Constructing We-ness: A Communal Coping Intervention for Couples Facing Chronic Illness.

Communal coping occurs when relationship partners view a stressful health problem as "ours," rather than yours or mine, and take collaborative action to deal with it. Although research employing linguistic (we-talk) and other measures of communal coping demonstrates relevance to a variety of chronic illnesses, the literature offers little about how clinicians can actively promote we-ness and teamwork to help patients and their partners achieve the health benefits this appears to confer. This paper highlights clinical and supporting scientific features of a narrative intervention designed to foster communal coping by couples in which one partner has a chronic illness. The illustrative illness is diabetes, but with modification the protocol is suitable for other chronic conditions as well. Grounded in systemic and narrative models of problem maintenance and change, the communal coping intervention represents a distillation of research and clinical experience with family consultation over several decades. In contrast to more directive and educational approaches, the intervention consists entirely of questions, with no direct suggestions or instruction about how patients, partners, or couples should change. These questions comprise 8 sequential modules (Coping Challenges, Trajectory and Focus, Illness as External Invader, You as a Couple, Past Teamwork in Overcoming Adversity, Present and Future Teamwork, Obstacles to Teamwork, and Wrap-Up), described here in manual-like detail.

El afrontamiento comunitario ocurre cuando las parejas de una relación ven un problema de salud estresante como nuestro, en lugar de tuyo o mío, y toman medidas colaborativas para resolverlo. Aunque las investigaciones que emplean medidas lingüísticas (uso de nosotros al hablar) y otras medidas de afrontamiento comunitario demuestran relevancia para diversas enfermedades crónicas, la bibliografía ofrece poco sobre cómo los profesionales clínicos pueden promover activamente la nostredad y el trabajo en equipo para ayudar a los pacientes y a sus parejas a obtener los beneficios de salud que esto parece conceder. Este artículo destaca las características científicas clínicas y respaldatorias de una intervención narrativa diseñada para fomentar el afrontamiento comunitario por parte de parejas en las cuales uno de sus integrantes tiene una enfermedad crónica. La enfermedad que se ejemplifica es la diabetes, pero con modificaciones, el protocolo es apropiado para otras enfermedades crónicas también. Basada en modelos sistémicos y narrativos de mantenimiento de problemas y de cambio, la intervención de afrontamiento comunitario representa una síntesis de la investigación y la experiencia clínica con consultas de familias durante varias décadas. En contraste con enfoques más autoritarios y educativos, la intervención consiste totalmente en preguntas, sin sugerencias directas ni órdenes sobre cómo los pacientes, las integrantes de la pareja o las parejas deben cambiar. Estas preguntas están compuestas por ocho módulos correlativos (Las dificultades del afrontamiento, La trayectoria y el enfoque, La enfermedad como invasor externo, Ustedes como pareja, El trabajo previo en equipo a la hora de superar la adversidad, El trabajo en equipo presente y futuro, Los obstáculos para el trabajo en equipo, y Conclusión), descritos aquí en detalle al estilo de un manual.

Beyond the "self" in self-regulation: Family interaction modulates situational self-control by adolescent drug users.

Prevailing views of adolescent self-regulation (ASR) as a relatively stable disposition or skill that an individual possesses in various degrees stand in contrast to a complementary, situational perspective from family systems theory casting ASR as intertwined with ongoing family processes and malleable depending on interpersonal interactions. Using observational data from a large, ethnically diverse sample of substance-using adolescents (N = 458), the current study examines the social context of ASR across 3 increasingly conflictual family interaction tasks. Coders rated ASR and 3 concurrent family interaction patterns: enmeshment, conflict avoidance, and negative affect. ASR declined across the 3 tasks, and independent of this systematic change, family-level negative affect in the first task exerted a strong lagged statistical effect on subsequent declines in ASR. The findings are consistent with family systems theory in both the context-dependent nature of ASR behavior and the modulating role of family interaction. In addition to its well-established dispositional properties, ASR may be of interest as a context-specific and potentially modifiable dependent variable. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis.

As evidence-based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural-strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off-model, nonsystemic formulations/interventions). Of these, "failure to think in threes" appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.

A medida que los tratamientos familiares factuales para el consumo de sustancias y los problemas de conducta en los adolescentes ganan terreno, la investigación de vanguardia trasciende los ensayos aleatorizados de eficacia teórica para abordar preguntas, por ejemplo, cómo funcionan estos tratamientos y cómo difundirlos mejor en entornos comunitarios. Un factor clave para la difusión eficaz es la fidelidad al tratamiento, que se refiere a implementar una intervención de una manera consecuente con un manual establecido. Si bien la mayor parte de la investigación de fidelidad es cuantitativa, el presente estudio ofrece un análisis clínico cualitativo de fallas de la fidelidad en un ensayo grande multicéntrico de eficacia real de Terapia Familiar Breve y Estratégica (BSFT) para el abuso de drogas en los adolescentes, donde los desarrolladores de la BSFT capacitaron a terapeutas de la comunidad para que apliquen esta intervención en sus propias agencias. Utilizando informes de casos y grabaciones de vídeo de sesiones de terapia, un panel independiente de expertos evaluó primero 103 casos con escalas de fidelidad cuantitativa basadas en el manual de BSFT y el marco estratégico estructural más amplio que respalda la intervención de la BSFT. Como la fidelidad fue generalmente baja, el panel revisó todos los casos cualitativamente para reconocer tipos o categorías emergentes de fallas de la fidelidad. Surgieron diez categorías de fallas caracterizadas por omisiones del terapeuta (p. ej.: el terapeuta no hizo participar a familiares clave, no pensó en grupos de tres) y licencias (p. ej.: desvío del modelo, formulaciones/intervenciones no sistémicas). De estas opciones, la falla en "no pensar en grupos de tres" pareció básica y particularmente problemática, lo cual refleja el lugar fundamental de esta idea en la teoría y la terapia estructural. Aunque nuestras observaciones estén sujetas a un posible sesgo, estas ponen de manifiesto posibles obstáculos a la hora de exportar un tratamiento familiar complejo como la BSFT a entornos comunitarios. Estos resultados también subrayan la importancia de la fidelidad al tratamiento en la investigación sobre terapia familiar.

A Semantic Corpus Comparison Analysis of Couple-Focused Interventions for Problematic Alcohol Use.

Incorporating spouses into interventions for problematic alcohol use is associated with increased efficacy; yet, little is known about the therapeutic processes that may explain these effects. In a study of partner language use during couple-focused alcohol interventions, we utilized a linguistic corpus comparison tool, Wmatrix, to identify semantic themes that differentiated couples with successful and unsuccessful treatment outcomes and may therefore also reflect potential change processes. Thirty-three couples participated in a randomized control trial of Family Systems Therapy (FST) or Cognitive Behavioural Therapy (CBT). Linguistic comparisons of partners' speech during the therapy sessions suggested that drinks and alcohol was a significant differentiating semantic theme. Specifically, patients and spouses in FST with successful outcomes used more language related to drinks and alcohol than patients and spouses in FST with unsuccessful outcomes. Post-hoc analyses of context suggested that, in FST, successful spouses spoke less about the patient's drinking and more about alcohol in general (without reference to an individual) than unsuccessful spouses. Conversely, spouses in CBT with successful outcomes used less language related to drinks and alcohol than spouses in CBT with unsuccessful outcomes. In CBT, successful spouses spoke more about the patient's and couple's drinking and less about the spouse's and other people's drinking than unsuccessful spouses. Results emphasize the role of spouse behaviour-in this case indexed via language use-in alcohol treatment outcomes. Findings also suggest potentially distinct therapeutic processes in FST and CBT and highlight the utility of linguistic corpus comparison methods in couple-focused intervention research. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Incorporating spouses into interventions for problematic alcohol use is associated with increased efficacy; yet, little is known about the specific therapeutic processes that may explain these effects. Findings from this study suggest that semantic themes such as drinks and alcohol in partner speech during therapy sessions differentiate successful and unsuccessful treatment outcomes among couples participating in two couple-focused interventions for problematic alcohol use. In addition, the context in which partners used alcohol-related language differed by intervention type and treatment outcome, which suggests potential therapeutic processes that are unique to the two interventions (Family Systems versus Cognitive Behavioural Therapy).

Partner Pronoun Use, Communal Coping, and Abstinence during Couple-Focused Intervention for Problematic Alcohol Use.

Communal coping-a process in which romantic partners view a problem as ours rather than yours or mine, and take collaborative action to address it -has emerged as an important predictor of health and treatment outcomes. In a study of partners' pronoun use prior to and during couple-focused alcohol interventions, we examined first-person plural (we-talk) and singular (I-talk) pronouns as linguistic markers of communal coping and behavioral predictors of treatment outcome. Thirty-three couples in which one partner abused alcohol were selected from a randomized control trial (N = 63) of couple-focused Cognitive-Behavioral or Family Systems Therapy if they had unambiguously successful or unsuccessful treatment outcomes (i.e., patient maintained abstinence for 30 days prior to treatment termination or had more than one heavy drinking day in the same period). Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech, derived from a videotaped pretreatment interaction task and three subsequent therapy sessions. Spouse we-talk during the intervention (accounting for pretreatment we-talk), as an index of communal orientation, uniquely predicted successful treatment outcomes. In contrast, both patient and spouse I-talk during the intervention (accounting for pretreatment I-talk), as a marker of individualistic orientation, uniquely predicted unsuccessful outcomes, especially when distinguishing active and passive (I vs. me/my) pronoun forms. Results strengthen evidence for the prognostic significance of spouse behavior for patient health outcomes and for communal coping (indexed via pronoun use) as a potential mechanism of change in couple-focused interventions for health problems.

A cross-sectional assessment of the long term effects of brief strategic family therapy for adolescent substance use.

BACKGROUND: Young adult drug use and law-breaking behaviors often have roots in adolescence. These behaviors are predicted by early drug use, parental substance use disorders, and disrupted and conflict-ridden family environments. AIM: To examine long-term outcomes of Brief Strategic Family Therapy (BSFT) compared to treatment as usual (TAU) in the rates of drug use, number of arrests and externalizing behaviors in young adults who were randomized into treatment conditions as adolescents. DESIGN: 261 of 480 adolescents who had been randomized to BSFT or TAU in the BSFT effectiveness study were assessed at a single time, 3-7 years post randomization. METHODS: Assessments of drug use, externalizing behaviors, arrests and incarcerations were conducted using Timeline Follow Back, Adult Self Report, and self-report, respectively. Drug use, arrests and incarcerations were examined using negative binomial models and externalizing behaviors were examined using linear regression. RESULTS: When compared with TAU, BSFT youth reported lower incidence of lifetime (IRR = 0.68, 95%CI [0.57, 0.81]) and past year (IRR = 0.54, 95%CI [0.40, 0.71]) arrests; lower rates of lifetime (IRR = 0.63, 95%CI [0.49, 0.81]) and past year (IRR = 0.70, 95%CI [0.53, 0.92]) incarcerations; and lower scores on externalizing behaviors at follow-up (B = -0.42, SE = .15, p = .005). There were no differences in drug use. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: BSFT may have long term effects in reducing the number of arrests, incarcerations and externalizing problems. These effects could be explained by the improvements in family functioning that occurred during the effectiveness study. This study contributes to the literature by reporting on the long term outcomes of family therapy for adolescent drug abuse.

Old wine in new bottles: decanting systemic family process research in the era of evidence-based practice.

Social cybernetic (systemic) ideas from the early Family Process era, though emanating from qualitative clinical observation, have underappreciated heuristic potential for guiding quantitative empirical research on problem maintenance and change. The old conceptual wines we have attempted to repackage in new, science-friendly bottles include ironic processes (when "solutions" maintain problems), symptom-system fit (when problems stabilize relationships), and communal coping (when we-ness helps people change). Both self-report and observational quantitative methods have been useful in tracking these phenomena, and together the three constructs inform a team-based family consultation approach to working with difficult health and behavior problems. In addition, a large-scale, quantitatively focused effectiveness trial of family therapy for adolescent drug abuse highlights the importance of treatment fidelity and qualitative approaches to examining it. In this sense, echoing the history of family therapy research, our experience with juxtaposing quantitative and qualitative methods has gone full circle-from qualitative to quantitative observation and back again.

Parallel demand-withdraw processes in family therapy for adolescent drug abuse.

Isomorphism, or parallel process, occurs in family therapy when patterns of therapist-client interaction replicate problematic interaction patterns within the family. This study investigated parallel demand-withdraw processes in brief strategic family therapy (BSFT) for adolescent drug abuse, hypothesizing that therapist-demand/adolescent-withdraw interaction (TD/AW) cycles observed early in treatment would predict poor adolescent outcomes at follow-up for families who exhibited entrenched parent-demand/adolescent-withdraw interaction (PD/AW) before treatment began. Participants were 91 families who received at least four sessions of BSFT in a multisite clinical trial on adolescent drug abuse (Robbins et al., 2011). Prior to receiving therapy, families completed videotaped family interaction tasks from which trained observers coded PD/AW. Another team of raters coded TD/AW during two early BSFT sessions. The main dependent variable was the number of drug-use days that adolescents reported in timeline follow-back interviews 7 to 12 months after family therapy began. Zero-inflated Poisson regression analyses supported the main hypothesis, showing that PD/AW and TD/AW interacted to predict adolescent drug use at follow-up. For adolescents in high PD/AW families, higher levels of TD/AW predicted significant increases in drug use at follow-up, whereas for low PD/AW families, TD/AW and follow-up drug use were unrelated. Results suggest that attending to parallel demand-withdraw processes in parent-adolescent and therapist-adolescent dyads may be useful in family therapy for substance-using adolescents.

Asymmetric partner pronoun use and demand-withdraw interaction in couples coping with health problems.

Recent research links first-person plural pronoun use (we-talk) by individual romantic partners to adaptive relationship functioning and individual health outcomes. To examine a possible boundary condition of adaptive we-talk in couples coping with health problems, we correlated asymmetric couple-level we/I-ratios (more we-talk relative to I-talk by the spouse than the patient) with a concurrent pattern of directional demand-withdraw (D-W) interaction in which the spouse demands change while the patient withdraws. Couples in which a partner who abused alcohol (n = 65), smoked cigarettes despite having heart or lung disease (n = 24), or had congestive heart failure (n = 58) discussed a health-related disagreement during a video-recorded interaction task. Transcripts of these conversations provided measures of pronoun use for each partner, and trained observers coded D-W patterns from the recordings. As expected, partner asymmetry in we/I-ratio scores predicted directional demand-withdraw, such that spouses who used more we-talk (relative to I-talk) than patients tended to assume the demand role in concurrent D-W interaction. Asymmetric I-talk rather than we-talk accounted for this association, and asymmetric you-talk contributed independently as well. In contrast to previous studies of we-talk by individual partners, the present results identify dyad-level pronoun patterns that clearly do not mark beneficent processes: asymmetric partner we/I-ratios and you-talk reflect problematic demand-withdraw interaction.

Perceptions of smoking-related risk and worry among dual-smoker couples.

INTRODUCTION: Quit rates are lower and relapse rates are higher for people in close relationships with a partner who smokes. Although desire to quit is often related to health concerns for one's self, much less is known about psychosocial factors associated with quitting in dual-smoker couples. This study investigated relations among beliefs about smoking and desire to quit from both partners' perspectives. METHODS: We recruited 63 couples in which both partners smoke daily. Participants were aged 21-67 (M = 43.0, SD = 11.3) and had been smoking for 4-51 years (M = 22.9, SD = 11.3). RESULTS: Individuals' desire to quit related to worry about partner's health (r = .29, p < .01), perceived risk of partner getting a disease if the partner continues to smoke (r = .39, p < .001), and belief that own smoking has caused partner physical harm (r = .38, p < .001). Within couples, partners were modestly concordant with regard to worry about harm of smoking for oneself (r = .30, p < .05) and partner (r = .30, p < .05), perceived risk of disease for oneself (r = .26, p < .05) and partner (r = .24, p < .05), and desire that partner quit (r = .34, p < .01). Participants had an extremely strong desire (78% = 7 on 1-7 scale) for their partner's help if they attempt to quit. CONCLUSIONS: Dual-smoker couples are at heightened health risks due to exposure to passive smoke and their own smoking. Partners' perceived risk and worry about the harms of smoking could be important leverage points for smoking cessation efforts. Interventions can be informed by considering both partners' beliefs and by helping partners develop plans for quitting and supporting each other.

Family consultation for psychiatrically complicated health problems.

We describe a social cybernetic view of health behavior problems and a team-based family consultation (FAMCON) format for strategic intervention based on that view. This approach takes relationships rather than individuals as the primary unit of analysis and attaches more importance to problem maintenance than to etiology. Treatment aims to interrupt two types of interpersonal problem maintenance-ironic processes and symptom-system fit (conceptualized, respectively, as positive and negative feedback cycles)-and to mobilize communal coping as a relational resource for change. A case example features a depressed husband and bipolar wife complaining of severe communication difficulties related to the husband's kidney cancer and diabetes. Over 6 consultation sessions, strategic interventions focused on interrupting ironic interpersonal patterns resolved the presenting complaint. Although cost-effectiveness is an open question, FAMCON may offer a useful alternative to psychoeducational and cognitive-behavioral treatments in the framework of stepped care.

We-talk, communal coping, and cessation success in a couple-focused intervention for health-compromised smokers.

We investigated first-person plural pronoun use (we-talk) by health-compromised smokers and their spouses as a possible implicit marker of adaptive, problem-resolving communal processes. Twenty couples in which one or both partners used tobacco despite one of them having a heart or lung problem participated in up to 10 sessions of a smoking cessation intervention designed to promote communal coping, where partners define smoking as "our" problem, rather than "your" problem or "my" problem, and take collaborative action to solve it. We used the Linguistic Inquiry Word Count automatic text analysis program to tabulate first-person pronoun use by both partners from transcripts of a pretreatment marital interaction task and later intervention sessions. Results indicated that pretreatment we-talk by the patient's spouse predicted whether the patient remained abstinent 12 months after quitting, and residualized change in we-talk by both partners during the course of intervention (controlling for baseline levels) predicted cessation outcomes as well. These findings add to evidence regarding the prognostic significance of partner we-talk for patient health and provide preliminary documentation of communal coping as a possible mechanism of change in couple-focused intervention.

Brief strategic family therapy versus treatment as usual: results of a multisite randomized trial for substance using adolescents.

OBJECTIVE: To determine the effectiveness of brief strategic family therapy (BSFT; an evidence-based family therapy) compared to treatment as usual (TAU) as provided in community-based adolescent outpatient drug abuse programs. METHOD: A randomized effectiveness trial in the National Drug Abuse Treatment Clinical Trials Network compared BSFT to TAU with a multiethnic sample of adolescents (213 Hispanic, 148 White, and 110 Black) referred for drug abuse treatment at 8 community treatment agencies nationwide. Randomization encompassed both adolescents' families (n = 480) and the agency therapists (n = 49) who provided either TAU or BSFT services. The primary outcome was adolescent drug use, assessed monthly via adolescent self-report and urinalysis for up to 1 year post randomization. Secondary outcomes included treatment engagement (≥2 sessions), retention (≥8 sessions), and participants' reports of family functioning 4, 8, and 12 months following randomization. RESULTS: No overall differences between conditions were observed in the trajectories of self-reports of adolescent drug use. However, the median number of days of self-reported drug use was significantly higher, χ2(1) = 5.40, p < .02, in TAU (Mdn = 3.5, interquartile range [IQR] = 11) than BSFT (Mdn = 2, IQR = 9) at the final observation point. BSFT was significantly more effective than TAU in engaging, χ2(1) = 11.33, p < .001, and retaining, χ2(1) = 5.66, p < .02, family members in treatment and in improving parent reports of family functioning, χ2(2) = 9.10, p < .011. CONCLUSIONS: We discuss challenges in treatment implementation in community settings and provide recommendations for further research.

Gender Differences in Quit Support by Partners of Health-Compromised Smokers.

In a study of spousal support for smoking cessation, 34 couples in which one partner continued to smoke despite having a heart or lung problem used an adaptation of Cohen & Lichtenstein's (1990) Partner Interaction Questionnaire to describe the spouse's attempts to help the primary (ill) smoker quit. Female smokers received less support for quitting from their spouse or partner than male smokers did, regardless of whether the support was positive or negative, whether the partner also smoked, or whether the smoker or partner rated the partner's support behavior Female patients in a treatment sub-sample were also less likely than men to achieve stable 1-year cessation if the couple had rated partner support at baseline as coercive or unhelpful. Given known gender differences in relapse risk, cessation interventions for health-compromised female smokers might profitably include partners in addition to the smokers themselves.

Health consequences of partner distress in couples coping with heart failure.

BACKGROUND: Chronic heart failure (HF) is associated with psychologic distress for patients and their spouses. Although research indicates that a patient's distress can influence the course of illness, less is known about possible effects of a spouse's distress on the patient or of a patient's distress on the health of the spouse. METHODS AND RESULTS: Baseline home interviews of 60 patients with HF (43 men, 17 women) and their spouses included assessments of each partner's psychologic distress (Hopkins Symptom Checklist-25) and perceived general health (Short Form-36 Questionnaire), as well as severity of patients' HF symptoms. We repeated the health and HF-symptom assessments in follow-up interviews 6 months later. As hypothesized, the spouse's distress at baseline predicted an unfavorable course of patients' HF symptoms and general health over the next 6 months, independently of the patient's own baseline distress. There were no prospective effects of the patient's distress on the spouse's health, however, suggesting that partner distress had asymmetric health consequences for patients and spouses. CONCLUSION: The results complement other evidence linking marital quality to the course of HF and highlight the importance of looking beyond the patient to improve prediction of health outcomes.

Affective synchrony in dual- and single-smoker couples: further evidence of "symptom-system fit"?

Couples in which one or both partners smoked despite one of them having a heart or lung problem discussed a health-related disagreement before and during a period of laboratory smoking. Immediately afterwards, the partners in these 25 couples used independent joysticks to recall their continuous emotional experience during the interaction while watching themselves on video. A couple-level index of affective synchrony, reflecting correlated moment-to-moment change in the two partners' joystick ratings, tended to increase from baseline to smoking for 9 dual-smoker couples but decrease for 16 single-smoker couples. Results suggest that coregulation of shared emotional experience could be a factor in smoking persistence, particularly when both partners in a couple smoke. Relationship-focused interventions addressing this fit between symptom and system may help smokers achieve stable cessation.

Prognostic significance of spouse we talk in couples coping with heart failure.

Recent research suggests that marital quality predicts the survival of patients with heart failure (HF), and it is hypothesized that a communal orientation to coping marked by first-person plural pronoun use (we talk) may be a factor in this. During a home interview, 57 HF patients (46 men and 16 women) and their spouses discussed how they coped with the patients' health problems. Analysis of pronoun counts from both partners revealed that we talk by the spouse, but not the patient, independently predicted positive change in the patient's HF symptoms and general health over the next 6 months and did so better than direct self-report measures of marital quality and the communal coping construct. We talk by the patient and spouse did not correlate, however, and gender had no apparent moderating effects on how pronoun use predicted health change. The results highlight the utility of automatic text analysis in couple-interaction research and provide further evidence that looking beyond the patient can improve prediction of health outcomes.

Symptom-system fit in couples: emotion regulation when one or both partners smoke.

In a laboratory smoking experiment, 25 couples in which 1 or both partners continued to smoke despite 1 of them having heart or lung disease discussed a health-related disagreement before and during a period of smoking. Immediately afterward, the partners used independent joysticks to recall their continuous emotional experience during the interaction while watching themselves on video. Participants in dual-smoker couples reported increased positive emotion contingent upon lighting up, whereas those in single-smoker couples reported the opposite. The results highlight the role of smoking in close relationships, particularly in regulating emotional closeness when both partners smoke. Attention to this fit between symptom and system may be useful in helping couples achieve stable cessation.

A family consultation intervention for health-compromised smokers.

Although spousal support predicts the success of a smoker's cessation efforts, "social-support" interventions based on teaching partners better support skills have had consistently disappointing results. We examined the potential utility of a family consultation (FAMCON) intervention based on family-systems principles in a treatment-development project involving 20 couples in which one partner (the primary smoker) continued to smoke despite having or being at significant risk for heart or lung disease. The 50% rate of stable abstinence achieved by primary smokers over at least 6 months exceeds benchmark success rates reported in the literature for other comparably intensive interventions, suggesting that a couple-focused intervention different in concept and format from social-support interventions tested in the past may hold promise for health-compromised smokers. The FAMCON approach appeared particularly well suited to female smokers and smokers whose partner also smoked--two subgroups at high risk for relapse.

Effect of marital quality on eight-year survival of patients with heart failure.

Recent evidence suggests that psychosocial factors such as self-efficacy, psychological distress, perceived social support, and marital quality have prognostic significance for morbidity and mortality after heart failure. Previously, we reported that interview and observational measures of marital quality obtained from 189 patients with heart failure (139 men and 50 women) and their spouses predicted all-cause patient mortality during the next 4 years, independent of the baseline illness severity (New York Heart Association class). We present additional follow-up results for this sample, with Cox regression analyses showing that a couple-level composite measure of marital quality continued to predict survival during an 8-year period (p <0.001), especially when the patient was a woman, and did so substantially better than individual (patient-level) risk and protective factors, such as psychological distress, hostility, neuroticism, self-efficacy, optimism, and breadth of perceived emotional support. In conclusion, relationship factors may be especially relevant in managing a difficult chronic condition such as heart failure, which makes stringent and complex demands on patients and their families.