Concurrent and Prospective Associations Between Communicated Emotional Arousal and Adjustment Among Couples Coping With Cancer.

BACKGROUND: The experience of cancer can create considerable emotional distress for patients and their committed partners. How couples communicate about cancer-related concerns can have important implications for adjustment. However, past research has primarily utilized cross-sectional designs and retrospective self-reports of couple communication. While informative, little is known about how patients and partners express emotion during conversations about cancer, and how these emotional patterns predict individual and relational adjustment. PURPOSE: The current investigation examined how patterns of emotional arousal within couples' communication about cancer was associated with concurrent and prospective individual psychological and relational adjustment. METHODS: At baseline, 133 patients with stage II- breast, lung, or colorectal cancer and their partners completed a conversation about a cancer-related concern. Vocally expressed emotional arousal (f0) was extracted from recorded conversations. Couples completed self-report measures of individual psychological and relational adjustment at baseline and at 4, 8, and 12 months later. RESULTS: Couples who started the conversation higher in f0 (i.e., greater emotional arousal) reported better individual and relational adjustment at baseline. If the non-cancer partner had lower f0 relative to patients, this predicted worse individual adjustment across follow-up. Additionally, couples who maintained their level of f0 rather than decreasing later in the conversation reported improvements in individual adjustment across follow-up. CONCLUSIONS: Elevated emotional arousal within a cancer-related conversation may be adaptive for adjustment, as it may reflect greater emotional engagement and processing of an important topic. These results may suggest ways for therapists to guide emotional engagement to enhance resilience in couples experiencing cancer.

Cancer is a stressful experience for patients and their partners. We know that how couples communicate about cancer is important, but we do not know much about how couples express emotion during cancer conversations and how those emotional expressions affect well-being. Our study looked at how couples' emotional arousal within cancer conversations relate to individual and relationship well-being. At the beginning of the study, cancer patients and their partners had a conversation about cancer. Within these conversations, we tracked the emotional arousal expressed in their voices. Couples also completed surveys about their well-being at the beginning of the study and later in time (4, 8, and 12 months later). We found that couples who started the conversation with higher emotional arousal had better initial well-being. Couples who remained higher in arousal later in the conversation improved in their individual well-being over time. We also found that if the non-cancer partner was low in arousal compared with patients, this predicted worse well-being over time. More research is needed, but these findings suggest that being emotionally aroused during conversations about important topics like cancer might be helpful for well-being, potentially because couples are discussing concerns and not backing off when it feels challenging.

Effects of a Parent-Focused HIV Prevention Intervention for Young Men Who have Sex with Men: A Pilot Randomized Clinical Trial.

Young men who have sex with men (YMSM) face the highest risk of HIV infection among adolescents, yet effective sexual health interventions for this population are limited. Parents and Adolescents Talking about Healthy Sexuality (PATHS) is an online intervention for parents designed to improve communication about HIV and increase behaviors supportive of YMSM sexual health. We conducted an RCT of PATHS with sixty-one parent-son dyads recruited online (sons were cisgender, gay or bisexual, ages 14-22). Assessments were completed at baseline, immediate post-intervention, and over the next 3 months. Per parent and son report, in the 3 months following the intervention, parents assigned to PATHS engaged in more HIV discussion, condom instruction, and facilitation of HIV testing. Parents also reported significant pre- to immediate-post intervention changes in attitudes, skills, and behavioral intentions relevant to engaging with their sons about sexual health. Parents are an untapped but promising resource in preventing HIV among YMSM.This trial was registered at ClinicalTrials.gov (Identifier: NCT04018573).

RESUMEN: Los hombres jóvenes que tienen sexo con hombres (HJSH) estan expuestos al mayor riesgo de infección del VIH entre los adolescentes, sin embargo, las intervenciones efectivas de salud sexual para esta población son limitadas. Padres y Adolescentes Hablando sobre la Sexualidad Saludable (PATHS) es una intervención en línea para padres, diseñada para mejorar la comunicación sobre el VIH y aumentar los comportamientos que apoyan la salud sexual de los hombres jóvenes que tienen sexo con hombres. Realizamos un ensayo controlado aleatorizado de PATHS con sesenta y uno díadas de padres e hijos reclutados en línea (los hijos eran cisgénero, homosexuales o bisexuales, de la edad de 14 a 22 años). Las evaluaciones se completaron al inicio, inmediatamente después de la intervención y durante los siguientes 3 meses. De acuerdo al informe de padres e hijos, en los tres meses después de la intervención, los padres asignados a PATHS tuvieron más discusiones sobre el VIH, instrucciones sobre el uso de los condones y facilitación de pruebas del VIH. Los padres también reportaron cambios significativos antes y después de la intervención en actitudes, habilidades e intenciones de comportamiento acerca de su involucración con la salud sexual de sus hijos. Los padres son un recurso inexplorado, pero prometedor en la prevención del VIH entre HJSH.

Promoting Resilience After Stroke in Dyads (ReStoreD): A Supplemental Analysis.

OBJECTIVE: To examine preliminary effects of ReStoreD (Resilience after Stroke in Dyads) on resilience in couples coping with stroke-related challenges. DESIGN: Supplemental analysis of prospective pilot trial with pre-/post-assessments and 3-month follow-up. SETTING: Community. PARTICIPANTS: Thirty-four cohabitating stroke-care partner dyads (N=34); at least 3 months post-stroke. INTERVENTIONS: 8-week self-administered dyadic intervention (ReStoreD) consisting of activities completed individually and as a couple. MAIN OUTCOME MEASURES: 10-item Connor-Davidson Resilience Scale. RESULTS: Care partner baseline resilience scores were significantly higher than persons with stroke scores. Repeated-measures analysis of variance suggest significant pre-post improvement in resilience for persons with stroke (mean difference [I - J]=-2.42, SE=.91, P=.04, 95% CI [-4.75, -0.08]) with a large effect size (η2=.34), which was maintained at 3-month follow-up. Care partners showed no significant change over time. CONCLUSIONS: This study provides preliminary evidence that ReStoreD improves resilience in persons with stroke. More research is needed to address resilience in care partners. These findings represent a promising first step to address the mental health needs in this population.

Posttraumatic growth and life course stress predict dyadic wellbeing among sexual and gender minority (SGM) and non-SGM couples facing cancer.

OBJECTIVE: This study examined: (1) Differences among sexual and gender minority (SGM) and non-SGM couples' life course stress, posttraumatic growth (PTG), individual, and dyadic wellbeing while facing cancer, (2) The predictive ability of PTG and life course stress on wellbeing for each dyad member, and (3) The predictive ability of dyad-level PTG and dyad-level life course stress on dyadic wellbeing. METHODS: Thirty SGM and 30 non-SGM dyads (N = 60) completed measures assessing demographics, life course stress, PTG, individual, and dyadic wellbeing. Regression and multilevel models tested predictive hypotheses. RESULTS: Participants were 56.3 years old on average (SD = 13.6) and were together for 24.2 (SD = 14.9) years. SGM participants reported greater life course stress and higher scores on the Depression, Anxiety, and Stress Scales (DASS-21) than non-SGM participants. A dyad members' higher PTG predicted their partners' higher DASS-21 score, dyad members' higher life course stress predicted their own higher DASS-21 score, and patients' higher life course stress predicted their partners' higher DASS-21 score. Greater dyadic PTG predicted greater dyadic wellbeing. CONCLUSIONS: SGM and non-SGM couples experience PTG equally despite SGM couples' greater life course stress and higher DASS-21 scores. Future research is needed to explore how PTG may affect individuals and couples differently.

Retention, engagement, and binge-eating outcomes: Evaluating feasibility of the Binge-Eating Genetics Initiative study.

OBJECTIVE: Using preliminary data from the Binge-Eating Genetics Initiative (BEGIN), we evaluated the feasibility of delivering an eating disorder digital app, Recovery Record, through smartphone and wearable technology for individuals with binge-type eating disorders. METHODS: Participants (n = 170; 96% female) between 18 and 45 years old with lived experience of binge-eating disorder or bulimia nervosa and current binge-eating episodes were recruited through the Recovery Record app. They were randomized into a Watch (first-generation Apple Watch + iPhone) or iPhone group; they engaged with the app over 30 days and completed baseline and endpoint surveys. Retention, engagement, and associations between severity of illness and engagement were evaluated. RESULTS: Significantly more participants in the Watch group completed the study (p = .045); this group had greater engagement than the iPhone group (p's < .05; pseudo-R2 McFadden effect size = .01-.34). Overall, binge-eating episodes, reported for the previous 28 days, were significantly reduced from baseline (mean = 12.3) to endpoint (mean = 6.4): most participants in the Watch (60%) and iPhone (66%) groups reported reduced binge-eating episodes from baseline to endpoint. There were no significant group differences across measures of binge eating. In the Watch group, participants with fewer episodes of binge eating at baseline were more engaged (p's < .05; pseudo-R2 McFadden  = .01-.02). Engagement did not significantly predict binge eating at endpoint nor change in binge-eating episodes from baseline to endpoint for both the Watch and iPhone groups. DISCUSSION: Using wearable technology alongside iPhones to deliver an eating disorder app may improve study completion and app engagement compared with using iPhones alone.

Perceived social support and ambulatory blood pressure during daily life: a meta-analysis.

Perceived social support has been linked to lower rates of morbidity and mortality. However, more information is needed on the biological mechanisms potentially responsible for such links. The main aim of this paper was to conduct a meta-analytic review of the association between perceived social support and awake ambulatory blood pressure (ABP) which is linked to cardiovascular morbidity and mortality. The review identified 12 studies with a total of 3254 participants. The omnibus meta-analysis showed that higher perceived social support was not significantly related to lower ABP (Zr = -0.052, [ -0.11, 0.01]). In addition, there was evidence of significant bias across several indicators. Future research will be needed to explore the boundary conditions linking social support to ABP and its implications for theoretical models and intervention development.

Vocally-Encoded Emotional Arousal as a Marker of Callous-Unemotional Traits in a Sample of Justice-Involved Adolescents.

Callous-unemotional (CU) traits are associated with severe and persistent juvenile offending. CU traits are also associated with dampened emotional arousal, which suggests that fundamental frequency (f0), a measure of vocally-encoded emotional arousal, may serve as an accessible psychophysiological marker of CU traits in youth. This study investigated the associations between f0 range measured during an emotionally evocative task, CU traits, and emotion dysregulation in a mixed-gender sample of 168 justice-involved youth. For boys, after controlling for covariates, wider f0 range-indicating greater emotional arousal-was negatively associated with CU traits and positively associated with emotion dysregulation. For girls, no significant associations with f0 range emerged; however, CU traits were positively associated with emotion dysregulation. Findings suggest that f0 range may serve as a valid indicator of CU traits in JJ-involved boys, and that detained boys and girls with high CU traits are characterized by different profiles of emotion dysregulation.

The Me in We dyadic communication intervention is feasible and acceptable among advanced cancer patients and their family caregivers.

BACKGROUND: Advanced cancer affects the emotional and physical well-being of both patients and family caregivers in profound ways and is experienced both dyadically and individually. Dyadic interventions address the concerns of both members of the dyad. A critical gap exists in advanced cancer research, which is a failure of goals research and dyadic research to fully account for the reciprocal and synergistic effects of patients' and caregivers' individual perspectives, and those they share. AIM: We describe the feasibility and acceptability of the Me in We dyadic intervention, which is aimed at facilitating communication and goals-sharing among caregiver and patient dyads while integrating family context and individual/shared perspectives. DESIGN: Pilot study of a participant-generated goals communication intervention, guided by multiple goals theory, with 13 patient-caregiver dyads over two sessions. SETTING/PARTICIPANTS: Patients with advanced cancer and their self-identified family caregivers were recruited from an academic cancer center. Dyads did not have to live together, but both had to consent to participate and all participants had to speak and read English and be at least 18 years or age. RESULTS: Of those approached, 54.8% dyads agreed to participate and completed both sessions. Participants generated and openly discussed their personal and shared goals and experienced positive emotions during the sessions. CONCLUSIONS: This intervention showed feasibility and acceptability using participant-generated goals as personalized points of communication for advanced cancer dyads. This model shows promise as a communication intervention for dyads in discussing and working towards individual and shared goals when facing life-limiting or end-of-life cancer.

Negative Partner Attributions Moderate the Association between Heart Rate Reactivity During Relationship Conflict and Relationship Satisfaction.

Numerous theoretical models of relationship distress suggest that strong, negative reactions to conflict are directly associated with lower levels of relationship satisfaction. Consistent with this supposition, substantial evidence links higher levels of subjective negative emotion, more pronounced and frequent expressions of negative affect, and higher levels of negative communication behaviors to lower levels of relationship satisfaction (e.g., Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). However, the evidence linking stress-related physiological responding during relationship conflict and relationship satisfaction is less compelling than would be anticipated based on theory. We propose that these theoretically unexpected but empirically well-replicated findings may be the result of different patterns in association between physiological reactivity and relationship satisfaction for couples with varying styles in how they typically perceive unwanted behavior in one another. The present study tests negative attributions for undesirable partner behaviors as a moderator of the association between heart rate reactivity (HRR) during relationship conflict and relationship satisfaction in a sample of 60 married couples. A significant interaction emerged between HRR and negative attributions of partner behavior in predicting relationship satisfaction such that higher levels of HRR were associated with lower levels of relationship satisfaction for individuals who typically made more negative attributions for undesirable partner behaviors, but with higher levels of relationship satisfaction for individuals who typically made fewer negative attributions for undesirable partner behaviors. Implications for conceptualizing reactivity during relationship conflict and couple interventions are discussed.

Varios modelos teóricos de distrés relacional sugieren que las reacciones fuertes y negativas al conflicto están directamente asociadas con niveles más bajos de satisfacción con la relación. De acuerdo con esta suposición, hay pruebas sustanciales que vinculan los niveles más altos de emoción negativa subjetiva, las expresiones más marcadas y frecuentes de afecto negativo, y los niveles más altos de conductas de comunicación negativa con niveles más bajos de satisfacción con la relación (p. ej.: Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). Sin embargo, las pruebas que conectan la respuesta fisiológica relacionada con el estrés durante el conflicto en la relación y la satisfacción con la relación son menos convincentes de lo que se esperaría según la teoría. Proponemos que estos resultados teóricamente inesperados, pero bien reproducidos empíricamente, pueden ser el resultado de diferentes patrones que asocian la reactividad fisiológica y la satisfacción con la relación en el caso de las parejas con estilos variados en cuanto a cómo perciben normalmente el comportamiento no deseado en el otro. El presente estudio evalúa las atribuciones negativas para las conductas no deseadas de la pareja como moderadoras de la asociación entre la reactividad de la frecuencia cardíaca (RFC) durante el conflicto en la relación y la satisfacción con la relación en una muestra de 60 parejas casadas. Surgió una interacción significativa entre la RFC y las atribuciones negativas de la conducta de la pareja a la hora de predecir la satisfacción con la relación, de manera que niveles más altos de RFC estuvieron asociados con niveles más bajos de satisfacción con la relación en personas que normalmente hicieron más atribuciones negativas para las conductas no deseadas de la pareja, pero con niveles más altos de satisfacción con la relación para las personas que normalmente hicieron menos atribuciones negativas para las conductas no deseadas de la pareja. Se debaten las implicancias para conceptualizar la reactividad durante el conflicto en la relación y las intervenciones en la pareja.

Escalation and Regulation of Emotional Arousal in Couples Predicts Relationship Satisfaction Concurrently and 25 Years Later.

Relationship distress and divorce are major risk factors for the development or exacerbation of psychopathology and psychosocial impairments. Given that heightened negative emotions within couples' interactions may portend negative relationship outcomes, it is critical to understand how emotions unfold across a conversation and how partners may influence each other's immediate emotional experiences. This study examined whether these regulatory dynamics within one interaction predicted relationship satisfaction concurrently and 25 years later. Vocally-encoded emotional arousal (f0 ) was measured during couples' (N = 25 couples) conversations about a relationship issue. Across different analytical strategies, results demonstrate that one partner's f0 dynamics had immediate and long-term associations with the other partner's satisfaction. Partners were less satisfied if the other partner (a) expressed higher f0 overall and (b) escalated more in f0 across the conversation. Yet, partners were more satisfied when their f0 escalated across the conversation. Also, women specifically were more satisfied if their f0 remained elevated longer before regulating back to their emotional baseline. Thus, higher f0 was associated with higher satisfaction in the same partner, but associated with less satisfaction in the other partner-particularly when these emotions come from women. It may be that partners have to decide whether to prioritize expressing their emotions fully or limit expression in the service of their partner's happiness. These findings challenge us to think of ways to address this "win-lose" scenario so that couples can balance both partners' emotional needs and preserve relationship quality across the life span.

El distrés relacional y el divorcio son grandes factores de riesgo para el desarrollo o la exacerbación de alteraciones psicopatológicas y psicosociales. Teniendo en cuenta que las emociones negativas intensificadas dentro de las interacciones de las parejas pueden predecir consecuencias negativas en las relaciones, es fundamental comprender cómo se revelan las emociones a lo largo de una conversación y cómo los integrantes de la pareja pueden influenciar las experiencias emocionales inmediatas del otro. Este estudio examinó si esta dinámica reguladora dentro de una interacción predijo la satisfacción con la relación inmediatamente y 25 años después. Se midió la codificación vocal de la excitación emocional (f0 ) durante las conversaciones de las parejas (N = 25 parejas) acerca de un problema en la relación. Entre diferentes estrategias analíticas, los resultados demuestran que la dinámica de la f0 de uno de los integrantes de la pareja tuvo asociaciones inmediatas y a largo plazo con la satisfacción del otro integrante de la pareja. Los integrantes de la pareja se sentían menos satisfechos si el otro integrante de la pareja (a) expresaba una f0 más elevada en general y (b) escalaba más en la f0 durante la conversación. Sin embargo, los integrantes de la pareja estaban más satisfechos cuando su f0 escalaba a lo largo de la conversación. También, las mujeres estaban específicamente más satisfechas si su f0 se mantenía elevada más tiempo antes de regularla para volver a su momento basal emocional. Por lo tanto, una f0 más elevada se asoció con una mayor satisfacción en el mismo integrante de la pareja, pero se asoció con una menor satisfacción en el otro integrante de la pareja, particularmente cuando estas emociones vienen de las mujeres. Es posible que los integrantes de la pareja tengan que decidir si priorizar la expresión completa de sus emociones o limitar la expresión al servicio de la felicidad de su pareja. Estos resultados nos plantean el desafío de pensar en maneras de abordar esta situación en la que "se gana o se pierde", de manera que las parejas puedan equilibrar las necesidades emocionales de ambos integrantes de la pareja y conservar la calidad de la relación durante su tiempo de vida.

The Binge Eating Genetics Initiative (BEGIN): study protocol.

BACKGROUND: The Binge Eating Genetics Initiative (BEGIN) is a multipronged investigation examining the interplay of genomic, gut microbiota, and behavioral factors in bulimia nervosa and binge-eating disorder. METHODS: 1000 individuals who meet current diagnostic criteria for bulimia nervosa or binge-eating disorder are being recruited to collect saliva samples for genotyping, fecal sampling for microbiota characterization, and recording of 30 days of passive data and behavioral phenotyping related to eating disorders using the app Recovery Record adapted for the Apple Watch. DISCUSSION: BEGIN examines the interplay of genomic, gut microbiota, and behavioral factors to explore etiology and develop predictors of risk, course of illness, and response to treatment in bulimia nervosa and binge-eating disorder. We will optimize the richness and longitudinal structure of deep passive and active phenotypic data to lay the foundation for a personalized precision medicine approach enabling just-in-time interventions that will allow individuals to disrupt eating disorder behaviors in real time before they occur. TRIAL REGISTRATION: The ClinicalTrials.gov identifier is NCT04162574. November 14, 2019, Retrospectively Registered.

Incorporating physiology into the study of psychotherapy process.

Increasing evidence indicates that psychological factors important to therapy effectiveness are associated with physiological activity. Knowledge of the physiological correlates of therapy process variables has the potential to provide unique insights into how and why therapy works, but little is currently known about the physiological underpinnings of specific therapy processes that facilitate client growth and change. The goal of this article is to introduce therapy process researchers to the use of physiological methods for studying therapy process variables. We do this by (a) presenting a conceptual framework for the study of therapy process variables, (b) providing an introductory overview of physiological systems with particular promise for the study of therapy process variables, (c) introducing the primary methods and methodological decisions involved in physiological research, and (d) demonstrating these principles and methods in a case of therapeutic presence during couple therapy. We close with a discussion of the promise and challenges in the study of physiological correlates of therapy process variables and consideration of future challenges and open questions in this line of research. Online supplemental materials include additional resources for therapy process researchers interested in getting started with physiological research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Coregulation of therapist and client emotion during psychotherapy.

OBJECTIVE: Close interpersonal relationships are fundamental to emotion regulation. Clinical theory suggests that one role of therapists in psychotherapy is to help clients regulate emotions, however, if and how clients and therapists serve to regulate each other's emotions has not been empirically tested. Emotion coregulation - the bidirectional emotional linkage of two people that promotes emotional stability - is a specific, temporal process that provides a framework for testing the way in which therapists' and clients' emotions may be related on a moment to moment basis in clinically relevant ways. METHOD: Utilizing 227 audio recordings from a relationally oriented treatment (Motivational Interviewing), we estimated continuous values of vocally encoded emotional arousal via mean fundamental frequency. We used dynamic systems models to examine emotional coregulation, and tested the hypothesis that each individual's emotional arousal would be significantly associated with fluctuations in the other's emotional state over the course of a psychotherapy session. RESULTS: Results indicated that when clients became more emotionally labile over the course of the session, therapists became less so. When changes in therapist arousal increased, the client's tendency to become more aroused during session slowed. Alternatively, when changes in client arousal increased, the therapist's tendency to become less aroused slowed.

"In Eight Minutes We Talked More About Our Goals, Relationship, Than We Have in Years": A Pilot of Patient-Caregiver Discussions in a Neuro-Oncology Clinic.

Primary brain cancer is a diagnosis that can have drastic health impacts on patient and caregiver alike. In high-stress situations, dyadic coping can improve psychosocial and health outcomes and communication about personal life goals maybe one way to facilitate this coping. In this study, we describe the feasibility and accessibility of a one-time, self-directed goal discussion pilot intervention for neuro-oncology patients and their primary caregivers. Ten dyads were taken to a private room to complete a pre-discussion questionnaire, a worksheet to elicit personal goals, complete an 8-min discussion of goals, a post-discussion questionnaire, and provided open-ended feedback about the process. Post-discussion, dyads reported that the intervention was not stressful. In open-ended feedback, dyads overwhelmingly reported that the intervention was a positive experience, providing a safe, calm environment to have difficult conversations. This intervention provides a positive framework for improving communication and discussion of goals between patient-caregiver dyads.

Communication of emotion in home hospice cancer care: Implications for spouse caregiver depression into bereavement.

OBJECTIVE: Family caregivers of cancer hospice patients likely benefit from clinician provision of verbal support and from expression of positive emotions. Our aim was to identify the effects of hospice nurse supportive communication as well as caregiver-nurse exchange of positive emotions on family caregiver depression during bereavement. METHODS: This prospective, observational longitudinal study included hospice nurses (N = 58) and family caregivers of cancer patients (N = 101) recruited from 10 hospice agencies in the United States. Digitally recorded nurse home visit conversations were coded using Roter interaction analysis system to capture emotion-focused caregiver-nurse communication and supportive nurse responses. Caregivers completed the Hospital Anxiety and Depression Scale Anxiety Subscale and Geriatric Depression Scale-Short Form at study enrollment and at 2, 6, and 12 months after patient death. RESULTS: Caregivers had moderate levels of depression at study enrollment and throughout bereavement. Multilevel modeling revealed that caregiver positive emotion communication and nurse emotional response communication are associated with caregiver depression in bereavement. There was no significant association between caregiver distress communication and depression in bereavement. CONCLUSIONS: This is the first study to demonstrate that communication demonstrating emotional expression between cancer spouse caregivers and nurses during home hospice may have implications for caregiver depression up to a year after patient death. Our findings may help identify caregivers who may be coping well in the short term but may struggle more over time.

When the "U" is not Inverted: Trajectories of Expressed Emotional Arousal Predict Relationship Satisfaction.

Maladaptive emotional reactivity and dysfunctional communication during couple conflict are both destructive to couple functioning, and observational research has elucidated how conflict escalates. However, much of the evidence is based on measures that combine content (i.e., what was said) and the emotion with which it was said, which are then examined using sequential analyses. Despite the general presumptions about underlying emotional reactivity and escalation in negative emotions as part of relationship distress and deterioration, little empirical data are available that directly examine these continuous shifts in emotions. The current study examined concurrent and longitudinal associations between relationship satisfaction and trajectories of change in vocally expressed emotional arousal during couple conflict in 62 couples who participated in a relationship education program. Contrary to expectations and patterns found in distressed couples, trajectories followed a U-shape rather than an inverted U-shape curve, with steeper and more persistent decreases in emotional arousal predicting more stable relationship satisfaction over time. In addition, there were within-couple effects. These results suggest that early signs for relationship deterioration may be less in the form of overt escalation as would be seen in distressed couples. Instead, couples who subsequently deteriorate more are less effective in calming emotional arousal. They also are less able to remain at lower emotional arousal. It is possible that the more pronounced escalation toward the end of the conversation in more at-risk couples is a precursor of the greater escalation patterns seen in distressed couples; this should be examined empirically. Limitations and implications are discussed.

La reactividad emocional desadaptativa y la comunicación disfuncional durante el conflicto de pareja son destructivas para el funcionamiento de la pareja, y la investigación observacional ha dilucidado cómo escala el conflicto. Sin embargo, gran parte de la evidencia está basada en mediciones que combinan el contenido (p. ej.: lo que se dijo) y la emoción con la que se dijo, que luego se analizan usando análisis secuenciales. A pesar de las presunciones generales acerca de la reactividad emocional subyacente y la escalada de las emociones negativas como parte del distrés y el deterioro de la relación, existen pocos datos empíricos que analicen directamente estos cambios continuos en las emociones. El presente estudio analizó las asociaciones simultáneas y longitudinales entre la satisfacción con la relación y las trayectorias de cambio en la agitación emocional expresada vocalmente durante el conflicto de pareja en 62 parejas que participaron en un programa de capacitación en relaciones. Contrariamente a las expectativas y los patrones hallados en las parejas problemáticas, las trayectorias siguieron una forma de U en lugar de una curva con forma de U invertida, con disminuciones más pronunciadas y más constantes de la agitación emocional que predicen una satisfacción más estable con la relación en el transcurso del tiempo. Además, hubo efectos dentro de la pareja. Estos resultados sugieren que las primeras señales de deterioro de la relación pueden ser menores en forma de escalada abierta de lo que se vería en las parejas problemáticas. En cambio, las parejas que posteriormente se deterioran más son menos eficaces a la hora de calmar la agitación emocional. También son menos capaces de permanecer en una agitación emocional más baja. Es posible que la escalada más pronunciada hacia el final de la conversación en las parejas con mayor riesgo sea una precursora de los patrones de mayor escalada observados en las parejas problemáticas; esto debería analizarse empíricamente. Se debaten las limitaciones y las consecuencias.

The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder.

Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple-based intervention for BED. Vocally encoded emotional arousal was measured during couples' (n = 11) conversations about BED. As predicted, partners' emotional reactivity to patients' emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients' and their own distress. After treatment, partners' arousal was no longer associated with the patients' emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners' emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple-based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.

La emociones negativas intensas y las estrategias conductuales desadaptativas para reducir el distrés emocional se producen no solo en pacientes con varias formas de psicopatología, sino también en sus parejas estables. Una estrategia común para disminuir el distrés es que las parejas se adapten a los síntomas del trastorno, lo cual reduce el distrés a corto plazo pero mantiene los síntomas a largo plazo. Se cree que la adaptación está motivada por la reacción conductual de la pareja a las emociones del paciente, pero las emociones de la pareja en este contexto aún no se han analizado. Este estudio piloto examinó cómo la adaptación de la pareja está relacionada con patrones específicos de corregulación emocional entre los pacientes con trastorno por atracón de alimentos y sus parejas, antes y después de una intervención en la pareja por trastorno por atracón de alimentos. Se midió la excitación emocional codificada en la voz durante conversaciones de las parejas (n = 11) acerca del trastorno por atracón de alimentos. Como se anticipó, la reacción emocional de las parejas a la excitación emocional de los pacientes estuvo asociada con una alta adaptación antes del tratamiento. Por lo tanto, las parejas pueden usar la adaptación como estrategia para reducir tanto el distrés de los pacientes como el propio. Después del tratamiento, la excitación de las parejas dejó de estar asociada con la excitación emocional de los pacientes. En cambio, las parejas demostraron una mayor estabilidad emocional con el tiempo, específicamente cuando la adaptación fue baja. Además, los pacientes estuvieron menos excitados emocionalmente después del tratamiento. En consecuencia, el tratamiento pudo haber disminuido la emocionalidad general de los pacientes y modificado la asociación entre la adaptación y la reacción emocional de las parejas. Si se reproduce, esta comprensión del contexto emocional asociada con la adaptación en los trastornos por atracón de alimentos puede fundamentar el tratamiento basado en la pareja abordando precipitantes emocionales específicos de conductas que mantienen los síntomas.

A pilot open trial of UNITE-BED: A couple-based intervention for binge-eating disorder.

OBJECTIVE: To evaluate the feasibility, acceptability, and preliminary efficacy of a couple-based intervention for binge-eating disorder (BED), called UNiting couples In the Treatment of Eating disorders-BED edition (UNITE-BED). METHOD: In an open pilot trial, 11 couples in which one or both adult partners had a diagnosis of DSM-5 threshold or sub-threshold BED participated in 22 weekly sessions of UNITE-BED. Patients also received individual treatment, outside of the context of the trial. Couples completed measures on treatment satisfaction, eating disorder symptom severity, depression, anxiety, emotion regulation, and relational functioning at post-treatment and 3-month follow-up. Statistical analyses were conducted to identify change over the course of treatment. RESULTS: UNITE was feasible and acceptable to the majority of couples (9% dropout; high satisfaction ratings). Objective binge abstinence was 81.8% and subjective binge abstinence was 45.5% by post-treatment. Patient binge-eating symptomatology reduced over the course of treatment with results maintained at follow up. Patients' depression symptoms decreased and patients' emotion regulation improved at both time points. DISCUSSION: Including partners in treatment for BED may be beneficial. Results support further evaluation of the efficacy of couple-based interventions for BED in larger randomized-controlled trials.

Cardiovascular Reactivity During Marital Conflict in Laboratory and Naturalistic Settings: Differential Associations with Relationship and Individual Functioning Across Contexts.

Cardiovascular reactivity during spousal conflict is considered to be one of the main pathways for relationship distress to impact physical, mental, and relationship health. However, the magnitude of association between cardiovascular reactivity during laboratory marital conflict and relationship functioning is small and inconsistent given the scope of its importance in theoretical models of intimate relationships. This study tests the possibility that cardiovascular data collected in laboratory settings downwardly bias the magnitude of these associations when compared to measures obtained in naturalistic settings. Ambulatory cardiovascular reactivity data were collected from 20 couples during two relationship conflicts in a research laboratory, two planned relationship conflicts at couples' homes, and two spontaneous relationship conflicts during couples' daily lives. Associations between self-report measures of relationship functioning, individual functioning, and cardiovascular reactivity across settings are tested using multilevel models. Cardiovascular reactivity was significantly larger during planned and spontaneous relationship conflicts in naturalistic settings than during planned relationship conflicts in the laboratory. Similarly, associations with relationship and individual functioning variables were statistically significantly larger for cardiovascular data collected in naturalistic settings than the same data collected in the laboratory. Our findings suggest that cardiovascular reactivity during spousal conflict in naturalistic settings is statistically significantly different from that elicited in laboratory settings both in magnitude and in the pattern of associations with a wide range of inter- and intrapersonal variables. These differences in findings across laboratory and naturalistic physiological responses highlight the value of testing physiological phenomena across interaction contexts in romantic relationships.

A multivariate dynamic systems model for psychotherapy with more than one client.

The dynamics of the give and take between therapist and client(s) is frequently of interest to therapy process researchers. Characterizing the ways that therapists respond to clients and clients respond to therapists can be challenging in therapeutic encounters involving a single therapist and a single client. The complexity of this challenge increases as the number of people involved in a therapeutic encounter increases not only because there are more people responding to one another but also because the patterns of responding can become more complex. This manuscript demonstrates how dyadic cross-lagged panel models can be extended to psychotherapeutic encounters involving 3 people and used to test processes that exist between dyadic subsets of the larger group as well as the group as one cohesive unit. Three hundred seventy-nine talk turns of fundamental frequency from a couple therapy session were modeled using 3 dyadic cross-lagged panel models, and each individual's respiratory sinus arrhythmia (RSA) was treated as a moderator. Although the regression coefficients for each dyadic subset (e.g., therapist-husband) were nonsignificant, an eigenvalue/eigenvector decomposition of the regression coefficients from the 3 dyadic cross-lagged panel models suggests that interdependence exists at the level of the whole group (i.e., therapist-husband-wife) rather than between pairs of individuals within the group (e.g., husband-wife). Further, an interaction involving husband's RSA suggested that interdependence involving the husband ceased when the husband displayed greater regulatory effort. This combination of statistical methods allows for clearly distinguishing between dyadic therapeutic processes and group-level therapeutic processes. (PsycINFO Database Record