Couple Connection and Cancer: Understanding the Mechanisms of Partner Support for Women with Breast Cancer

Previous research has demonstrated that social support can be an effective tool for women with breast cancer to cope with negative outcomes due to the disease. Interventions have been created to increase social support for women with breast cancer; however, these interventions have produced inconsistent findings. To create a successful support intervention, research should first identify malleable factors that could lead to changes in support. Communication and relationship schematic processing (RSP) are two such potential factors. The current study investigated the relationship between (a) communication and RSP, (b) partner support satisfaction, and (c) outcomes in women with breast cancer to determine whether communication and RSP are related to support satisfaction, which relates to outcomes. Seventy-eight couples participated in this study as part of a larger intervention study. Couples participated in a videotaped decision-making interaction task, which was observationally coded for communication and RSP. Couples also completed self-report questionnaires, and women completed daily diaries after the assessment. Path analyses suggested that negative couple communication is associated with lower levels of support satisfaction, which is related to less positive mood, higher negative mood, lower role functioning, and less relationship satisfaction in women with breast cancer. Post hoc analyses suggested that, when RSP pull is included in the model, male RSP quality and RSP pull for males are both related to higher support satisfaction, which is related to greater positive mood, less negative mood, higher role functioning, and greater relationship satisfaction. On the other hand, RSP pull for females is associated with lower support satisfaction, which is related to less positive mood, higher negative mood, lower role functioning, and less relationship satisfaction. Implications of these findings, limitations, and future directions are discussed

Daily Measures of Spousal Support in Women with Breast Cancer

The effects of partner support on women with breast cancer were investigated utilizing a daily diary methodology. Fifty-four women who had recently been diagnosed with early-stage breast cancer completed daily diary measures of partner support amount and satisfaction, mood, cancer symptoms, and role functioning each day for 30 days. Results indicate that the relationship between support amount and satisfaction and the various outcomes differs depending on the level of support, suggesting different underlying mechanisms for average, same-day, and previous-day support. Women’s average amount and satisfaction with support may help protect the women from the negative impact of breast cancer, while a woman’s daily fluctuations in support seem to be related to her experience on that specific day. For previous-day support, amount appears to operate in the expected direction, while the effect of satisfaction is unclear. Thus, amount and satisfaction are both important when investigating effects of partner support

The relationship between stressful life events and cognitive function in HIV-infected men

Previous studies have demonstrated an impact of stress on immune function, and recent studies have suggested an adverse effect of stress on the brain. However, no previous study has examined the impact of stress on cognitive function. This article examines the relationship between stress and cognitive function in 82 HIV-negative subjects and 251 HIV-positive subjects. Subjects completed a comprehensive neuropsychological examination, measures of anxiety and depression, and a measure of stressful life events. After controlling for the impact of anxiety, depression, age, and education, stressful life events were related to cognitive impairment only among the HIV-positive subjects. The data were interpreted in the context of previous studies that have demonstrated an adverse effect of stress on the brain and suggest that this adverse impact may be expressed in the setting of a compromised immune system. Furthermore, this analysis suggests several implications for patient management

Longitudinal Associations Between PTSD Symptoms and Dyadic Conflict Communication Following a Severe Motor Vehicle Accident

There are well-documented associations between posttraumatic stress disorder (PTSD) symptoms and intimate relationship impairments, including dysfunctional communication at times of relationship conflict. To date, the extant research on the associations between PTSD symptom severity and conflict communication has been cross-sectional and focused on military and veteran couples. No published work has evaluated the extent to which PTSD symptom severity and communication at times of relationship conflict influence each other over time or in civilian samples. The current study examined the prospective bidirectional associations between PTSD symptom severity and dyadic conflict communication in a sample of 114 severe motor vehicle accident (MVA) survivors in a committed intimate relationship at the time of the accident. PTSD symptom severity and dyadic conflict communication were assessed at 4 and 16 weeks post-MVA, and prospective associations were examined using path analysis. Total PTSD symptom severity at 4 weeks prospectively predicted greater dysfunctional communication at 16 weeks post-MVA but not vice versa. Examination at the level of PTSD symptom clusters revealed that effortful avoidance at 4 weeks prospectively predicted greater dysfunctional communication at 16 weeks, whereas dysfunctional communication 4 weeks after the MVA predicted more severe emotional numbing at 16 weeks. Findings highlight the role of PTSD symptoms in contributing to dysfunctional communication and the importance of considering PTSD symptom clusters separately when investigating the dynamic interplay between PTSD symptoms and relationship functioning over time, particularly during the early posttrauma period. Clinical implications for the prevention of chronic PTSD and associated relationship problems are discussed

The significant others’ responses to trauma scale (SORTS): applying factor analysis and item response theory to a measure of PTSD symptom accommodation

Background: Symptom accommodation by family members (FMs) of individuals with posttraumatic stress disorder (PTSD) includes FMs’ participation in patients’ avoidance/safety behaviours and constraining self-expression to minimise conflict, potentially maintaining patients’ symptoms. The Significant Others’ Responses to Trauma Scale (SORTS) is the only existing measure of accommodation in PTSD but has not been rigorously psychometrically tested.Objective: We aimed to conduct further psychometric analyses to determine the factor structure and overall performance of the SORTS. Method: We conducted exploratory and confirmatory factor analyses using a sample of N = 715 FMs (85.7% female, 62.1% White, 86.7% romantic partners of individuals with elevated PTSD symptoms).Results: After dropping cross-loading items, results indicated good fit for a higher-order model of accommodation with two factors: an anger-related accommodation factor encompassed items related largely to minimising conflict, and an anxiety-related accommodation factor encompassed items related primarily to changes to the FM’s activities. Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction, although the factors showed somewhat distinct associations. Item Response Theory analyses indicated that the scale provided good information and robust coverage of different accommodation levels.Conclusions: SORTS data should be analysed as both a single score as well as two factors to explore the factors’ potential differential performance across treatment and relationship outcomes

Cognitive–behavioural conjoint therapy versus prolonged exposure for PTSD in military service members and veterans: results and lessons from a randomized controlled trial

Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD. The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive–Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders – provider’s treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD. There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments. This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships. Differential dropout from trial of couple versus individual therapy for PTSD.General pattern of improvements in relationship outcomes in couple therapy for PTSD.PTSD symptoms improved in the individual and couple therapy for PTSD.Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout by condition on trial analyses are discussed. Differential dropout from trial of couple versus individual therapy for PTSD. General pattern of improvements in relationship outcomes in couple therapy for PTSD. PTSD symptoms improved in the individual and couple therapy for PTSD. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout by condition on trial analyses are discussed.</p