Couples communication and cancer: Sequences and trajectories of behavioral affective processes in relation to intimacy.

Cancer poses a set of physical and emotional challenges to the patient, spouse, and their relationship. One challenge for couples is discussing cancer-related concerns in a manner that facilitates intimacy. Current couple-based interventions have been shown to have mixed efficacy, and little is known about how they bring about improvements. This study aims to expand our understanding of dyadic communication and intimacy to adapt and/or develop more effective interventions for couples coping with cancer. To accomplish this goal, the present study examined affective and behavioral processes associated with intimacy using the valence-affective-connection (VAC) framework and observational coding methods. Participants were 134 couples in which a patient was diagnosed with breast, colorectal, or lung cancer. Couples completed a battery of questionnaires, including a self-report measure of intimacy. Couples also completed a 15-min videotaped interaction about a cancer topic of their choosing, which was observationally coded for communication behavior and affective expression. Couples coping with cancer who reported higher versus lower intimacy engaged in qualitatively different levels, types, and patterns of communication behavior and affective expression. Specifically, couples who reported lower relationship intimacy used negative approach behavior and hard negative affect more frequently and for longer periods of time and were more likely to use avoidance-based communication. Higher intimacy couples were less likely to sustain the use of negative behavior and affect and displayed more reciprocity of positive joining affect. The study highlights important considerations for couple-based interventions and research in the context of cancer. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attachment in Couples Coping with Cancer: Associations with Observed Communication and Long-Term Health.

Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with poorer psychosocial well-being, yet studies examining links between attachment, communication, and long-term physical well-being are lacking. We examined (a) associations between patient and partner attachment (measured with the adult attachment scale [AAS-Revised]) and observed communication (across affect [the Relational Affective Topography System (RATS) coding system] and behavior [the Asymmetric Behavior Coding System (ABCS) coding system]) and (b) the extent to which attachment and communication independently predicted long-term physical well-being (measured by the Functional Assessment of Cancer Therapy-General Population [FACT-GP]). Participants were 134 couples [mean age 53.9 (SD = 13.4), 86.2% Caucasian, 66% of patients, 36% of partners female]. Patient participants had either breast, colorectal, or lung cancer. Couples individually completed self-report measures of attachment (baseline) and physical well-being (baseline and 4, 8, and 12 months later). At baseline, couples engaged in a 15 min videorecorded cancer-related conversation coded for communication behavior and affective expression. Patients and partners with higher anxious and avoidant attachment exhibited more negative affect and negative approach behaviors. A greater avoidant attachment was associated with less positive affective expression. Attachment insecurity and affective expression were prospectively linked with physical well-being. Findings indicate that attachment is associated with overt communication behaviors and that insecure attachment and affective expression may be risk factors for poorer health outcomes.

Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial.

BACKGROUND: For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions can to be beneficial for patients and partners. However, these studies have been limited by reliance on in-person treatment delivery and have not targeted couples at high risk for poor outcomes. This study tests the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples reporting high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning. METHODS: This RCT is designed to evaluate the efficacy of CCST in improving patient and partner relationship functioning (primary outcome). Secondary outcomes include patient and partner psychological functioning and patient symptoms and health care use. We also examine the role of objective and self-reported communication behaviors as mediators of treatment effects. Two hundred thirty patients with advanced lung, gastrointestinal, genitourinary, and breast cancer and their partners will be randomized to CCST or an education control intervention. Participants in both conditions complete self-reported outcome measures at baseline, mid-treatment, post-treatment, and 3 months post-treatment. Objective measures of communication are derived from video-recorded couple conversations collected at baseline and post-treatment. An implementation-related process evaluation (assessing implementation outcomes and potential barriers to/facilitators of implementation) will be conducted to inform future efforts to implement CCST in real-world settings. DISCUSSION: This trial can yield important new knowledge about effective ways to improve patient and partner adjustment to advanced cancer. TRIAL REGISTRATION: This study trial is registered at clinicaltrials.gov (Trial # NCT04590885); registration date: October 19, 2020.

Using web-based technologies to increase reach, inclusion, and generalizability in behavioral observation research.

Social scientists have long utilized observations of human behavior in research designs. For researchers studying couples, observation of romantic partners has led to important discoveries about how such behavior is associated with physical, mental, and family health. Historically, these methods have been used in in-person laboratory paradigms that place notable limitations on reach and inclusion. This has, in turn, restricted the generalizability of such research to couples who may not attend an in-person laboratory assessment. Transferring the observational laboratory into an online format has the potential to expand the capabilities of these methods to include more diverse couples. This article presents two empirical studies that used online methods to conduct observational behavioral research with sexual and gender minority couples, populations that could be difficult to reach using traditional methods in many places. We demonstrate that we were able to reach, recruit, and enroll diverse couples that more closely resemble the population of same-sex couples in the United States than likely would have been reached in-person. Further, we show that the quality of the observational data collected via the internet allowed for over 94% of collected data to be coded, with acceptable interrater reliabilities and convergent validity. These studies provide a proof-of-concept of online observational methods, accompanied by a tutorial for using such methods. We discuss possible extensions of these online methods, their limitations, and the potential to help further the field of close relationships by reaching more diverse relationships and increasing the generalizability of our research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Suicide as an interpersonal phenomenon: Dyadic methodological and statistical considerations in suicide research.

Interpersonal risk and resilience factors are prominent in current conceptual models of suicide. A growing body of empirical evidence links suicidal thoughts and behaviors to a range of interpersonal phenomenon adding further support to the value of this line of inquiry. At present, research on interpersonal phenomenon focuses on assessing individuals' perceptions of interpersonal phenomenon, such as appraisals of burdensomeness, experienced loneliness, and thwarted belongingness. As this line of research continues to develop, we argue that it would be valuable to consider incorporating conceptual models of interpersonal phenomenon and corresponding methodological approaches from closely allied fields. After providing a brief overview of interpersonal models of suicide, we present an introduction to conceptual models of interpersonal phenomenon developed in relationship science, describe how these models can be applied to the study of interpersonal phenomenon in suicide research, and close with a guided tutorial on data collection and statistical analysis methods for testing hypotheses derived from these conceptual approaches. References for additional reading are provided, and the Appendix S1 provides simulated data sets and statistical code for the analyses in the tutorial section.

Couple Communication in Cancer: Protocol for a Multi-Method Examination.

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples' ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being.

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).

The effect of stress on empathic accuracy in romantic couples.

Accurately understanding the thoughts and feelings of romantic partners, termed empathic accuracy, is critical for optimal relationship functioning. Empathic failure is linked to common reasons couples seek therapy (Doss, Simpson, & Christensen, 2004; Jacobson & Christensen, 1996) and is either implicitly or explicitly a target of many couple therapies (e.g., Jacobson & Christensen, 1996). More specifically, couple therapies target partners' abilities to accurately understand one another preceding and during conflict, periods characterized by high levels of stress. The current study tests the hypothesis that acute stress can be harmful for empathic accuracy in romantic couples, and tests two competing path models of the impact of stress on accuracy. Results show that an acute stressor affected accuracy of men and women differently, impairing accuracy in women but not observably affecting men's accuracy. The effect of the stressor on empathic accuracy for women was mediated by curvilinear arousal, and men's accuracy was also associated with curvilinear arousal. This pattern of results suggests that moderate arousal is optimal for empathic accuracy for both men and women, but this effect was twice as large for women relative to men. These findings point toward potential avenues to improve existing couple therapies by incorporating strategies to mitigate the effects of stress, thereby increasing couples' ability to accurately understand one another in therapy. These findings also suggest strategies for couples to be optimally productive when having important relationship conversations by attending to their level of arousal. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Conceptual and statistical issues in couples observational research: Rationale and methods for design decisions.

Observational behavioral coding methods are widely used for the study of relational phenomena. There are numerous guidelines for the development and implementation of these methods that include principles for creating new and adapting existing coding systems as well as principles for creating coding teams. While these principles have been successfully implemented in research on relational phenomena, the ever expanding array of phenomena being investigated with observational methods calls for a similar expansion of these principles. Specifically, guidelines are needed for decisions that arise in current areas of emphasis in couple research including observational investigation of related outcomes (e.g., relationship distress and psychological symptoms), the study of change in behavior over time, and the study of group similarities and differences in the enactment and perception of behavior. This article describes conceptual and statistical considerations involved in these 3 areas of research and presents principle- and empirically based rationale for design decisions related to these issues. A unifying principle underlying these guidelines is the need for careful consideration of fit between theory, research questions, selection of coding systems, and creation of coding teams. Implications of (mis)fit for the advancement of theory are discussed. (PsycINFO Database Record