The Transplant Evaluation Rating Scale (TERS): A Tool for the Psychosocial Evaluation of Lung Transplant Candidates.

OBJECTIVES: An evaluation of psychosocial functioning prior to lung transplantation is advisable for anticipating behavioral difficulties and for screening for any psychological distress that might be harmful to posttransplantation outcomes and adjustment. METHODS: In this cross-sectional, single-center study, the level of psychosocial functioning of N = 75 patients before lung transplantation was rated using the Transplant Evaluation Rating Scale (TERS). RESULTS: he reliability of the TERS total score was satisfactory at α = 0.75. A two-factorial solution (emotional sensitivity; defiance) was found. Higher TERS scores were significantly associated with higher depressive and anxiety symptoms (r = .38/r = .42), lower quality of life (r = -.26), and fewer years abstinent from smoking (r = -.35). No associations were found with lung disease and symptom severity. CONCLUSIONS: The TERS appears to be a reliable and valid measure with clinical utility for specifying behavioral concerns prior to lung transplantation.

[Emotional Arousal (Voice Stress) and Posttraumatic Growth as well as Relationship Satisfaction of Partners of Women with Breast Cancer in the Context of Social Support]. / Stimmlich enkodierte emotionale Erregung (Voice Stress) und Posttraumatische Reifung sowie Partnerschaftszufriedenheit bei Partnern von Brustkrebspatientinnen im Kontext der sozialen Unterstützung.

Introduction Breast cancer is associated with significant psychosocial strains for both patients and partners. Constructive social support and positive communication behavior have been shown to be protective against the burdens associated with breast cancer. Individual levels of emotional arousal during social support interactions with one's spouse are an important aspect of couples' support behaviors and can be assessed via vocal fundamental frequency (f0). Methods N=44 couples had standardized seven-minute long interactions asking the male partner to describe his thoughts and feelings with regard to their wives' breast cancer. Using actor-partner interdependence models (APIM), f0's associations with individual posttraumatic growth (PTG) and perceived marital quality were differentially investigated. Results Significant actor effects for f0 and PTG were found for both husbands as well as tendencies for partner effects and wives. Perceived marital quality was not significantly associated with one's own levels of emotional arousal. No significant partner effects emerged for any of the variables of interest. Discussion Contrary to findings in couples' conflict discussions, higher levels of emotional arousal in social support interactions are associated with positive aspects of psychological functioning. F0 during social support could be associated with higher levels of self-efficacy, which might be beneficial for PTG and constructive ways of emotional expression. Constructive expression of emotional arousal could lead to heightened involvement in support interactions and may be voiced via higher levels of f0. Further analyses to replicate these findings are necessary.

Fundamental frequency during cognitive preparation and its impact on therapy outcome for panic disorder with Agoraphobia.

BACKGROUND: Cognitive preparation plays a crucial role in CBT with exposure for panic disorder and agoraphobia. High emotional arousal while developing the exposure rationale might impair patients' cognitive capacities for processing information about treatment and impede therapeutic outcome. OBJECTIVE: This study investigates whether patients' vocally encoded emotional arousal, assessed by fundamental frequency (f0), during rationale development is associated with premature treatment dropout, insight into the rationale, and symptom reduction. METHODS: Patients' (N = 197, mean age 36.1 years, 79.2% female) f0 during rationale development was measured based on treatment videos from a randomized controlled trial of CBT for panic disorder and agoraphobia. Insight was rater assessed. Symptom severity was self- and rater assessed at the beginning and end of therapy. RESULTS: Higher f0 mean during rationale development was associated with lower probability of insight and less reduction in avoidance behavior. f0 was not associated with dropout. Insight was associated with lower probability of dropout and partially mediated the association between f0 and avoidance reduction. DISCUSSION: This study highlights the importance of emotional arousal during cognitive preparation for exposure. Therapists should ensure that patients are not too highly aroused while learning about the exposure rationale as an important step in treatment.

Predicting long-term risk for relationship dissolution using nonparametric conditional survival trees.

Identifying risk factors for divorce or separation is an important step in the prevention of negative individual outcomes and societal costs associated with relationship dissolution. Programs that aim to prevent relationship distress and dissolution typically focus on changing processes that occur during couple conflict, although the predictive ability of conflict-specific variables has not been examined in the context of other factors related to relationship dissolution. The authors examine whether emotional responding and communication during couple conflict predict relationship dissolution after controlling for overall relationship quality and individual well-being. Using nonparametric conditional survival trees, the study at hand simultaneously examined the predictive abilities of physiological (systolic and diastolic blood pressure, heart rate, cortisol) and behavioral (fundamental frequency; f0) indices of emotional responding, as well as observationally coded positive and negative communication behavior, on long-term relationship stability after controlling for relationship satisfaction and symptoms of depression. One hundred thirty-six spouses were assessed after participating in a randomized clinical trial of a relationship distress prevention program as well as 11 years thereafter; 32.5% of the couples' relationships had dissolved by follow up. For men, the only significant predictor of relationship dissolution was cortisol change score (p = .012). For women, only f0 range was a significant predictor of relationship dissolution (p = .034). These findings highlight the importance of emotional responding during couple conflict for long-term relationship stability.

Emotional arousal predicts observed social support in German and American couples talking about breast cancer.

Social support in couples often occurs during conversations and is an important predictor of positive outcomes in patients with breast cancer. Even though talking about cancer may be upsetting, vocally expressed emotional arousal and its association with social support have not been examined. The goal of this study was to examine the role of vocally encoded emotional arousal and social support behaviors in 129 German and American couples, assessed at baseline of clinical trials for women with breast cancer and their male partners. Range of fundamental frequency was used as a measure of expressed emotional arousal during videotaped interactions in which the women shared cancer-related concerns. Social support behaviors were assessed as specific social support behaviors at the talk-turn level (positive, neutral, and negative) and broader communication behaviors also relevant to social support at the global level (depth and articulation, caring, quality of communication) using the Social Support Interaction Coding System (Bradbury & Pasch, 1994). Data were analyzed using actor-partner interdependence models. Women displayed more positive, fewer neutral support-receiving behaviors, and greater depth and articulation if their own emotional arousal was higher. Women also displayed more neutral and (at the trend level) fewer positive support-receiving behaviors if their partners' emotional arousal was higher. Men's behaviors were not associated with their own or women's emotional arousal. Results indicate that it may be adaptive for women with cancer to openly experience their distress during social support conversations with their partners; high emotional arousal of the partners may interfere with this process.

The interpersonal process model of demand/withdraw behavior.

The demand/withdraw interaction pattern is a destructive cycle of relationship communication behavior that is associated with negative individual and relationship outcomes. Demand/withdraw behavior is thought to be strongly linked to partners' emotional reactions, but current theories are inconsistent with empirical findings. The current study proposes the interpersonal process model of demand/withdraw behavior, which includes linkages between each partners' emotional reactions and the interpersonal behavior of demanding and withdrawing. Data come from problem solving discussions of 55 German couples with observationally coded demand/withdraw behavior and fundamental frequency (f0) to measure vocally encoded emotional arousal. Actor-partner interdependence models (Kenny, Kashy, & Cook, 2006) were used to examine associations among demand/withdraw behavior and f0 in the overall discussion and 5-min segments. Significant cross-partner associations emerged for demanding and withdrawing behavior across the whole conversation as well as within 5-min segments, and these associations are partially accounted for by each individual's f0. When behaviorally coded demanders expressed more vocal arousal, they demanded more and withdrew less while their partners withdrew more. In contrast, when behaviorally coded withdrawers expressed more vocal arousal, their partners demanded less and withdrew more. Findings demonstrate that demand/withdraw behavior varies between couples (i.e., some couples engage in a stronger demand/withdraw cycle than others) and between segments (i.e., when 1 partner increases demanding, the other increases withdrawing). Findings support key elements of the interpersonal process model, showing intra- and interpersonal pathways linking demand/withdraw behavior and emotion and demonstrate the importance of partners' behavioral roles in these linkages.

The siren song of vocal fundamental frequency for romantic relationships.

A multitude of factors contribute to why and how romantic relationships are formed as well as whether they ultimately succeed or fail. Drawing on evolutionary models of attraction and speech production as well as integrative models of relationship functioning, this review argues that paralinguistic cues (more specifically the fundamental frequency of the voice) that are initially a strong source of attraction also increase couples' risk for relationship failure. Conceptual similarities and differences between the multiple operationalizations and interpretations of vocal fundamental frequency are discussed and guidelines are presented for understanding both convergent and non-convergent findings. Implications for clinical practice and future research are discussed.

Fundamental frequency during couple conflict: an analysis of physiological, behavioral, and sex-linked information encoded in vocal expression.

The human voice is one of the sounds most frequently experienced by human beings. During couple conflict, higher fundamental frequency (f0), a physical property of human speech, has been linked to an increased risk of divorce, less beneficial response to couple therapy, and higher levels of dysfunctional communication behavior. F0 is generally considered to be a measure of emotional arousal, but it is not currently clear whether this interpretation is appropriate for understanding spouses' f0 during couple interaction. The goal of the current article is to clarify what forms of information are encoded in f0 during couple conflict by examining the relations between f0 range, physiological variables, and communication behavior during the conflict discussions of 67 German couples. In line with evolutionary models of speech production, associations emerged in the expected directions between f0 and: (a) physiological variables (e.g., heart rate, blood pressure, and cortisol); (b) self-reported communication behavior; and (c) observationally coded communication behavior. Additionally, simultaneous examination of physiological variables and observationally coded communication behaviors revealed that associations between both sets of variables and f0 range were largely independent of one another. Furthermore, women's range of f0 was significantly greater than men's range of f0. With regard to social signaling theories, f0 range can be understood as a nonverbal transmission of distress. Implications for future research on and use of f0 are discussed.

Greater emotional arousal predicts poorer long-term memory of communication skills in couples.

Many studies have examined the importance of learning skills in behaviorally based couple interventions but none have examined predictors of long-term memory for skills. Associations between emotional arousal and long-term recall of communication skills delivered to couples during a behaviorally based relationship distress prevention program were examined in a sample of 49 German couples. Fundamental frequency (f(0)), a vocal measure of encoded emotional arousal, was measured during pre-treatment couple conflict. Higher levels of f(0) were linked to fewer skills remembered 11 years after completing the program, and women remembered more skills than men. Implications of results for behaviorally based couple interventions are discussed.