Family Caregivers' Progress Toward Values Moderates the Associations between Behavioral Symptoms of Dementia, Caregiver Burden, and Depressive Symptoms.

Increasingly, dementia caregiver interventions are informed by acceptance-based approaches such as Acceptance and Commitment Therapy. These interventions promote psychological skills like psychological flexibility and value-based living. Less is known how these constructs interact within well-established caregiver stress processes. We examined a moderated mediation model (N = 161 dementia caregivers; PROCESS Procedure; SPSS Release 4.1), with BPSD frequency (Revised Memory and Behavior Problems Checklist) predicting depressive symptoms (10-item CES-D), mediated via caregiver burden (short Burden inventory). The moderator was the Values Questionnaire, and we controlled for gender, caregiver duration, age, income, and education. Results: revealed that the indirect effect of BPSD on depressive symptoms through caregiver burden was weakened through higher progress toward values (moderated mediation significant at p < .05). Committed action toward values signify caregivers' success at balancing care-related stress with other priorities. Interventions that build skills in values-based living have promise for caregivers, offering healthier ways to adjust to being a caregiver.

Examining the link between exercise-specific relational processes and physical activity, psychological distress, and relationship satisfaction among heterosexual and gay male couples.

Despite the important role of romantic relationships in physical activity, little research has examined the role of gender and sexual orientation in exercise-specific relational processes. Utilizing cross-sectional, dyadic data from 462 heterosexual and gay couples, the present study examined how exercise encouragement, exercise discouragement, and frequency of exercise disagreements are related to physical activity, psychological distress, and relationship satisfaction. We included important covariates and examined gender and sexual orientation as moderators. Higher exercise encouragement was associated with more frequent physical activity (for gay men only), lower psychological distress (for women only), and higher relationship satisfaction regardless of gender and sexual orientation. Higher exercise discouragement was associated with more physical activity for all participants and higher levels of psychological distress for gay men only. Finally, more frequent exercise disagreements were associated with more psychological distress for all participants. These findings highlight important implications for physical activity promotion, prevention, and intervention.

New Opportunities for Advancing Dyadic Health Science in Gerontology.

As dyadic health science enters a golden age, important conceptual, theoretical, and technical challenges remain. This forum brings together perspectives on the burgeoning dyadic literature from several subdisciplines within aging research. We first define key concepts and terms so that interested researchers can navigate the complex and various ways in which dyadic health research is conducted. We discuss exciting scientific advances and close by identifying crucial challenges and considerations that coincide with important future directions for the field.

The Implications of Being "In it Together": Relationship Satisfaction and Joint Health Behaviors Predict Better Health and Stronger Concordance Between Partners.

BACKGROUND: Extensive evidence shows that satisfying marriages boost physical health and longevity. A separate literature reveals strong concordance in couples' health, but the relationship processes that contribute to health concordance remain poorly understood. PURPOSE: The current study examined whether relationship satisfaction and joint health behaviors-the extent to which couples eat, sleep, and exercise together-are associated simultaneously with better health and greater health similarity between partners. METHODS: Heterogeneous variance multilevel models were applied to data from 234 married couples (Mage = 46, Range = 20-84) reporting on their relationship satisfaction, joint health behaviors, and four health indicators-health satisfaction, depressive symptoms, comorbidities, and medication use. RESULTS: More satisfied couples engaged in more joint health behaviors than less satisfied counterparts. When joint health behaviors and relationship satisfaction were examined as separate fixed effects, both predicted greater health satisfaction and fewer depressive symptoms. More joint health behaviors were also associated with less medication use. When both were modeled together, only relationship satisfaction predicted depressive symptoms. By contrast, in random effects, joint health behaviors predicted greater similarity in health satisfaction, depressive symptoms, and comorbidities. Relationship satisfaction only predicted more similar depressive symptoms. CONCLUSIONS: Although more satisfied couples engaged in more joint health behaviors. relationship satisfaction and joint health behaviors uniquely predicted couples' health quality and concordance, suggesting that distinct mechanisms may drive better health and stronger health resemblance.

A primer on sleep for MFTs: Implications and practical considerations.

Despite many marriage and family therapists (MFTs) utilizing the Biopsychosocial-Spiritual (BPSS) framework in assessment and treatment, there is still a lack of education on sleep and the implications for mental, emotional, and relational health. Newer research within many fields highlights the far-reaching spillover effects of short or poor-quality sleep that can affect our clients. MFTs need to know how to assess, how to provide proper psychoeducation, how to apply this knowledge in clinical settings, and how to collaborate with other healthcare providers. As such, the purpose of this article is threefold: (a) review the biopsychosocial-spiritual importance of sleep; (b) equip MFTs with information on sleep assessment, how to identify situations for referral, and how to provide psychoeducation on sleep hygiene; and (c) review important considerations for research and practice for MFTs.

Associations between partner's diet undermining and poor diet in mixed-weight, older gay married couples: a dyadic mediation model.

BACKGROUND: Prior studies have examined how individuals may undermine their partner's efforts to maintain a healthy diet, but gay couples have not been represented in this work. Additionally, research has not accounted for mixed-weight status [lighter partner (LP) and heavier partner] nor investigated the mechanisms through which undermining is associated with dietary outcomes. OBJECTIVE/DESIGN/MEASURES: Utilising dyadic data from 224 gay married couples across the United States, we tested associations between perceptions of partner's diet undermining strategies and diet quality with couple food disagreements and depressive symptoms as putative, serial mediators in an actor-partner interdependence mediation model. RESULTS: Results revealed that more severe diet undermining was associated with both partners' poorer diet quality, which was explained by more frequent couple food disagreements and higher depressive symptoms for both heavier and LPs. CONCLUSION: These findings suggest that undermining strategies are detrimental to both partners' relational health (increased conflict), emotional health (depressive symptoms) and physical health (diet)-regardless of weight status-and provide valuable targets for prevention and intervention. Our study underscores the interdependence of couple relations in lifestyle changes and specifically highlight the need for health professionals to discuss the partner's indirect or unintended disruptions to the patient's plan.

Psychological and relational health profiles of soldiers in committed romantic relationships.

The present study explored the heterogeneity of military service members' psychological and relational functioning using a sample of 7,866 soldiers in committed romantic relationships from the Army Study to Assess Risk and Resilience in Service members (Army STARRS). A latent profile analysis was conducted to identify and predict unique clusters of soldiers' relative psychological (i.e., posttraumatic stress disorder, depression, and anxiety symptom severity) and relational (i.e., relationship happiness, how often their relationship was going well, how often they confided in their partner, how often they considered or discussed ending their relationship, relational insecurity, and relational turbulence) functioning. Results revealed 4 distinct classes of comparative psychological and relational health: hardy soldiers and healthy relaters (70.2%), stressed soldiers but healthy relaters (13.1%), hardy soldiers but strained relaters (12.7%), and stressed soldiers and strained relaters (4.0%). Class descriptions, as well as implications for theory and clinical practice are reviewed. Notably, 7 out of 10 soldiers in this nationally representative sample reported little to no psychological or relational distress. These findings invite more adaptive narratives of service member resilience and a more nuanced conceptualization of gradations in psychological and relational functioning. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Using Difference Scores to Inform Therapy Practice: Differences in Perceptions of Attachment Behaviors between Partners in a Clinical Sample.

Using clinically relevant research methodology, this study focuses on differences (cross-partner difference scores) in perceptions of attachment behaviors (emotional accessibility, responsiveness, and engagement) between partners in couples therapy. In general, findings suggest that higher levels of self-enhancement attachment behaviors (participant perceives self as demonstrating more attachment behaviors than the partner's ratings of the participant) are associated with lower relationship satisfaction and greater relationship instability. The association between attachment behavior difference scores and measures of relationship health is mediated through partner perceived positive communication. These results suggest that differences in perceptions between partners' level of attachment behaviors are an important clinical construct for therapy. As such, clinical recommendations for addressing self-enhancing attachment behaviors, and the mediating role of positive communication, are discussed with recommendations for researchers.

Evaluative coping, emotional distress, and adherence in couples with Type 2 diabetes.

INTRODUCTION: Spousal support is one of the strongest and most consistent predictors of Type 2 diabetes treatment adherence. However, the effects of both spouses' evaluations of dyadic coping on emotional distress and patients' physical health remain largely unknown. METHOD: Dyadic data from 117 married couples in which one member is diagnosed with Type 2 diabetes were evaluated in two separate models to explore the associations between (a) patients' and spouses' depression symptoms and patients' adherence to dietary and exercise regimens, and (b) patients' and spouses' acute stress levels and patients' adherence to dietary and exercise regimens. Finally, evaluative dyadic coping was included as a possible moderator between these associations. RESULTS: Results from an actor-partner interdependence model revealed significant actor effects of patients' depression symptoms on patients' adherence to dietary and exercise regimens. Spouses' evaluation of dyadic coping attenuated the direct paths between spouses' depression symptoms and patients' adherence to dietary regimens. No direct pathways were found from patients' or spouses' acute stress to patients' adherence to dietary and exercise regimens. However, spouses' evaluation of dyadic coping attenuated the direct paths between spouses' acute stress and patients' adherence to dietary regimens. DISCUSSION: Tapping into spouses' evaluations of dyadic coping has significant implications for patients' diabetes health outcomes (e.g., adherence to dietary and exercise treatment regimens). Findings from this study highlight the need for systemic interventions targeting both partners. (PsycINFO Database Record

Commitment, Forgiveness, and Relationship Self-Regulation: An Actor Partner Interdependence Model of Relationship Virtues and Relationship Effort in Couple Relationships.

Dyadic data from 679 committed couples were used to examine associations between commitment, forgiveness, and perceptions of partner's relationship self-regulation (RSR) behaviors-that is effort and strategies that partners exert to maintain the relationship. We found that for both partners, higher self-reports of commitment and forgiveness were associated with higher perceptions of their partner's RSR. For females, higher commitment and forgiveness were associated with higher male perceptions of her RSR, and higher male forgiveness was associated with higher female perceptions of his RSR. These findings demonstrate the importance of marital virtues and relationship work and give credence to the marital competence model of "other-centeredness" by Carroll et al. (2006, Journal of Family Issues, 27(7), 1001). Clinical implications are discussed.

Associations Between Economic Pressure and Diabetes Efficacy in Couples With Type 2 Diabetes.

Objective: The purpose of this study was to explore dyadic associations between economic pressure and diabetes self-efficacy via emotional distress in patients with type 2 diabetes and their partners. Background: Understanding how economic pressure is associated with successful diabetes management is an important area for research, as couples with type 2 diabetes can incur heavy economic pressures that could likely influence diabetes outcomes. Method: Data from 117 married couples were used to test actor-partner associations using moderated mediation analyses in a structural equation modeling framework. Problem-solving communication was tested as a possible moderator of the economic pressure-emotional distress pathway. Results: Results revealed that greater patient economic pressure was associated with lower patient and spouse confidence in the patient's diabetes management ability through higher levels of patient emotional distress. The deleterious association between economic pressure and emotional distress was less pronounced when spouses reported more effective problem-solving communication. Conclusion: These results provide evidence that the economic pressure couples with type 2 diabetes face may reduce the patient and spouse's confidence in the patient's diabetes management ability. Implications: This study demonstrates the importance of couple's relationship processes in buffering the impact of economic pressure on diabetes management, providing a clear target for intervention and education efforts.

Does Personality Matter in Diabetes Adherence? Exploring the Pathways between Neuroticism and Patient Adherence in Couples with Type 2 Diabetes.

BACKGROUND: Personality has received some attention in the Type 2 diabetes literature; however, research has not linked personality and diabetes adherence behaviors (diet and exercise), identified pathways through which they are associated, nor taken into consideration important contextual factors that influence behavior (the patient's partner). METHODS: Dyadic data from 117 married, heterosexual couples in which one member is diagnosed with Type 2 diabetes was used to explore associations between each partner's neuroticism and patient dietary and exercise adherence through the pathways of negative affect, depression symptoms, and couple-level diabetes efficacy (both patient and spouse report of confidence in the patient's ability to adhere to diabetes management regimens). RESULTS: Results revealed that higher levels of neuroticism were associated with lower patient dietary and exercise adherence through (1) higher levels of depression symptoms (for patients' neuroticism) and negative affect (for spouses' neuroticism), and (2) lower levels of couple-level diabetes efficacy. CONCLUSIONS: The results from this study provide evidence that both patient and spouse personality traits are associated with patient dietary and exercise adherence through increased emotional distress-albeit different emotional pathways for patients and spouses-and lower couple confidence in the patients' ability to manage their diabetes.

The Role of Attachment Behaviors in the Link between Relationship Satisfaction and Depression in Clinical Couples: Implications for Clinical Practice.

Using dyadic, clinical data from 104 couples in committed relationships, the purpose of this study was to determine whether relationship satisfaction was associated with depression through perceived partner attachment behaviors-accessibility, responsiveness, and engagement-for both men and women. We found that one's satisfaction in the relationship was the lens through which they viewed their partner's attachment behaviors and-women's relationship satisfaction was the lens through which her male partner viewed her attachment behaviors. Finally, women's relationship satisfaction is associated with both individuals' depression through her perceived partner's accessibility, responsiveness, and engagement. The findings from this study are important because they provide clinically relevant and mutable constructs in which clinicians can intervene at an attachment level in distressed marriages with depressed partners.

A dyadic multiple mediation model of patient and spouse stressors predicting patient dietary and exercise adherence via depression symptoms and diabetes self-efficacy.

Using dyadic data from 117 married couples in which one partner was diagnosed with Type 2 diabetes, the purpose of this study was to determine whether a number of specific patient and spouse stressors (chronic life stress, diabetes-specific stress, and physical health stress in the form of the number of comorbidities) were associated with Type 2 diabetes patients' dietary and exercise adherence through two potentially modifiable patient and spouse factors-depression symptoms and diabetes self-efficacy. We found that patient and spouse stressors, particularly patient and spouse diabetes stress and the number of patient comorbidities, were related to patient dietary and exercise adherence through patient depression symptoms and both patient and spouse diabetes self-efficacy. These conclusions were strengthened by incorporating a number of relevant control variables in our models and by testing four alternative models which supported our proposed model. These results are important because they provide further evidence of the significant role spouses' play in managing diabetes and they provide diabetes educators and clinicians with specific targets for intervention programming.

The Brief Accessibility, Responsiveness, and Engagement Scale: A Tool for Measuring Attachment Behaviors in Clinical Couples.

Measuring attachment behaviors is relevant to creating secure couple relationships. This article seeks to test and examine the reliability and validity of the Brief Accessibility, Responsiveness, and Engagement (BARE) Scale-a practical measure of couple attachment-in a clinical sample. Couples took the BARE and other assessments measuring relationship functioning (self and partner reports of relationship satisfaction, relationship stability, positive and negative communication, and attachment styles). Results suggest that the BARE appears to be a reliable and valid tool for assessing couple attachment and can accurately predict and classify whether the couples belong in the clinical or nonclinical group, as well as their level of relationship satisfaction. Results also indicate attachment behaviors are related to relationship outcomes.

Older couples with and without cardiovascular disease: testing associations between and among affective communication, marital satisfaction, physical and mental health.

The American Heart Association (Go et al., 2013) estimated that about 2,150 Americans die each day from cardiovascular disease (CVD). For those 65 years of age or older, the total cost of heart related services in 2009 was $121.2 billion (Go et al., 2013). Many people live with the chronic conditions of cardiovascular disease (Petersen et al., 2005). Researchers have identified the genetic, medical, and lifestyle habits of those with CVD, yet there is a dearth of literature focusing on the relational/social aspects of cardiovascular disease and how such factors are associated with the risk, presentation, and maintenance of cardiovascular illness. Considering that men have a higher lifetime risk for developing CVD than women (51.7% to 39.2%; Roger et al., 2012), the purpose of this study was to compare various aspects of the couple relationship among and between couples with a husband who reports CVD and couples in which neither report CVD.