Communal Coping in Couples With Health Problems

Prior to the 1990s, the predominant view of stress and coping defined stress as occurring when an individual perceives a situation as a challenge, threat, or loss and evaluates her capacity to respond based on her available resources. As an expansion of this intrapersonal perspective, the last 20 years have seen the emergence of two prominent interpersonal perspectives on stress and coping that account for the importance of social relationships in the coping process: the Systemic Transactional Model (STM) of dyadic coping and communal coping. In this article, I outline these two perspectives and highlight their points of convergence and divergence. I propose that one difference between the models is that communal coping involves an explicit focus on a communal or shared appraisal process, in which relationship partners view a problem or stressor as “ours” rather than “yours” or “mine.” I review existing methods for assessing communal coping (e.g., self-report, language use, behavioral observation) across laboratory, intervention, and real-world settings and summarize empirical evidence for the prognostic significance of communal coping for relationship and health functioning. I propose the utility of incorporating measurement of shared appraisal into future research on dyadic coping with stress, because of its potential to impact health through its influence on primary and secondary stress appraisal processes and physiological stress response systems. Finally, I outline biological and behavioral pathways through which communal coping may influence health as directions for future research

Medical Care Disruptions During the First Six-Months of the COVID19 Pandemic: The Experience of Older Breast Cancer Survivors

Purpose Older cancer survivors required medical care during the COVID-19 pandemic despite infection risks, but there are limited data on medical care in this age group. Methods. We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors ages 60-98 from five US regions (n=321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included self-reported interruptions in ability to see doctors, receive treatment or supportive therapies, or fill prescriptions. Logistic regression models evaluated bivariate and multivariate associations between care disruptions and education, medical, psychosocial and COVID-19-related factors. Multivariate models included age, county COVID-19 rates, comorbidity and post-diagnosis time. Results. There was a high response rate (n=262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were significantly higher with more education (OR 1.23 per one-year increase, 95% CI 1.09-1.39, p =0.001) and greater depression (OR 1.04 per one-point increase in CES-D score, CI 1.003-1.08, p=0.033); tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99 per one-point increase, p=0.012). There was a trend for associations between disruptions and comorbidity (unadjusted OR 1.13 per 1 added comorbidity, 95% CI 0.99-1.29, p=0.07). Adjusting for covariates, only higher education (p=0.001) and tangible social support (p=0.006) remained significantly associated with having care disruptions. Conclusions. Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions

Loneliness and mental health during the COVID‐19 pandemic in older breast cancer survivors and noncancer controls

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background: The coronavirus disease 2019 (COVID-19) pandemic has had wide-ranging health effects and increased isolation. Older with cancer patients might be especially vulnerable to loneliness and poor mental health during the pandemic. Methods: The authors included active participants enrolled in the longitudinal Thinking and Living With Cancer study of nonmetastatic breast cancer survivors aged 60 to 89 years (n = 262) and matched controls (n = 165) from 5 US regions. Participants completed questionnaires at parent study enrollment and then annually, including a web-based or telephone COVID-19 survey, between May 27 and September 11, 2020. Mixed-effects models were used to examine changes in loneliness (a single item on the Center for Epidemiologic Studies-Depression [CES-D] scale) from before to during the pandemic in survivors versus controls and to test survivor-control differences in the associations between changes in loneliness and changes in mental health, including depression (CES-D, excluding the loneliness item), anxiety (the State-Trait Anxiety Inventory), and perceived stress (the Perceived Stress Scale). Models were adjusted for age, race, county COVID-19 death rates, and time between assessments. Results: Loneliness increased from before to during the pandemic (0.211; P = .001), with no survivor-control differences. Increased loneliness was associated with worsening depression (3.958; P < .001) and anxiety (3.242; P < .001) symptoms and higher stress (1.172; P < .001) during the pandemic, also with no survivor-control differences. Conclusions: Cancer survivors reported changes in loneliness and mental health similar to those reported by women without cancer. However, both groups reported increased loneliness from before to during the pandemic that was related to worsening mental health, suggesting that screening for loneliness during medical care interactions will be important for identifying all older women at risk for adverse mental health effects of the pandemic

Communal Coping as a Change Process in Couple-Focused Interventions for Health Problems

Communal coping—a process in which romantic partners view a problem or stressor as "ours" rather than "yours" or "mine" and engage in collaborative problem solving to address it —has emerged as an important predictor of health and treatment outcomes. This study investigated communal coping as a theoretically derived and empirically supported intervention target within two couple-focused interventions for health problems: Family Systems Therapy for problematic alcohol use and Family Consultation for health-compromised smoking. With a combined sample of 56 couples (37 alcohol, 21 smoking), this study investigated within-session changes in communal coping—indexed via observable, communal coping behaviors and first-person plural pronoun use (we-talk)—prior to and following therapist implementation of specific solution-focused therapy techniques that aimed to promote communal coping in the couples during a target therapy session. Teams of trained raters observed the target therapy sessions and made independent ratings of couple communal coping behaviors and therapist adherence. Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech during the target therapy sessions. Both patients and spouses showed increases in communal coping behavior and we-talk from a "baseline" problem-focused therapy block to the "active" solution-focused therapy block. In addition, exploratory analyses revealed that several couple and therapist characteristics, as well as specific solution-focused techniques were associated with within-session changes in communal coping. Findings from this study identify communal coping as a client change process and solution-focused therapy techniques as a therapist change process within the two interventions, and demonstrate successful engagement of communal coping as a therapeutic target

Relationship closeness buffers the effects of perceived stress on transcriptomic indicators of cellular stress and biological aging marker p16INK4a.

Chronic stress can accelerate biological aging, offering one mechanism through which stress may increase age-related disease risk. Chronic activation of the sympathoadrenal system increases cellular energy production, resulting in cell stress that can initiate cellular senescence, a permanent state of cell growth arrest. Our previous research linked psychosocial stress with increased expression of senescence marker p16INK4a; however, less is known about the role of protective psychosocial factors in biological aging. We examined relationship closeness (perceived interconnectedness with one's spouse) as a protective buffer of the effects of stress on expression of the p16INK4a-encoding gene (CDKN2A) and transcription control pathways activated under cell stress. Seventy parents (Mage=43.2) completed interview-based and questionnaire measures of psychosocial stress and relationship closeness. Blood samples assessed CDKN2A expression and inferred activity of a priori-selected transcription factors Nrf2 and heat shock factors (HSFs) via genome-wide transcriptome profiling. Random intercept models adjusting for age, sex, and ethnicity/race revealed that perceived stress was associated with elevated CDKN2A expression for parents with low but not high closeness. Secondary bioinformatics analyses linked the interaction of perceived stress and relationship closeness to Nrf2 and HSF-1 activity. Findings identify relationship closeness as a protective factor that may buffer the impact of stress on cellular stress and senescence pathways

Chronic stress exposure and daily stress appraisals relate to biological aging marker p16INK4a.

Previous research has linked exposure to adverse social conditions with DNA damage and accelerated telomere shortening, raising the possibility that chronic stress may impact biological aging pathways, ultimately increasing risk for age-related diseases. Less clear, however, is whether these stress-related effects extend to additional hallmarks of biological aging, including cellular senescence, a stable state of cell cycle arrest. The present study aimed to investigate associations between psychosocial stress and two markers of cellular aging-leukocyte telomere length (LTL) and cellular senescence signal p16INK4a. Seventy-three adults (Mage = 43.0, SD = 7.2; 55% female) with children between 8-13 years of age completed interview-based and questionnaire measures of their exposures to and experiences of stress, as well as daily reports of stress appraisals over an 8-week diary period. Blood samples were used to assess markers of cellular aging: LTL and gene expression of senescent cell signal p16INK4a (CDKN2A). Random effects models covarying for age, sex, ethnicity/race, and BMI revealed that participants with greater chronic stress exposure over the previous 6 months (b = 0.011, p =  .04), perceived stress (b = 0.020, p &lt;  .001), and accumulated daily stress appraisals over the 8-week period (b = 0.013, p =  .02) showed increased p16INK4a. No significant associations with LTL were found. These findings extend previous work on the impact of stress on biological aging by linking chronic stress exposure and daily stressful experiences to an accumulation of senescent cells. Findings also support the hypothesis that chronic stress is associated with accelerated aging by inducing cellular senescence, a common correlate of age-related diseases

Interpersonal Focus in the Emotional Autobiographical Memories of Older and Younger Adults

The present study examined the interpersonal focus within autobiographical memories (AMs) of older and younger adults from the perspective of socioemotional selectivity theory (SST). Specifically, we measured interpersonal focus directly through rater codings (relational vs. individual focus) and social word use, and indirectly through personal pronoun use. Forty-five older (M-age = 76.76) and 25 younger (M-age = 18.64) adults recalled positive and negative AMs, which were then coded and processed through computerized text analysis software to obtain word-use counts. Consistent with SST, the positive AMs of older adults were more interpersonally focused compared to negative AMs and younger adults. The results suggest that the positive life experiences of older adults tend to be associated with a high degree of social importance and focus on others.12 month embargo; published online: 26 February 2020This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]