety of poor outcomes such as increased likelihood of psychopathology and high-risk behaviors across the lifespan. Early treatment may help to buffer these effects, but parents and youth display only moderate levels of agreement in reporting family violence, making it more difficult to identify children who have been exposed. Additionally, most studies on family violence reporting have focused primarily on small samples in specific high-risk populations, and little is known about the generalizability of these findings. Thus, the present study assessed concordance in family violence reporting and its correlates using the population-based, demographically diverse sample from the U.S. Adolescent Brain Cognitive Development (ABCD®) study. Participants were 10,532 children between 9 and 10 years old, and their parent or guardian, from 21 sites across the United States. Overall, 30% (N = 3119) of the sample reported family violence and most of those reports (N = 2629) had discordant violence reporting, meaning child- and parent-report did not correspond with each other. Multinomial logistic regression was used to assess the likelihood of participants belonging in one of the following groups: no violence reported, concordant violence reported, and discordant violence reported. Results indicated that Black or Non-Hispanic children, male children, and children with greater externalizing problems were more likely to report family violence, and parents with lower levels of education and income were more likely to report family violence. These findings likely reflect differences in distribution of risk factors among racial and ethnic minoritized individuals including increased parenting stress and decreased access to mental health treatment. Among those reporting violence, Hispanic children and children with less externalizing problems were more likely to be in the discordant group. Findings suggest that both parent and child reports are needed to assess violence and screen for appropriate services.

A randomized controlled trial examining the effects of intranasal oxytocin on alcohol craving and intimate partner aggression among couples.

BACKGROUND: While alcohol use disorder (AUD) is a well-established risk factor for intimate partner aggression (IPA), effective treatments for co-occurring AUD and IPA (AUD/IPA) are lacking. Oxytocin is one promising pharmacological candidate for AUD/IPA given its potential to modulate social behavior and attenuate alcohol use. However, emerging data suggests that oxytocin's prosocial effects are inconsistent, and a small number of studies have also found that oxytocin might have the potential to be aggressogenic. No studies have directly examined the impact of oxytocin on alcohol- or IPA-related outcomes in a dyadic context. METHODS: The goal of this double-blind, randomized, and placebo-controlled trial was to examine the effects of a single dose of intranasal oxytocin (40 international units) on cue-induced alcohol craving, subjective aggression, laboratory task-based IPA, and cortisol reactivity in a sample of 100 couples (N = 200 individuals) with AUD and physical IPA in their current relationship. RESULTS: There were no statistically significant differences between the oxytocin and placebo conditions for any of the primary outcomes. CONCLUSIONS: Findings suggest that a single dose of intranasal oxytocin was not efficacious in mitigating alcohol craving or aggression in this sample. Although hypotheses were not supported, the findings provide important evidence that oxytocin was not aggressogenic in this high-risk sample. Future research investigating dispositional and contextual moderators of oxytocin response in addition to the therapeutic effects of more intensive oxytocin dosing or administration strategies on alcohol craving and aggression is warranted.

Conducting Couple Therapy via Telehealth: Special Considerations for Virtual Success.

Couples may experience any number of barriers to in-person couple therapy, including scheduling difficulties, childcare needs, and stigma. Providing couple treatment via telehealth can address these obstacles and improve accessibility. However, couple therapists considering the transition to telehealth may be unsure of how to alter their current treatment approach for remote delivery. Further, there are often specific concerns of how to handle safety concerns or high-conflict couples via telehealth. The goal of this paper is to provide concrete suggestions, from pre-treatment screening through treatment, for how to conduct successful couple therapy via telehealth.

Advancing our understanding of the intersection between emotion regulation and alcohol and drug use problems: Dyadic analysis in couples with intimate partner violence and alcohol use disorder.

BACKGROUND: An extensive body of literature has linked emotion regulation to alcohol and drug use problems, including among populations characterized by intimate partner violence (IPV). Advancing this research, the goal of the current study was to examine cognitive emotion regulation strategies and alcohol and drug use problems within a dyadic framework. Specifically, we examined actor and partner effects of maladaptive and adaptive cognitive emotion regulation strategies on alcohol and drug use problems. METHODS: Eighty-four romantic couples (N = 168 total participants) participating in a randomized controlled trial who reported physical IPV and an alcohol use disorder completed self-reported measures of cognitive emotion regulation as well as alcohol and drug use problems. RESULTS: Regarding actor effects, men's greater use of maladaptive cognitive emotion regulation strategies was positively related to their alcohol use problems (p < .001), whereas both women's (p = .02) and men's (p = .047) greater use of adaptive cognitive emotion regulation strategies was negatively related to their own alcohol use problems. In terms of partner effects, men's greater use of maladaptive cognitive emotion regulation strategies (p = .001) and less use of adaptive cognitive emotion regulation strategies (p = .017) was related to their partners' greater drug use problems. CONCLUSIONS: Findings replicate and extend existing work in this area, showing that men's and women's emotion regulation strategies are related to their own alcohol and drug use problems and that men's cognitive emotion regulation strategies are also related to their partners' drug use problems.

Time Spent Together in Intimate Relationships: Implications for Relationship Functioning.

Current models of relationship functioning often emphasize conflict with a particular focus on the behaviors that occur in that context. Much less is known about the impact of time spent interacting in the absence of conflict. The primary aim of this study is to test associations between time spent in various forms of daily interaction (engaging in a shared activity, talking, and arguing) and multiple relationship outcomes while controlling for positive and negative communication during conflict. The present sample consists of 49 married couples (N = 98 individuals). Data were analyzed using multilevel models to account for non-independence of the data. Consistent with previous literature, communication behaviors were related to relationship outcomes. After controlling for communication, couples who spent more time arguing per day were less satisfied in their relationships, and perceived greater negative qualities in their relationships. Finally, couples who spend a larger proportion of their time together talking reported greater satisfaction, perceived more positive qualities in their relationships, and experienced greater closeness. These findings suggest that low salience interactions account for unique variance in relationship functioning above and beyond what is currently studied. Future research is needed to determine possible mechanisms by which low salience interactions are related to relationship outcomes.

Craving Moderates the Effects of Intranasal Oxytocin on Anger in Response to Social Stress Among Veterans With Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorder.

PURPOSE/BACKGROUND: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur among US military veterans. Oxytocin may have therapeutic value in treating both conditions. The potential for oxytocin to augment affective features common to PTSD and AUD, such as anger, is relevant to inform emerging treatments. METHODS/PROCEDURES: We examined the influence of intranasally administered oxytocin on connections between alcohol craving and stress-induced anger in a sample of 73 veterans (91.3% men) with co-occurring PTSD and AUD. Participants self-administered oxytocin (40 IU) or placebo (saline) 45 minutes before completing the Trier Social Stress Task (TSST). Self-reports of alcohol craving and anger were assessed pre- and post-TSST using a modified visual analog scale. Multiple regression analysis, including main effects for group, baseline craving, and their interaction, was used to predict post-TSST anger. FINDINGS/RESULTS: A marginally significant interaction was observed, suggesting a positive association between baseline craving and anger for those in the oxytocin group (B = 0.65, P = 0.01). Among those reporting low craving, participants in the oxytocin group reported significantly lower post-TSST anger than those in the placebo group. IMPLICATIONS/CONCLUSIONS: The current study is among the first to examine relevant psychosocial moderators that may influence the effects of oxytocin among veterans with comorbid PTSD and AUD. Although oxytocin attenuated ratings of anger after a stress task among those with low baseline craving, findings suggest that oxytocin may not be as effective at reducing anger, a highly salient factor in PTSD, for individuals experiencing high levels of craving. Findings are consistent with the social salience hypothesis and suggest that individual differences in alcohol craving should be considered when evaluating oxytocin as a potential treatment for individuals with comorbid PTSD and AUD.

A replication and extension of the interpersonal process model of demand/withdraw behavior: Incorporating subjective emotional experience.

The demand/withdraw (D/W) interaction pattern is a maladaptive cycle of behavior that is associated with a wide range of deleterious individual and relational outcomes. Partners' emotional responding during couple conflict has long been theorized to play a central role in the occurrence of D/W. The interpersonal process model of D/W behavior suggests that each partner's emotional responses are associated with their own as well as the other partner's behavior in the D/W cycle and that the nature of these associations varies across partners. A prior test of the interpersonal process model provided support for sex- and role-specific associations between vocal emotional expression and demanding and withdrawing behaviors. The current study expands the conceptual frame of the interpersonal process model by incorporating subjective emotional experience. Hypothesized associations between subjective emotional experience, emotional expression, and role-specific demanding and withdrawing behaviors were tested in a sample of 59 couples using an actor-partner interdependence model. Results reveal that spouses experience and express nonsignificantly different levels of negative affect but strongly differ in how the experience and expression of those emotions are related to demanding and withdrawing behaviors. High levels of women's demanding behavior were associated with the combination of experiencing and expressing high levels of negative affect, while high levels of men's withdrawing behavior were associated with experiencing high levels of negative affect but expressing low levels of negative affect. Implications of results for understanding emotional processes in maladaptive cycles and for clinical practice are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Negative Partner Attributions Moderate the Association between Heart Rate Reactivity During Relationship Conflict and Relationship Satisfaction.

Numerous theoretical models of relationship distress suggest that strong, negative reactions to conflict are directly associated with lower levels of relationship satisfaction. Consistent with this supposition, substantial evidence links higher levels of subjective negative emotion, more pronounced and frequent expressions of negative affect, and higher levels of negative communication behaviors to lower levels of relationship satisfaction (e.g., Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). However, the evidence linking stress-related physiological responding during relationship conflict and relationship satisfaction is less compelling than would be anticipated based on theory. We propose that these theoretically unexpected but empirically well-replicated findings may be the result of different patterns in association between physiological reactivity and relationship satisfaction for couples with varying styles in how they typically perceive unwanted behavior in one another. The present study tests negative attributions for undesirable partner behaviors as a moderator of the association between heart rate reactivity (HRR) during relationship conflict and relationship satisfaction in a sample of 60 married couples. A significant interaction emerged between HRR and negative attributions of partner behavior in predicting relationship satisfaction such that higher levels of HRR were associated with lower levels of relationship satisfaction for individuals who typically made more negative attributions for undesirable partner behaviors, but with higher levels of relationship satisfaction for individuals who typically made fewer negative attributions for undesirable partner behaviors. Implications for conceptualizing reactivity during relationship conflict and couple interventions are discussed.

Varios modelos teóricos de distrés relacional sugieren que las reacciones fuertes y negativas al conflicto están directamente asociadas con niveles más bajos de satisfacción con la relación. De acuerdo con esta suposición, hay pruebas sustanciales que vinculan los niveles más altos de emoción negativa subjetiva, las expresiones más marcadas y frecuentes de afecto negativo, y los niveles más altos de conductas de comunicación negativa con niveles más bajos de satisfacción con la relación (p. ej.: Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). Sin embargo, las pruebas que conectan la respuesta fisiológica relacionada con el estrés durante el conflicto en la relación y la satisfacción con la relación son menos convincentes de lo que se esperaría según la teoría. Proponemos que estos resultados teóricamente inesperados, pero bien reproducidos empíricamente, pueden ser el resultado de diferentes patrones que asocian la reactividad fisiológica y la satisfacción con la relación en el caso de las parejas con estilos variados en cuanto a cómo perciben normalmente el comportamiento no deseado en el otro. El presente estudio evalúa las atribuciones negativas para las conductas no deseadas de la pareja como moderadoras de la asociación entre la reactividad de la frecuencia cardíaca (RFC) durante el conflicto en la relación y la satisfacción con la relación en una muestra de 60 parejas casadas. Surgió una interacción significativa entre la RFC y las atribuciones negativas de la conducta de la pareja a la hora de predecir la satisfacción con la relación, de manera que niveles más altos de RFC estuvieron asociados con niveles más bajos de satisfacción con la relación en personas que normalmente hicieron más atribuciones negativas para las conductas no deseadas de la pareja, pero con niveles más altos de satisfacción con la relación para las personas que normalmente hicieron menos atribuciones negativas para las conductas no deseadas de la pareja. Se debaten las implicancias para conceptualizar la reactividad durante el conflicto en la relación y las intervenciones en la pareja.

Relative importance of conflict topics for within-couple tests: The case of demand/withdraw interaction.

Researchers commonly employ observational methods, in which partners discuss topics of concern to them, to test gender differences and other within-couple differences in couple conflict behavior. We describe a previously unidentified assumption upon which statistical tests in these observational studies are frequently reliant: whether each partner is more concerned or dissatisfied with the topic selected for them than the partner is. We term this the relative importance assumption and show that common procedures for selecting conflict discussion topics can lead to widespread violations of the assumption in empirical studies. Study 1 conducts a systematic review of the literature and finds that few existing studies ensure relative importance is met. Study 2 uses two empirical samples to estimate how often relative importance is violated when not ensured, finding it is violated in one third of interaction tasks. Study 3 examines the potential consequences of violating the relative importance assumption when testing within-couple differences in observed behavior, focusing on gender differences in the demand/withdraw pattern. Results show that these tests were profoundly impacted by violations of relative importance. In light of these violations, we conduct a more rigorous test of demand/withdraw theories and clarify previously inconsistent results in the literature. We recommend explicit consideration of relative importance for studies testing within-couple effects, provide methodological recommendations for selecting topics in future studies, and discuss implications for clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sleep Quality and Inflammation in Married Heterosexual Couples: an Actor-Partner Analysis.

BACKGROUND: Subjective sleep quality is a predictor of important health outcomes, but little work has examined the social context of sleep that might inform theoretical models and intervention approaches. The present study tested actor-partner models of sleep quality and its links to inflammatory markers. METHOD: Participants were 84 middle-age to older adult heterosexual married couples who completed the Pittsburgh Sleep Quality Index and had blood drawn for determination of CRP and IL-6 levels. RESULTS: Main results indicated that only actor levels of poor global sleep quality predicted higher CRP levels. No actor × partner or gender × actor/partner interactions were significant. These results were also not moderated by relationship quality. Secondary analyses, focused on the different components of sleep quality, revealed marginally significant evidence for partner's poor sleep (i.e., sleep disturbances, sleep latency) on one's own inflammatory outcomes. CONCLUSION: These results suggest the promise of modeling sleep quality as a dyadic process that can impact inflammation and potentially related health outcomes.

Strained Bedfellows: An Actor-Partner Analysis of Spousal Attachment Insecurity and Sleep Quality.

Background: The quality of interpersonal ties-especially closer relationships-appears to be associated with physical health outcomes. Sleep is one pathway through which relationships and health appear to be linked, but this has been inadequately investigated in the context of dyadic attachment. Purpose: The present study examined links between relationship-specific attachment anxiety (which can involve preoccupation with one's partner, negative relationship cognitions, and fear of abandonment) and avoidance (e.g., low emotional investment or intimacy) and sleep quality. Methods: Attachment, assessed using the Experience in Close Relationship (ECR), was used to predict Pittsburgh Sleep Quality Inventory (PSQI)-assessed sleep quality in 92 married heterosexual couples via actor-partner interdependence models. Depression was examined as a potential mediator of this association. Results: Consistent with hypotheses, actors' anxious attachment predicted diminished quality of their own sleep, whereas actors' avoidant attachment was unrelated to their own sleep quality. Results further suggested that couples in which both spouses were higher in attachment anxiety experience better sleep quality (b = -0.74, SE = 0.28, p = .0082, 95% CI [-1.287, -0.196]). Conversely, couples in which both spouses were higher in attachment avoidance showed poorer sleep quality (b = 0.56, SE = 0.23, p = .0188, 95% CI [0.095, 1.016]). These effects were found to be independent of marital satisfaction and depression. Some evidence was also consistent with mediation of links between attachment and sleep quality via depression. Conclusions: Results suggest adult romantic attachment and sleep are associated in complex ways, highlighting the importance of dyadic approaches to the study of relationships, sleep, and health.

Social support and sleep: A meta-analysis.

OBJECTIVE: While the implications of social support are increasingly well understood, no meta-analytic review to date has examined the intersection of the social support and sleep literatures. The aims of this meta-analysis were primarily to review the association between social support and sleep and additionally to test several proposed moderators from prior work. METHOD: Using a literature search and the ancestry approach, the review identified 61 studies with a total of 105,437 participants. RESULTS: Random-effects modeling showed that greater social support was significantly related to improved sleep outcomes (Zr = -.152). These results were not moderated by the operationalization of support, study design, or chronic conditions. CONCLUSIONS: These data indicate a robust association between social support and favorable sleep outcomes. (PsycINFO Database Record

Cardiovascular Reactivity During Marital Conflict in Laboratory and Naturalistic Settings: Differential Associations with Relationship and Individual Functioning Across Contexts.

Cardiovascular reactivity during spousal conflict is considered to be one of the main pathways for relationship distress to impact physical, mental, and relationship health. However, the magnitude of association between cardiovascular reactivity during laboratory marital conflict and relationship functioning is small and inconsistent given the scope of its importance in theoretical models of intimate relationships. This study tests the possibility that cardiovascular data collected in laboratory settings downwardly bias the magnitude of these associations when compared to measures obtained in naturalistic settings. Ambulatory cardiovascular reactivity data were collected from 20 couples during two relationship conflicts in a research laboratory, two planned relationship conflicts at couples' homes, and two spontaneous relationship conflicts during couples' daily lives. Associations between self-report measures of relationship functioning, individual functioning, and cardiovascular reactivity across settings are tested using multilevel models. Cardiovascular reactivity was significantly larger during planned and spontaneous relationship conflicts in naturalistic settings than during planned relationship conflicts in the laboratory. Similarly, associations with relationship and individual functioning variables were statistically significantly larger for cardiovascular data collected in naturalistic settings than the same data collected in the laboratory. Our findings suggest that cardiovascular reactivity during spousal conflict in naturalistic settings is statistically significantly different from that elicited in laboratory settings both in magnitude and in the pattern of associations with a wide range of inter- and intrapersonal variables. These differences in findings across laboratory and naturalistic physiological responses highlight the value of testing physiological phenomena across interaction contexts in romantic relationships.

Social support, social integration, and inflammatory cytokines: A meta-analysis.

OBJECTIVE: Social support and social integration have been linked to lower rates of morbidity and mortality. However, the biological mechanisms responsible for such links need greater attention to advance theory and unique intervention opportunities. The main aim of this article was to conduct a meta-analytic review of the association between social support-social integration and inflammatory cytokines (e.g., interleukin-6, C-reactive protein) and test several proposed moderators from prior qualitative reviews. METHOD: A literature search was conducted using the ancestry approach and with databases PsycINFO, Medline, and EMBASE by crossing the exact keywords social support or social integration with inflammation. The review identified 41 studies with a total of 73,037 participants. RESULTS: The omnibus meta-analysis showed that social support-social integration were significantly related to lower levels of inflammation (Zr = -.073). These results were not moderated by the operationalization of social relationships or the type of population, cytokine, and design. CONCLUSIONS: These data suggest that inflammation is at least one important biological mechanism linking social support and social integration to the development and course of disease. Future work should continue to build on this review and address next-generation questions regarding antecedent processes, mechanisms, and other potential moderators. (PsycINFO Database Record

A multivariate dynamic systems model for psychotherapy with more than one client.

The dynamics of the give and take between therapist and client(s) is frequently of interest to therapy process researchers. Characterizing the ways that therapists respond to clients and clients respond to therapists can be challenging in therapeutic encounters involving a single therapist and a single client. The complexity of this challenge increases as the number of people involved in a therapeutic encounter increases not only because there are more people responding to one another but also because the patterns of responding can become more complex. This manuscript demonstrates how dyadic cross-lagged panel models can be extended to psychotherapeutic encounters involving 3 people and used to test processes that exist between dyadic subsets of the larger group as well as the group as one cohesive unit. Three hundred seventy-nine talk turns of fundamental frequency from a couple therapy session were modeled using 3 dyadic cross-lagged panel models, and each individual's respiratory sinus arrhythmia (RSA) was treated as a moderator. Although the regression coefficients for each dyadic subset (e.g., therapist-husband) were nonsignificant, an eigenvalue/eigenvector decomposition of the regression coefficients from the 3 dyadic cross-lagged panel models suggests that interdependence exists at the level of the whole group (i.e., therapist-husband-wife) rather than between pairs of individuals within the group (e.g., husband-wife). Further, an interaction involving husband's RSA suggested that interdependence involving the husband ceased when the husband displayed greater regulatory effort. This combination of statistical methods allows for clearly distinguishing between dyadic therapeutic processes and group-level therapeutic processes. (PsycINFO Database Record

Graphic methods for interpreting longitudinal dyadic patterns from repeated-measures actor-partner interdependence models.

Researchers commonly use repeated-measures actor-partner interdependence models (RM-APIM) to understand how romantic partners change in relation to one another over time. However, traditional interpretations of the results of these models do not fully or correctly capture the dyadic temporal patterns estimated in RM-APIM. Interpretation of results from these models largely focuses on the meaning of single-parameter estimates in isolation from all the others. However, considering individual coefficients separately impedes the understanding of how these associations combine to produce an interdependent pattern that emerges over time. Additionally, positive within-person, or actor, effects are commonly misinterpreted as indicating growth from one time point to the next when they actually represent decline. We suggest that change-as-outcome RM-APIMs and vector field diagrams (VFDs) can be used to improve the understanding and presentation of dyadic patterns of association described by standard RM-APIMs. The current article briefly reviews the conceptual foundations of RM-APIMs, demonstrates how change-as-outcome RM-APIMs and VFDs can aid interpretation of standard RM-APIMs, and provides a tutorial in making VFDs using multilevel modeling. (PsycINFO Database Record