Sequential analysis of marital interactions involving alcoholic, depressed, and nondistressed men

Depressive Symptoms, Criticism, and Counter-Criticism in Marital Interactions

Although people with depressive symptoms face criticism, hostility, and rejection in their close relationships, we do not know how they respond. Following interpersonal theories of depression, it might be expected that depressive symptoms would be associated with a tendency to receive and also to express criticism toward one's spouse, and that at least some of this criticism would be a contingent response to criticism received (i.e., "counter-criticism"). However, other research has determined that depressive symptoms/behaviors suppress partner criticism, suggesting that depressed people might respond to partner criticism similarly, by subsequently expressing less criticism. In a sample of 112 married couples, partial correlations, regressions, and Actor-Partner Interdependence Modeling indicated that lower criticism and counter-criticism expression during a laboratory marital interaction task was associated with higher depressive symptoms, especially when such individuals were clinically depressed. Furthermore, during a separate and private Five-Minute Speech Sample, lower criticism by partners was associated with higher depressive symptoms, especially when those who chose the interaction topic were also clinically depressed. All analyses controlled for relationship adjustment. These results suggest that spouses with higher depressive symptoms and clinical depression diagnoses may be suppressing otherwise ordinary criticism expression toward their nondepressed partners; furthermore, nondepressed partners of depressed people are especially likely to display less criticism toward their spouse in a private task.

Behavioral Couple Therapy in the Treatment of a Female Alcohol-Dependent Patient With Comorbid Depression, Anxiety, and Personality Disorders

Behavioral Couple Therapy (BCT) has shown to be effective in the treatment of alcohol dependence. However, it is still unclear whether this intervention is effective in severe caseswith comorbid other conditions. The aim of the present study is to illustrate the assessment, case conceptualization, prioritizing of interventions and treatment in a female “treatment resistant” alcohol-dependent patient, with comorbid depression, anxiety, personality disorders, andmarital problems, using a BCT manual. In total, the treatment consisted of 19 sessions, during a 7-month period. Results show BCT to be successful in treating alcohol dependence and to some extent increasing marital satisfaction. At posttreatment the patient did no longer meet criteria for major depressive disorder. At 3-month follow-up she had been abstinent for 51/2 months, with a 2-day lapse, and her depressive disorder was still in full remission. This case demonstrates—even with severe comorbid conditions—that targeting the drinking problem is the treatment of choice. However, we stress the importance of a thorough assessment of other Axis I and II disorders.

Neural substrates involved in anger induced by audio-visual film clips among patients with alcohol dependency

BACKGROUND

Very little is known about the neural circuitry underlying anger processing among alcoholics. The purpose of this study was to examine the altered brain activity of alcoholic individuals during transient anger emotion.

METHODS

Using functional magnetic resonance imaging (fMRI), 18 male patients diagnosed with alcohol dependence in an inpatient alcohol treatment facility and 16 social drinkers with similar demographics were scanned during the viewing of anger-provoking film clips.

RESULTS

While there was no significant difference in the level of experienced anger between alcohol-dependent patients and non-alcoholic controls, significantly greater activation was observed in the bilateral dorsal anterior cingulate cortex (dACC) and the right precentral gyrus among alcoholic patients compared to the normal controls.

CONCLUSIONS

In summary, specific brain regions were identified that are associated with anger among patients with alcohol dependency.

Typology of Couples Entering Alcohol Behavioral Couple Therapy: An Empirical Approach and Test of Predictive Validity on Treatment Response

This study aimed to examine whether classification of couples in which one partner has an alcohol problem is similar to that reported in the general couples literature. Typologies of couples seeking alcohol behavioral couple therapy (ABCT) were developed via hierarchical cluster analysis using behavioral codes of couple interactions during their first ABCT session. Four couples types based on in-session behavior were established reliably, labeled avoider, validator, hostile, and ambivalent-detached. These couple types resembled couples types found in previous research. Couple type was associated with baseline relationship satisfaction, but not alcohol use. Results suggest heterogeneity in couples with alcohol problems presenting to treatment; further study is needed to investigate the function of alcohol within these different types.

Husbands' and wives' alcohol use disorders and marital interactions as longitudinal predictors of marital adjustment

In this longitudinal study, the relationships among wives' and husbands' lifetime alcoholism status, marital behaviors, and marital adjustment were tested. Participants were 105 couples from the Michigan Longitudinal Study (MLS), an ongoing multimethod investigation of substance use in a community-based sample of alcoholics, nonalcoholics, and their families. At baseline (T1), husbands and wives completed a series of diagnostic measures, and lifetime diagnosis of alcohol use disorder (AUD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), was assessed. Couples completed a problem-solving marital interaction task 3 years later at T2, which was coded for the ratio of positive to negative behaviors. Couples also completed a measure of marital adjustment at T4 (9 years after T1 and 6 years after T2). Results showed that husbands' lifetime AUD predicted lower levels of their wife's positive marital behaviors 3 years later but was not related to their own or their wife's marital adjustment 9 years from baseline. By contrast, wives' lifetime AUD had direct negative associations with their own and their husband's marital satisfaction 9 years later, and wives' marital behaviors during the problem-solving task predicted their own and their husband's marital satisfaction 6 years later. Findings indicate that marital adjustment in alcoholic couples may be driven more by the wives' than the husbands' AUD and marital behavior. Implications for intervention with alcoholic couples were discussed.

Depression, marital satisfaction and communication in couples: investigating gender differences

The correlation between depression and dysfunctional marital interaction is well documented, but only a few studies have examined gender-related differences in marital interaction patterns of couples with a depressed partner. In this paper we examined differences in observed marital communication in a sample of 62 Swiss couples presenting for treatment of depression. There were 16 maritally distressed couples with a depressed wife, 21 maritally nondistressed couples with a depressed wife, 18 maritally distressed couples with a depressed husband, and 7 maritally nondistressed couples with a depressed husband. Marital interaction behavior was found to depend on gender, depression, marital distress, as well as gender of the depressed partner. Our results suggest the need for a gender-sensitive model of the link between marital interaction and depression.

Paternal alcoholism, negative parenting, and the mediating role of marital satisfaction

Given the documented association between paternal alcoholism and negative parenting behaviors, the purpose of this study was to examine longitudinally whether marital satisfaction mediates this relationship. Participants consisted of 197 families (102 without an alcoholic father, 95 with an alcoholic father) who were assessed at three time points: when children were 12, 24, and 36 months old. Results indicated that paternal alcoholism at 12 months was associated with decreased marital satisfaction at 24 months for both mothers and fathers. Marital satisfaction at 24 months in turn was associated with decreases in parental warmth and sensitivity at 36 months. Furthermore, marital satisfaction mediated the association between paternal alcoholism and parental warmth and sensitivity for both mothers and fathers. The implications of these findings for interventions for alcoholic families are discussed.

Emphasizing interpersonal factors: an extension of the Witkiewitz and Marlatt relapse model

AIM

Recently, Witkiewitz & Marlatt reformulated the Marlatt & Gordon relapse model to account for current research findings. The present paper aims to extend this model further to incorporate social variables more fully.

METHODS

The social-factors and alcohol-relapse literatures were reviewed within the framework of the reformulated relapse model.

RESULTS

The literature review found that the number of social network members, investment of the individual in the social network, levels of general and alcohol-specific support available within the social network and specific behaviors of network members all predict drinking outcomes. However, little is known about the mechanisms by which these social variables influence outcomes. The authors postulate that social variables influence outcomes by affecting intra-individual factors central to the reformulated relapse prevention model, including processes (e.g. self-efficacy, outcome expectancies, craving, motivation, negative affective states) and behaviors (e.g. coping and substance use). The authors suggest specific hypotheses and discuss methods that can be used to study the impact of social factors on the intra-individual phenomena that contribute to relapse.

CONCLUSION

The proposed extension of the relapse model provides testable hypotheses that may guide future alcohol-relapse research.

Unique Aspects of Female-primary Alcoholic Relationships

OBJECTIVE

This descriptive paper assesses the applicability of knowledge about alcoholic relationships to treatment-seeking alcoholic women.

METHODS

One hundred and nine heterosexual couples were recruited between 1997 and 2000 for a randomized clinical trial of treatments for female alcoholics. Measures included the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Timeline Followback Interview, Areas of Change Questionnaire, Dyadic Adjustment Scale-Revised, Spouse Behavior Questionnaire, and Drinking Patterns Questionnaire.

RESULTS

Couples reported moderate levels of relationship distress the women claimed that relationship issues were important antecedents to their alcohol consumption. Male partners reported frequent use of active and passive strategies for coping with their wives drinking.

CONLCUSIONS

Results suggest that findings on marital distress are applicable to both populations, but that findings on reasons for drinking from male-primary alcoholic couples may not be fully applicable to female-primary alcoholic couples.

For better or for worse? The effects of alcohol use on marital functioning

Two competing hypotheses propose opposite effects for the relation between alcohol use and marital functioning. One hypothesis conceptualizes alcohol use as maladaptive and proposes that it serves as a chronic stressor that causes marital dysfunction and subsequent dissolution. An opposing hypothesis proposes that alcohol use is adaptive and serves to temporarily relieve stressors that cause marital dysfunction, stabilizing the marital relationship, and perhaps preventing dissolution. Sixty studies were reviewed that tested the relation between alcohol use and one of three marital functioning domains (satisfaction, interaction, and violence). Results provide overwhelming support for the notion that alcohol use is maladaptive, and that it is associated with dissatisfaction, negative marital interaction patterns, and higher levels of marital violence. A small subset of studies found that light drinking patterns are associated with adaptive marital functioning; however, more research is necessary to replicate these effects and identify specific conditions under which they occur.

Marital research in the 20th century and a research agenda for the 21st century

In this article we review the advances made in the 20th century in studying marriages. Progress moved from a self-report, personality-based approach to the study of interaction in the 1950s, following the advent of general systems theory. This shift led, beginning in the 1970s, to the rapid development of marital research using a multimethod approach. The development of more sophisticated observational measures in the 1970s followed theorizing about family process that was begun in the decade of the 1950s. New techniques for observation, particularly the study of affect and the merging of synchronized data streams using observational and self-report perceptual data, and the use of sequential and time-series analyses produced new understandings of process and power. Research in the decades of the 1980s and 1990s witnessed the realization of many secular changes in the American family, including the changing role of women, social science's discovery of violence and incest in the family, the beginning of the study of cultural variation in marriages, the expansion of the measurement of marital outcomes to include longevity, health, and physiology (including the immune system), and the study of comorbidities that accompany marital distress. A research agenda for the 21st century is then described.

Marriage and health: his and hers

This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.

A comparison of marital interaction patterns between couples in which the husband does or does not have Alzheimer's disease

Objectives. Our main purpose was to examine similarities and differences in patterns of interpersonal interaction between Alzheimer's disease (AD) caregiving and noncaregiving couples (n = 54). Methods. Twenty-seven wives caring for moderately impaired husbands with probable AD and 27 noncaregiving wives from comparable sociodemographic backgrounds were videotaped in their homes during both mealtime and a future event planning task. In addition, they completed self-report questionnaires to assess depression, stress, relationship mutuality, and perceived hope. Results. Compared with their counterparts, caregiving wives reported higher levels of depression and stress, but similar shared values and closeness. For the three factors developed from the Marital Interaction Coding System (MICS, version IV; Supportive Facilitative, and Rapport Building), a complex pattern of results was found in which disease status, type of task, and gender interacted significantly. Noncaregiving couples were more interactive overall and expressed more support to each other. Caregiving wives were found to be most facilitative during the planning task, whereas AD husbands were highest on interactions that built rapport (e.g., smiling) during that same task. Caregiving wives actually increased their facilitative behavior from the mealtime to planning task, probably reflecting the increased demand characteristics of the latter.

DISCUSSION

This study is one of a small body of literature to describe the negative impact of AD on spousal communication as observed and coded in two videotaped interaction situations in the home. Suggestions are made for future research, including the inclusion of longitudinal designs and non-Caucasian couples.

Observation of couple conflicts: clinical assessment applications, stubborn truths, and shaky foundations

The purpose of this review is to provide a balanced examination of the published research involving the observation of couples, with special attention toward the use of observation for clinical assessment. All published articles that (a) used an observational coding system and (b) relate to the validity of the coding system are summarized in a table. The psychometric properties of observational systems and the use of observation in clinical practice are discussed. Although advances have been made in understanding couple conflict through the use of observation, the review concludes with an appeal to the field to develop constructs in a psychometrically and theoretically sound manner.

Sequential interactions in the marital communication of depressed men and women

Despite studies showing patterns of sequential interaction between depressed wives and their husbands, no published research has contrasted sequential interactions of depressed husbands and their wives. This study compared problem-solving interactions of 49 couples with a depressed husband, 41 with a depressed wife, and 50 normal controls. Interactions were coded using the Marital Interaction Coding System. Although no clear patterns of sequential interaction distinguished couples with a depressed wife from normal control couples, results suggested a unique pattern of interaction between depressed husbands and their spouses, whereby positive communications from the husband resulted in decreased positivity and increased negativity from their wives. Given the importance of positivity for promoting effective problem solving, this pattern appears to have important implications for couples' long-term marital satisfaction and husbands' mood regulation.

Individual psychopathology and marital distress. Analyzing the association and implications for therapy

This article is a review of the association of individual and marital problems. The focus is on depression, alcohol abuse, anxiety disorders, and the functional psychoses, each of which interact with marital distress in important ways. Although the causal connections between these disorders and marital distress are complex and only particularly understood, the available evidence shows that individuals' and couples' problems often exacerbate each other. Consequently, regardless of whether the initial presentation is individual or couple focused, there is routinely a need to assess both individual and relationship functioning. Couples therapy, and in particular behavioral couples therapy (BCT), is an important element of effective treatment of depression, alcohol abuse, anxiety disorders, and the functional psychoses. The integration of couple and individual therapy presents a number of clinical challenges, and in concluding this article the authors provide guidelines for managing these challenges.

Alcoholism in adolescents and their families. Family-focused assessment and management

A family-focused approach is the most effective clinical method in the assessment and management of substance abuse in adolescents and their parents. The impact of alcoholism and substance abuse on parents and children, psychosocial risk factors, and indicators of alcoholism are important considerations when using this approach. Education regarding the family-focused approach to the treatment of substance abuse deserves a high priority in the training of pediatricians and other primary care physicians. As Doherty and Baird suggest," . . . the key to this training will not be . . . the development of a more sensitive liver function test, . . . but (rather) will be to help primary care physicians view individual patients as a part of a social context. The challenge will be to train the physicians to evaluate the patient in his or her social and family system for significant disturbances that commonly occur with chemical dependency. By evaluating the presenting patient in a family context, the primary care physician has the means to discover chemical dependency in early stages, when treatment options are less disruptive; when outcome is improved; and when the emotional and economic losses to patient, family and community are reduced."